Appendix_J_-_Cost_Plan_Contract_List.xlsx
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Appendix J - Cost Plan Contract List
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Cost Plan Contract List
| Appendix J - List of all Cost Plan Contracts Eligible for Review | ||||
| Note: CMS reserves the right to select which contracts will or will not be reviewed based on our internal risk assessment. | ||||
| This may result in certain plans being reviewed more frequently than others, and some contract years will be | ||||
| finalized without review. Additionally, CMS reserves the right to determine when to pass on Medical review for | ||||
| certain Plan contract years. | ||||
| Contract Number | Contract Name | Location | Primary Payment Methodology** | Primary Statistical Methodology*** |
| 90091 | United Mine Workers of America Health & Retirement | Washington, DC | Fee For Service (FFS) | Paid Claims |
| H0502 | The Contra Costa Health Plan | Martinez, CA | FFS | Billed Charges |
| H0602 | Rocky Mountain Health Maintenance Organization | Grand Junction, CO | FFS | FFS Equivalent |
| H0657 | Colorado Choice Health Plans | Alamosa, CO | FFS | Relative Value Unit (RVU) |
| H1251 | Hawaii Medical Service Association | Honolulu, HI | FFS | Eligible |
| H1651 | Medical Associates Health Plan, Inc. | Dubuque, IA | Salaried Physicians | FFS Equivalent |
| H2150 | Kaiser Foundation HP of the Mid-Atlantic States | Rockville, MD | Salaried Physicians | RVU |
| H2450 | Medica Insurance Company | Minneapolis, MN | FFS | Billed Charges |
| H2461 | Blue Cross and Blue Shield of Minnesota | Eagan, MN | FFS | Billed Charges |
| H2462 | Group Health Plan, Inc. (MN) | Minneapolis, MN | FFS | Billed Charges |
| H3314 | Health Insurance Plan of Greater New York | New York, NY | Capitated Payments | RVU |
| H3503 | Sanford Heart of America Health Plan | Sioux Falls, SD | FFS | Billed Charges |
| H4556 | Consolidated Association of Railroad Employees HC | Temple, TX | FFS - Medicare Schedule | Paid Claims |
| H4564 | Scott and White Health Plan. | Temple, TX | Capitated Payments | Billed Charges |
| H4652 | Union Pacific Railroad Employees Health Systems | Salt Lake City, UT | FFS - Medicare Schedule | Number of claims |
| H4906 | C&O Employees' Hospital Association | Clifton Forge, VA | FFS - Medicare Schedule | Paid Claims |
| H5256 | Medical Associates Clinic Health Plan | Dubuque, IA | Salaried Physicians | FFS Equivalent |
| H5264 | Dean Health Plan, Inc. | Madison, WI | Salaried Physicians | Billed Charges |
| H6050 | Kaiser Foundation HP, Inc. Southern California | Oakland, CA | Salaried Physicians | RVU |
| H6052 | Kaiser Foundation HP, Inc. Northern California | Oakland, CA | Salaried Physicians | RVU |
| H6053 | Santa Fe Employees Hospital Association | Covina, CA | FFS - Medicare Schedule | Paid Claims |
| H6140 | Wabash Memorial Hospital Association | Decatur, IL | Salaried Physicians | Encounters/ RVU |
| H6141 | Sidney Hillman HC | Chicago, IL | Salaried Physicians | Visits |
| H6142 | Union Health Services, Inc. | Chicago, IL | Salaried Physicians | Encounters |
| H6334 | New York Hotel Trades Council & Hotel Association of NYC. | New York, NY | Salaried Physicians | Encounters |
| H6360 | Kaiser Foundation HP of Ohio/ Healthspan Integrated Care | Cleveland, OH | Salaried Physicians | RVU |
| ** Primary payment mechanism is as indicated on Worksheet D of the most recently reviewed cost report. |
| Plan may also utilize additional payment mechanisms or a variation of the one listed here. |
| *** Primary statistical method is as indicated on Worksheet K of the most recently reviewed cost report. Plan |
| may also utilize additional statistical methodologies or a variation of the one listed here. |
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