Provider Reimbursement Sample Clauses

Provider Reimbursement. The HMO must make payment for all Medically Necessary Covered Services provided to all Members for whom the HMO is paid a capitation. A STAR+PLUS HMO must also make payment for all Functionally Necessary Covered Services provided to all Members for whom the HMO is paid a capitation. The HMO must ensure that claims payment is timely and accurate as described in Section 8.1.18.
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Provider Reimbursement. The MCO must pay for all Medically Necessary Covered Services provided to all Members for whom the MCO is paid a capitation. A STAR+PLUS MCO must also pay for all Functionally Necessary Covered Services provided to all Members for whom the MCO is paid a capitation. The MCO must ensure that claims payment is timely and accurate as described in Section 8.1.
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Provider Reimbursement. The Department may define an alternative payment methodology to which Contractor must adhere to when reimbursing Providers for provided services. 5.7.7.1 For all FQHCs and RHCs that elect to use the Department’s alternative payment methodology, Contractor shall pay contracted FQHCs and RHCs at least the Department’s full cost‐based per‐ visit rate for Covered Services. 5.7.7.2 Provider agreements shall require that Network Providers submit benefit expense claim data, as defined in 7.11.6.2, for all Covered Services provided to Enrollees.
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Provider Reimbursement. The MCO must pay for all Medically Necessary Covered Services provided to Members. A STAR+PLUS MCO must also pay for all Functionally Necessary Covered Services provided to Members. The MCO's Network Provider Agreement must include a complete description of the payment methodology or amount, as described in Uniform Managed Care Manual Chapter 8. 1. The MCO must ensure claims payment is timely and accurate as described in Section 8.1.18.5, "Claims Processing Requirements," and UMCM Chapters 2.0 through 2. 2. The MCO must require tax identification numbers from all participating Providers. The MCO is required to do back-up withholding from all payments to Providers who fail to give tax identification numbers or who give incorrect numbers. Provider payments must comply with all applicable state and federal laws, rules, and regulations, including the following sections of the Patient Protection and Affordable Care Act (PPACA) and, upon implementation, corresponding federal regulations: • Section 2702 of PPACA, entitled "Payment Adjustment for Health Care-Acquired Conditions;" • Section 6505 of PPACA, entitled "Prohibition on Payments to Institutions or Entities Located Outside of the United States;" and • Section 1202 of the Health Care and Education Reconciliation Act as amended by PPACA, entitled "Payments to Primary Care Physicians." As required by Texas Government Code § 533.005(a)(25), the MCO cannot implement across-the-board Provider reimbursement rate reductions unless: (1) it receives HHSC's prior approval, or (2) the reductions are based on changes to the Medicaid fee schedule or cost containment initiatives implemented by HHSC. For purposes of this requirement an across-the-board rate reduction is a reduction that applies to all similarly-situated providers or types of providers. The MCO must submit a request for an across-the-board rate reduction to HHSC's Director of Program Operations, if the reduction is not based on a change in the Medicaid fee schedule or cost containment initiative implemented by HHSC. The MCO must submit the request at least 90 days prior to the planned effective date of the reduction, and provide a copy to the Health Plan Manager. If HHSC does not issue a written statement of disapproval within 45 days of receipt, then the MCO may move forward with the reduction on the planned effective date.
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Provider Reimbursement. 1. For the term of this Contract, the Program Administrator, pursuant to its agreement with Governing Board, shall reimburse providers at rates determined by Governing Board. Governing Board shall establish a Provider Rates Policy that sets forth the basis for provider payment rates which is subject to revision from time to time as determined by Governing Board. 2. The Program Administrator, pursuant to its agreement with Governing Board, shall use its reasonable best efforts to reimburse providers on a timely basis. 3. Reimbursement to providers made in error may be recovered by the Program Administrator, on behalf of Governing Board, or Governing Board or its designee.
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Provider Reimbursement. Although not in the Agreement, BCBS stated in its March 2008 Aware Pro- vider Service Agreement Renewal letter that there will be three changes relating to reimbursement: 1) BCBS will use of the 2008 Medicare Relative Value Units (RVUs) in place of using the 2007 ▇▇▇▇- sitional Fully Implemented RVUs; 2) Unlisted Injectable Drugs will be paid at 82% of AWP (Average Wholesale Price); and 3) BCBS will be applying a site of service differential payment starting July 1, 2009.
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Provider Reimbursement. 10.1 Applicants who are approved for HPE may receive medical services from any registered AHCCCS provider. 10.2 Hospitals or other registered Medicaid providers that provide medical care to HPE eligible applicants must submit claims to the AHCCCS Administration and will be reimbursed on a fee-for- service basis at the current AHCCCS rates for services rendered during the HPE period. 10.3 Applicants made presumptively eligible will be enrolled as AHCCCS Fee-for-Service members. 10.4 Hospitals may not charge applicants to apply for HPE or for assisting them with the submission of a full Medicaid/AHCCCS application. 10.5 AHCCCS will not reimburse the Hospital for completing a HPE determination or for submitting a full Medicaid application.
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Provider Reimbursement. 1. The SE shall be responsible for reimbursing network and non-network providers in accordance with the requirements of this Contract (see Article 3.18 and Article 2. Except as otherwise provided in this Contract (see Article 6.15), for Medicaid services the SE shall negotiate the reimbursement methodology and rate with providers. The methodology may include but is not limited to fee-for-service, case rates, or subcapitation. If the SE changes an existing reimbursement methodology or rate, it shall take steps to transition the provider to the new methodology/rate and prevent adverse financial consequences to the provider. 3. For non-Medicaid services (to both Medicaid and non-Medicaid consumers), the SE shall use the providers and reimbursement methodology and rate specified by the Collaborative. 4. Regardless of a provider’s reimbursement methodology, the SE shall ensure that it receives required reports and data (e.g., encounter data) from network providers. 5. The SE shall develop and implement a plan, approved by the Collaborative, for moving toward a uniform system of service rates across Collaborative funding streams, specifically utilizing the Collaborative common service definitions. a. The plan shall be presented to the Collaborative for approval no later than that the date specified by the Collaborative. b. The SE shall work with Collaborative staff, as appropriate, in the implementation of its plan. c. The SE shall present any substantive changes to its plan to the Collaborative for review and approval prior to making those changes. d. The SE shall include in its plan: i. The changes it will need to make to its fiscal and claims payment systems to implement its plan; ii. How it will give providers the support and training that may be necessary in making the transition to the system; iii. How it will minimize impact on providers where more uniformity will result in a lower reimbursement rate for a particular provider, provider type, or geographic area; specifically, how it will phase in rate changes that will likely lower a high-volume or specialty provider’s overall revenue by more than ten percent (10%) in any six (6) month period; and iv. How its uniform rate structure will assist access in rural and frontier areas. e. The SE shall make progress toward the goals of more uniform rates through the implementation of this plan and shall submit a semi-annual report to the Collaborative on its progress. 6. The SE shall evaluate administrative costs ...
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Provider Reimbursement 
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Related to Provider Reimbursement

  • Educational Reimbursement ‌ 9.10.1. The Employer is desirous of having employees participate in courses and training opportunities to enhance their skills and enable them to advance to other positions. Accordingly, it shall be the Employer's goal to assist full-time, regular employees in the furtherance of this policy by offering a tuition reimbursement program for courses or training at accredited colleges and universities. 9.10.2. To qualify for reimbursement, the employee must make application to, and receive prior approval from, the Sheriff such approval shall be at the sole discretion of the Sheriff. 9.10.3. An employee requesting tuition reimbursement must submit a written application showing: a) The course curriculum description; b) dates and times of classes; c) duration of the course; d) narrative statement of how the course will benefit the Employer as well as the employee. 9.10.4. If an employee's application is approved, the reimbursement will be for tuition only if and when: a) The course is completed within six (6) months of approval; b) completed with a "pass" in a pass/fail grading system or a grade of "C" or better. The maximum reimbursement per credit will be the cost of a credit charged by Centralia College. 9.10.5. An employee who receives tuition reimbursement agrees to continue to work for the Employer for twelve (12) months following the completion of the course; if not, the reimbursement is pro-rated and the employee authorizes reimbursement to the Employer from the last paycheck issued. An employee who is unable to remain in the Employer's employment, due to circumstances beyond the employee's control, shall not be required to reimburse the Employer if the twelve (12) month period is not met. 9.10.6. Reimbursement shall be for actual tuition, or the cost of the course. All other expenses, such as travel and books, shall be borne by the employee.

  • Education Reimbursement The County will provide education reimbursement for education costs incurred by regular employees who apply for such reimbursement in accordance with the policies and procedures governing the education reimbursement program. The maximum reimbursement shall be $1,500 per year.

  • Tuition Reimbursement A. The Employer will reimburse a full-time employee for the cost of tuition in accordance with Regulation 10.12.060 and for the cost of books as long as the subject matter of the specific course or course of study is job-related and the tuition costs do not exceed those found at a state university. The employee must receive approval from the Chief prior to taking the course. Tuition reimbursement shall be approved for all job-related undergraduate and graduate work. A request for tuition shall not be unreasonably denied. B. If an employee receives a scholarship, the total amount of the reimbursement from the Employer, combined with the scholarship, shall not exceed one hundred percent (100%) of the cost of tuition and books. C. A satisfactory grade of C or higher or equivalent is required for reimbursement, and a copy of the course transcript showing satisfactory completion, along with a copy of the approved reimbursement application, a copy of the registration or receipt showing the amount paid, and a taxability of tuition reimbursement Interoffice Communication shall be submitted with the reimbursement request within sixty (60) calendar days of receiving final grades. D. In the event the Employer directs an employee to attend any formal training course, the costs of all books and incidental fees will be paid by the Employer. “Life experience” credits will be reimbursed on a per-credit basis, not to exceed the University of Washington tuition rates. E. Once a request for tuition reimbursement has been approved, the Employer will reimburse the cost of tuition as provided above. Approved tuition reimbursements shall be paid to the employee within sixty (60) calendar days of timely submission to the Employer. An employee shall not receive federal or state educational reimbursement funds that exceed the total tuition for any course. F. If an employee receiving tuition reimbursement misses two (2) consecutive terms of school, the Employer shall send a letter requesting the employee notify the Employer of whether the employee intends to continue to attend school. If the employee does not attend school during the following two (2) terms then the employee must reapply for tuition reimbursement when attendance resumes. G. When an employee completes an educational program, the employee shall notify the Employer so the Employer can remove the employee’s name from the tuition reimbursement list. If the employee pursues an additional degree then the employee must reapply for tuition reimbursement. H. No more than twenty-five percent (25%) of the bargaining unit members shall receive tuition reimbursement at any given time. If at any time the maximum twenty-five percent (25%) limit is reached, then all subsequent requests for tuition reimbursement shall be placed on a waiting list in order of the date of application.

  • Meal Reimbursement When an employee is specifically directed by the City to work two (2) hours or longer at the beginning or end of their normal work shift away from their place of residence of at least eight (8) hours or work two (2) hours or longer at the end of their work shift of at least eight (8) hours when the employee is called in to work on their regular day off, or otherwise works under circumstances for which meal reimbursement is authorized per Ordinance 111768 and the employee actually purchases a reasonably priced meal away from his place of residence as a result of such additional hours of work, the employee shall be reimbursed for the "reasonable cost" of such meal in accordance with Seattle Municipal Code (SMC) 4.20.

  • Travel Reimbursement 2.1 The County will only cover costs associated with travel for vendors outside a 45-mile radius from the Williamson County Courthouse, ▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇ ▇▇▇▇▇. 2.2 The County will only cover costs associated with travel as documented work for County. If a vendor is also doing business for another client, the travel costs must be split in proportion to the amount of work actually performed for the County and the other client. The only allowable travel expense will be for the specific days worked for Williamson County. 2.3 No advance payments will be made to vendor for travel expenditures. The travel expenditure may only be reimbursed after the expenditure/trip has already occurred and vendor has provided the Williamson County Auditor with all necessary and required backup. 2.4 Vendors must submit all travel reimbursement requests on each employee in full. Specifically, a travel reimbursement request must include all related travel reimbursement expenses relating to a particular trip for which vendor seeks reimbursement. Partial travel reimbursement requests will not be accepted (i.e. vendor should not submit hotel and mileage one month then the next month submit rental car and airfare). If the travel reimbursement appears incomplete, the invoice will be sent back to the vendor to be submitted when all information is ready to submit in full. 2.5 Reimbursement for transportation costs will be at the most reasonable means of transportation (i.e.: airline costs will be reimbursed for coach rate, rental car costs will only be reimbursed if rental car travel was most reasonable means of travel as compared to travel by air). 2.6 The County will not be responsible for, nor will the County reimburse additional charges due to personal preference or personal convenience of individual traveling. 2.7 The County will not reimburse airfare costs if airfare costs were higher than costs of mileage reimbursement. 2.8 Additional expenses associated with travel that is extended to save costs (i.e. Saturday night stay) may be reimbursed if costs of airfare would be less than the cost of additional expenses (lodging, meals, car rental, mileage) if the trip had not been extended. Documentation satisfactory to the Williamson County Auditor will be required to justify expenditure. 2.9 County will only reimburse travel expense to necessary personnel of the vendor (i.e. no spouse, friends or family members). 2.10 Except as otherwise set forth herein, a vendor must provide a paid receipt for all expenses. If a receipt cannot be obtained, a written sworn statement of the expense from the vendor may be substituted for the receipt. 2.11 Sales tax for meals and hotel stays are the only sales taxes that will be reimbursed. Sales tax on goods purchased will not be reimbursed. A sales tax exemption form is available from the Williamson County Auditor’s Office upon request. 2.12 The County will not pay for any late charges on reimbursable items. It is the responsibility of the vendor to pay the invoice first and seek reimbursement from the County.