payment allowable One Care and allowable, as amount (more SCO could Medicaid wrap in some cases) reduce the is less than the amount One traditional Care and SCO patient co-pay plans pay providers; providers would still receive more on average for a Dual in integrated managed care products than in FFS $100.00 total $97.55 total total More than ≥$100.00 (Medicare $97.55, but less allowable: than $100.00 $100) Payment from One Care / SCO plan with provider pricing benchmark Bad debt $20.00 $100.00 Patient Copay reimbursement Payment from $4.55 One Care / SCO plan $13.00 Medicaid Payment
payment allowable, as Medicaid wrap is less than the traditional patient co-pay allowable amount (more in some cases) One Care and SCO could reduce the amount One Care and SCO plans pay providers; providers would still receive more on average for a Dual in integrated managed care products than in FFS $100.00 total (Medicare allowable: $100) $97.55 total ≥$100.00 total More than $97.55, but less than $100.00 Payment from One Care / SCO plan with provider pricing benchmark $20.00 Patient Copay Bad debt reimbursement $4.55 $100.00 Payment from One Care / SCO plan $13.00 Medicaid Payment
180614-dual-demo-2.0.docx