Vistas de Transición 12/11/2024

Public Hearing on Plan Vital Implementation · December 11, 2024

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2:42:55

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2:40:00

Payment structure and ASES reimbursement overview

Presentation

14:47 → 16:40(1m 52s)

Unidentified Speaker 1 asks about two payment structures for benefits: insurer-risked benefits versus benefits ASES reimburses 100%. Agency representative (Unidentified Speaker 2) confirms the two basic payment structures and explains insurers contract with provider groups (IPAs) paid based on assigned lives.

Keywords:

Speakers:Unidentified Speaker 1Unidentified Speaker 2

Public session examining Puerto Ricos Medicaid Plan Vital implementation focused on insurer payments, actuarial premium setting, MMIS data reconciliation, unpaid supplemental drug claims (including HIV medications), pharmacy network issues, and municipal billing reconciliations.

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Transcript

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