Timing of Capitation Payments Sample Clauses

The "Timing of Capitation Payments" clause defines when capitation payments—fixed, periodic payments made to healthcare providers for each enrolled patient—are to be made under a contract. Typically, this clause specifies the payment schedule, such as monthly or quarterly, and may outline procedures for adjustments or reconciliations if enrollment numbers change. Its core practical function is to ensure predictability and clarity for both payers and providers regarding when payments will be received, thereby supporting financial planning and reducing disputes over payment timing.
Timing of Capitation Payments. Enrollments CMS and EOHHS will make monthly per member per month capitation payments to the Contractor. The PMPM capitation payment for a particular month will reflect payment for the beneficiaries with effective enrollment into the Contractor’s ICO as of the first day of that month, as described in Section 2.3.A.
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Timing of Capitation Payments. 4.2.2.1. CMS and DMAS will each make monthly Capitation Payments to the Contractor. If an individual is enrolled with the Contractor on the first day of a month, the Contractor has the responsibility of providing covered services to that Enrollee for that month, even if the Enrollee moves to another locality. If the Enrollee moves to a locality outside of the Contractor’s Service Area, the Enrollee will be disenrolled from the Contractor at the end of the month that the move is confirmed. Any and all costs incurred by the Contractor in excess of the Capitation Payment will be borne in full by the Contractor. The Contractor shall accept the Department’s electronic transfer of funds to receive Capitation Payments. 4.2.2.2. Enrollments 4.2.2.2.1. CMS will make monthly PMPM Capitation Payment to the Contractor. The PMPM Capitation Payment for a particular month will reflect payment for the beneficiaries with effective Enrollment into the Contractor’s MMP as of the first day of that month, as described in Section 2.3. 4.2.2.2.2. DMAS will make monthly PMPM Capitation Payments to the Contractor retrospectively for the previous month’s Enrollment (e.g., payment for June enrollment will occur in July, July payment will be made in August, etc.). The PMPM Capitation Payment for a particular month will reflect payment for the beneficiaries with effective Enrollment into the Contractor’s MMP as of the first day of the previous month. 4.2.2.3. Disenrollments 4.2.2.3.1. The final PMPM Capitation Payment made by CMS and DMAS to the Contractor for each Enrollee will be for the month: a) in which the disenrollment was submitted, b) the Enrollee loses eligibility, or c) the Enrollee dies (see Section 2.3).
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Timing of Capitation Payments. 1. New Enrollments EOHHS will make capitation payments for Enrollees. Enrollments received and approved by EOHHS on or before the last business day of the month will be effective the first calendar day of the following month. EOHHS will make monthly capitation payments to the Contractor for the month beginning on the effective date of enrollment.
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Timing of Capitation Payments. 4.4.2.1 Enrollments 4.4.2.2 CMS and the Department will make monthly per member per month Capitation payments to the Contractor. The PMPM Capitation payment for a particular month will reflect payment for the Enrollees with effective enrollment into the Contractor’s Demonstration Plan as of the first day of that month, as described in Section 2.3.1. 4.4.2.3 Disenrollments 4.4.2.4 The final per member per month Capitation payment made by CMS and the Department to the Contractor for each Enrollee will be for the month in which the disenrollment was submitted, the Enrollee loses eligibility, or the Enrollee dies (see Section 2.3.2). 4.4.2.5 Timing of Medicaid Component of the Rate 4.4.2.6 Capitation paid by the Department for the Medicaid Component is due to the Contractor by the fifteenth (15th) day of the service month. Payments due from the Department, including late charges, will be paid in accordance with the State Prompt Payment Act (30 ILCS 540) and rules (74 Ill. Admin. Code 900) when applicable. Collection of underlying amounts owed plus interest shall be the Contractor’s sole financial remedy against the Department for late payments by the State. Payment terms contained on the Contractor’s invoices shall have no force and effect. 4.4.2.7 Adjustments in amounts paid by the Department due to lags in the eligibility system are described in Section 4.2.1.
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Timing of Capitation Payments. The State will make capitation payments to the CONTRACTOR on the first Friday of the enrollment month for all Members enrolled in that month and for any retroactive enrollments being made.
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Timing of Capitation Payments 
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