Affiliated Provider Enrollment. Contractor shall assure that all Affiliated Providers, including out-of-State Affiliated Providers, are enrolled in the HFS Medical Program, if such enrollment is required by the Department’s rules or policy in order to submit claims for reimbursement or otherwise participate in the HFS Medical Program. Contractor shall make a good faith effort to give written notice of termination of a Provider as soon as practicable, but in no event later than fifteen (15) days following such termination, to each Enrollee who received his or her primary care from, or was seen on a regular basis by, the terminated Provider.
Affiliated Provider Enrollment. Contractor shall assure that all Affiliated Providers that provide Medicare Covered Services are enrolled as Medicare providers in order to submit claims for reimbursement or otherwise participate in the Medicare Program. Contractor shall assure that all Affiliated Providers, including out-of-State Affiliated Providers that provide Medicaid Covered Services are enrolled in the HFS Medical Program, if such enrollment is required by the Department’s rules or policy in order to submit claims for reimbursement or otherwise participate in the HFS Medical Program.
Affiliated Provider Enrollment. Contractor shall assure that all Affiliated Providers that provide Medicare Covered Services do not appear on the CMS preclusion list in order to submit claims for reimbursement or otherwise participate in the Medicare Program. Contractor shall assure that all Affiliated Providers, including out-of-State Affiliated Providers that provide Medicaid Covered Services are screened and enrolled in the HFS Medical Program, in compliance with 42 C.F.R. § 438.602(b). Payment of a portion of a Medicare Covered Service by a Contractor does not constitute a Medicaid Covered Service for the purposes of this section.
