Common use of Change in Enrollment During Hospital/Inpatient Facility Stay Clause in Contracts

Change in Enrollment During Hospital/Inpatient Facility Stay. When the MCP learns of a currently hospitalized member’s intent to disenroll through the CCR or the HIPAA 834, the disenrolling MCP shall notify the hospital/inpatient facility and treating providers as well as the enrolling MCP, if applicable, of the change in enrollment. The disenrolling MCP shall notify the inpatient facility that it will remain responsible for the inpatient facility charges through the date of discharge; and shall notify the treating providers that it will remain responsible for provider charges through the date of disenrollment. The disenrolling MCP shall not request and/or require that a disenrolled member be discharged from the inpatient facility for transfer to another inpatient facility. Should a discharge and transfer to another inpatient facility be medically necessary, the disenrolling MCP shall notify the treating providers to work with the enrolling MCP or ODM as applicable to facilitate the discharge, transfer, and authorization of services as needed. When the enrolling MCP learns through the disenrolling MCP, through ODM or other means, that a new member who was previously enrolled with another MCP was admitted prior to the effective date of enrollment and remains an inpatient on the effective date of enrollment, the enrolling MCP shall contact the hospital/ inpatient facility. The enrolling MCP shall verify that it is responsible for all medically necessary Medicaid covered services from the effective date of MCP membership, including professional charges related to the inpatient stay; the enrolling MCP shall inform the hospital/inpatient facility that the admitting/disenrolling MCP remains responsible for the hospital/inpatient facility charges through the date of discharge. The enrolling MCP shall work with the hospital/inpatient facility to facilitate discharge planning and authorize services as needed. When the MCP learns that a new member who was previously on Medicaid fee-for-service was admitted prior to the effective date of enrollment and remains an inpatient on the effective date of enrollment, the MCP shall notify the hospital/inpatient facility and treating providers that the MCP is responsible for the professional charges effective on the date of enrollment, and shall work to ensure discharge planning provides continuity using MCP-contracted or authorized providers. If an individual has been admitted to a hospital prior to the first day of Medicaid eligibility and no retroactive eligibility occurs, the MCP is responsible for reimbursement of the inpatient hospital claim for the days the member is enrolled in the MCP. The days prior to eligibility would be considered non-covered days, and the claim should be processed for payment as partial eligibility.

Change in Enrollment During Hospital/Inpatient Facility Stay. When the MCP learns of a currently hospitalized member’s intent to disenroll through the CCR or the HIPAA 834, the disenrolling MCP shall notify the hospital/inpatient facility and treating providers as well as the enrolling MCP, if applicable, of the change in enrollment. The disenrolling MCP shall notify the inpatient facility that it will remain responsible for the inpatient facility charges through the date of discharge; and shall notify the treating providers that it will remain responsible for provider charges through the date of disenrollment. The disenrolling MCP shall not request and/or require that a disenrolled member be discharged from the inpatient facility for transfer to another inpatient facility. Should a discharge and transfer to another inpatient facility be medically necessary, the disenrolling MCP shall notify the treating providers to work with the enrolling MCP or ODM as applicable to facilitate the discharge, transfer, and authorization of services as needed. When the enrolling MCP learns through the disenrolling MCP, through ODM or other means, that a new member who was previously enrolled with another MCP was admitted prior to the effective date of enrollment and remains an inpatient on the effective date of enrollment, the enrolling MCP shall contact the hospital/ inpatient facility. The enrolling MCP shall verify that it is responsible for all medically necessary Medicaid covered services from the effective date of MCP membership, including professional charges related to the inpatient stay; the enrolling MCP shall inform the hospital/inpatient facility that the admitting/disenrolling MCP remains responsible for the hospital/inpatient facility charges through the date of discharge. The enrolling MCP shall work with the hospital/inpatient facility to facilitate discharge planning and authorize services as needed. When the MCP learns that a new member who was previously on Medicaid fee-for-service was admitted prior to the effective date of enrollment and remains an inpatient on the effective date of enrollment, the MCP shall notify the hospital/inpatient facility and treating providers that the MCP is responsible for the professional charges effective on the date of enrollment, and shall work to ensure discharge planning provides continuity using MCP-contracted or authorized providers. If an individual has been admitted to a hospital prior to the first day of Medicaid eligibility and no retroactive eligibility occurs, the MCP is responsible for reimbursement of the inpatient hospital claim for the days the member is enrolled in the MCP. The days prior to eligibility would be considered non-covered days, and the claim should be processed for payment as partial eligibility.

Change in Enrollment During Hospital/Inpatient Facility Stay. When the MCP an XXXX learns of a currently hospitalized member’s intent to disenroll through the CCR or the HIPAA 834, the disenrolling MCP MCOP shall notify the hospital/inpatient facility and treating providers as well as the enrolling MCPMCOP, if applicable, of the change in enrollment. The disenrolling MCP MCOP shall notify the inpatient facility that it will remain responsible for the inpatient facility charges through the date of discharge; and shall notify the treating providers that it will remain responsible for provider charges through the date of disenrollment. The disenrolling MCP MCOP shall not request and/or require that a disenrolled member be discharged from the inpatient facility for transfer to another inpatient facility. Should a discharge and transfer to another inpatient facility be medically necessary, the disenrolling MCP MCOP shall notify the treating providers to work with the enrolling MCP MCOP or ODM as applicable to facilitate the discharge, transfer, transfer and authorization of services as needed. When the enrolling MCP MCOP learns through the disenrolling MCPMCOP, through ODM or other means, that a new member who was previously enrolled with another MCP MCOP was admitted prior to the effective date of enrollment and remains an inpatient on the effective date of enrollment, the enrolling MCP MCOP shall contact the hospital/ inpatient facility. The enrolling MCP MCOP shall verify that it is responsible for all medically necessary Medicaid covered services from the effective date of MCP MCOP membership, including professional charges related to the inpatient stay; the enrolling MCP . The MCOP shall inform the hospital/inpatient facility that the admitting/disenrolling MCP MCOP remains responsible for the hospital/inpatient facility charges through the date of discharge. The enrolling MCP MCOP shall work with the hospital/inpatient facility to facilitate discharge planning and authorize services as needed. When the MCP MCOP learns that a new member who was previously on Medicaid fee-for-service was admitted prior to the effective date of enrollment and remains an inpatient on the effective date of enrollment, the MCP MCOP shall notify the hospital/inpatient facility and treating providers that the MCP MCOP is responsible for the professional charges effective on the date of enrollment, and shall work to ensure discharge planning provides continuity using MCPMCOP-contracted or authorized providers. If an individual has been admitted to a hospital prior to the first day of Medicaid eligibility and no retroactive eligibility occurs, the MCP MCOP is responsible for reimbursement of the inpatient hospital claim for the days the member is enrolled in the MCPMCOP. The days prior to eligibility would be considered non-covered days, and the claim should be processed for payment as partial eligibility.

Change in Enrollment During Hospital/Inpatient Facility Stay. When the MCP an MCOP learns of a currently hospitalized member’s intent to disenroll through the CCR or the HIPAA 834, the disenrolling MCP MCOP shall notify the hospital/inpatient facility and treating providers as well as the enrolling MCPMCOP, if applicable, of the change in enrollment. The disenrolling MCP MCOP shall notify the inpatient facility that it will remain responsible for the inpatient facility charges through the date of discharge; and shall notify the treating providers that it will remain responsible for provider charges through the date of disenrollment. The disenrolling MCP MCOP shall not request and/or require that a disenrolled member be discharged from the inpatient facility for transfer to another inpatient facility. Should a discharge and transfer to another inpatient facility be medically necessary, the disenrolling MCP MCOP shall notify the treating providers to work with the enrolling MCP MCOP or ODM as applicable to facilitate the discharge, transfer, transfer and authorization of services as needed. When the enrolling MCP MCOP learns through the disenrolling MCPMCOP, through ODM or other means, that a new member who was previously enrolled with another MCP MCOP was admitted prior to the effective date of enrollment and remains an inpatient on the effective date of enrollment, the enrolling MCP MCOP shall contact the hospital/ inpatient facility. The enrolling MCP MCOP shall verify that it is responsible for all medically necessary Medicaid covered services from the effective date of MCP MCOP membership, including professional charges related to the inpatient stay; additionally, the enrolling MCP The MCOP shall inform the hospital/inpatient facility that the admitting/disenrolling MCP MCOP remains responsible for the hospital/inpatient facility charges through the date of discharge. The enrolling MCP MCOP shall work with the hospital/inpatient facility to facilitate discharge planning and authorize services as needed. When the MCP MCOP learns that a new member who was previously on Medicaid fee-for-service was admitted prior to the effective date of enrollment and remains an inpatient on the effective date of enrollment, the MCP MCOP shall notify the hospital/inpatient facility and treating providers that the MCP MCOP is responsible for the professional charges effective on the date of enrollment, and shall work to ensure discharge planning provides continuity using MCPMCOP-contracted or authorized providers. If an individual has been admitted to a hospital prior to the first day of Medicaid eligibility and no retroactive eligibility occurs, the MCP MCOP is responsible for reimbursement of the inpatient hospital claim for the days the member is enrolled in the MCPMCOP. The days prior to eligibility would be considered non-covered days, and the claim should be processed for payment as partial eligibility.

Change in Enrollment During Hospital/Inpatient Facility Stay. When the MCP an XXXX learns of a currently hospitalized member’s intent to disenroll through the CCR or the HIPAA 834, the disenrolling MCP MCOP shall notify the hospital/inpatient facility and treating providers as well as the enrolling MCPMCOP, if applicable, of the change in enrollment. The disenrolling MCP MCOP shall notify the inpatient facility that it will remain responsible for the inpatient facility charges through the date of discharge; and shall notify the treating providers that it will remain responsible for provider charges through the date of disenrollment. The disenrolling MCP MCOP shall not request and/or require that a disenrolled member be discharged from the inpatient facility for transfer to another inpatient facility. Should a discharge and transfer to another inpatient facility be medically necessary, the disenrolling MCP MCOP shall notify the treating providers to work with the enrolling MCP MCOP or ODM as applicable to facilitate the discharge, transfer, transfer and authorization of services as needed. When the enrolling MCP MCOP learns through the disenrolling MCPMCOP, through ODM or other means, that a new member who was previously enrolled with another MCP MCOP was admitted prior to the effective date of enrollment and remains an inpatient on the effective date of enrollment, the enrolling MCP MCOP shall contact the hospital/ inpatient facility. The enrolling MCP MCOP shall verify that it is responsible for all medically necessary Medicaid covered services from the effective date of MCP MCOP membership, including professional charges related to the inpatient stay; additionally, the enrolling MCP The MCOP shall inform the hospital/inpatient facility that the admitting/disenrolling MCP MCOP remains responsible for the hospital/inpatient facility charges through the date of discharge. The enrolling MCP MCOP shall work with the hospital/inpatient facility to facilitate discharge planning and authorize services as needed. When the MCP MCOP learns that a new member who was previously on Medicaid fee-for-service was admitted prior to the effective date of enrollment and remains an inpatient on the effective date of enrollment, the MCP MCOP shall notify the hospital/inpatient facility and treating providers that the MCP MCOP is responsible for the professional charges effective on the date of enrollment, and shall work to ensure discharge planning provides continuity using MCPMCOP-contracted or authorized providers. If an individual has been admitted to a hospital prior to the first day of Medicaid eligibility and no retroactive eligibility occurs, the MCP MCOP is responsible for reimbursement of the inpatient hospital claim for the days the member is enrolled in the MCPMCOP. The days prior to eligibility would be considered non-covered days, and the claim should be processed for payment as partial eligibility.

Change in Enrollment During Hospital/Inpatient Facility Stay. When the MCP learns of a currently hospitalized member’s intent to disenroll through the CCR or the HIPAA 834, the disenrolling MCP shall notify the hospital/inpatient facility and treating providers as well as the enrolling MCP, if applicable, of the change in enrollment. The disenrolling MCP shall notify the inpatient facility that it will remain responsible for the inpatient facility charges through the date of discharge; and shall notify the treating providers that it will remain responsible for provider charges through the date of disenrollment. The disenrolling MCP shall not request and/or require that a disenrolled member be discharged from the inpatient facility for transfer to another inpatient facility. Should a discharge and transfer to another inpatient facility be medically necessary, the disenrolling MCP shall notify the treating providers to work with the enrolling MCP or ODM as applicable to facilitate the discharge, transfer, transfer and authorization of services as needed. When the enrolling MCP learns through the disenrolling MCP, through ODM or other means, that a new member who was previously enrolled with another MCP was admitted prior to the effective date of enrollment and remains an inpatient on the effective date of enrollment, the enrolling MCP shall contact the hospital/ inpatient facility. The enrolling MCP shall verify that it is responsible for all medically necessary Medicaid covered services from the effective date of MCP membership, including professional charges related to the inpatient stay; the enrolling MCP shall inform the hospital/inpatient facility that the admitting/disenrolling MCP remains responsible for the hospital/inpatient facility charges through the date of discharge. The enrolling MCP shall work with the hospital/inpatient facility to facilitate discharge planning and authorize services as needed. When the MCP learns that a new member who was previously on Medicaid fee-for-service was admitted prior to the effective date of enrollment and remains an inpatient on the effective date of enrollment, the MCP shall notify the hospital/inpatient facility and treating providers that the MCP is responsible for the professional charges effective on the date of enrollment, and shall work to ensure discharge planning provides continuity using MCP-contracted or authorized providers. If an individual has been admitted to a hospital prior to the first day of Medicaid eligibility and no retroactive eligibility occurs, the MCP is responsible for reimbursement of the inpatient hospital claim for the days the member is enrolled in the MCP. The days prior to eligibility would be considered non-covered days, and the claim should be processed for payment as partial eligibility.

Change in Enrollment During Hospital/Inpatient Facility Stay. When the an MCP learns of a currently hospitalized member’s intent to disenroll through the CCR or the HIPAA 834, the disenrolling MCP shall must notify the hospital/inpatient facility and treating providers as well as the enrolling MCP, if applicable, of the change in enrollment. The disenrolling MCP shall must notify the inpatient facility that it will remain responsible for the inpatient facility charges through the date of discharge; and shall must notify the treating providers that it will remain responsible for provider charges through the date of disenrollment. The disenrolling MCP shall not request and/or require that a disenrolled member be discharged from the inpatient facility for transfer to another inpatient facility. Should a discharge and transfer to another inpatient facility be medically necessary, the disenrolling MCP shall must notify the treating providers to work with the enrolling MCP or ODM as applicable to facilitate the discharge, transfer, transfer and authorization of services as needed. When the enrolling MCP learns through the disenrolling MCP, through ODM or other means, that a new member who was previously enrolled with another MCP was admitted prior to the effective date of enrollment and remains an inpatient on the effective date of enrollment, the enrolling MCP shall contact the hospital/ inpatient facility. The enrolling MCP shall verify that it is responsible for all medically necessary Medicaid covered services from the effective date of MCP membership, including professional charges related to the inpatient stay; the enrolling MCP shall must inform the hospital/inpatient facility that the admitting/disenrolling MCP remains responsible for the hospital/inpatient facility charges through the date of discharge. The enrolling MCP shall work with the hospital/inpatient facility to facilitate discharge planning and authorize services as needed. When the an MCP learns that a new member who was previously on Medicaid fee-for-for- service was admitted prior to the effective date of enrollment and remains an inpatient on the effective date of enrollment, the MCP shall notify the hospital/inpatient facility and treating providers that the MCP is responsible for the professional charges effective on the date of enrollment, and shall work to ensure that discharge planning provides continuity using MCP-contracted or authorized providers. If an individual has been admitted to a hospital prior to the first day of Medicaid eligibility and no retroactive eligibility occurs, the MCP is responsible for reimbursement of the inpatient hospital claim for the days the member is enrolled in the MCP. The days prior to eligibility would be considered non-covered days, and the claim should be processed for payment as partial eligibility.

Change in Enrollment During Hospital/Inpatient Facility Stay. When the MCP learns of a currently hospitalized member’s intent to disenroll through the CCR or the HIPAA 834, the disenrolling MCP shall notify the hospital/inpatient facility and treating providers as well as the enrolling MCP, if applicable, of the change in enrollment. The disenrolling MCP shall notify the inpatient facility that it will remain responsible for the inpatient facility charges through the date of discharge; and shall notify the treating providers that it will remain responsible for provider charges through the date of disenrollment. The disenrolling MCP shall not request and/or require that a disenrolled member be discharged from the inpatient facility for transfer to another inpatient facility. Should a discharge and transfer to another inpatient facility be medically necessary, the disenrolling MCP shall notify the treating providers to work with the enrolling MCP or ODM as applicable to facilitate the discharge, transfer, transfer and authorization of services as needed. When the enrolling MCP learns through the disenrolling MCP, through ODM or other means, that a new member who was previously enrolled with another MCP was admitted prior to the effective date of enrollment and remains an inpatient on the effective date of enrollment, the enrolling MCP shall contact the hospital/ inpatient facility. The enrolling MCP shall verify that it is responsible for all medically necessary Medicaid covered services from the effective date of MCP membership, including professional charges related to the inpatient stay; the enrolling MCP shall inform the hospital/inpatient facility that the admitting/disenrolling MCP remains responsible for the hospital/inpatient facility charges through the date of discharge. The enrolling MCP shall work with the hospital/inpatient facility to facilitate discharge planning and authorize services as needed. When the MCP learns that a new member who was previously on Medicaid fee-for-for- service was admitted prior to the effective date of enrollment and remains an inpatient on the effective date of enrollment, the MCP shall notify the hospital/inpatient facility and treating providers that the MCP is responsible for the professional charges effective on the date of enrollment, and shall work to ensure discharge planning provides continuity using MCP-contracted or authorized providers. If an individual has been admitted to a hospital prior to the first day of Medicaid eligibility and no retroactive eligibility occurs, the MCP is responsible for reimbursement of the inpatient hospital claim for the days the member is enrolled in the MCP. The days prior to eligibility would be considered non-covered days, and the claim should be processed for payment as partial eligibility.

Change in Enrollment During Hospital/Inpatient Facility Stay. When the MCP an XXXX learns of a currently hospitalized member’s intent to disenroll through the CCR or the HIPAA 834, the disenrolling MCP MCOP shall notify the hospital/inpatient facility and treating providers as well as the enrolling MCPMCOP, if applicable, of the change in enrollment. The disenrolling MCP MCOP shall notify the inpatient facility that it will remain responsible for the inpatient facility charges through the date of discharge; and shall notify the treating providers that it will remain responsible for provider charges through the date of disenrollment. The disenrolling MCP MCOP shall not request and/or require that a disenrolled member be discharged from the inpatient facility for transfer to another inpatient facility. Should a discharge and transfer to another inpatient facility be medically necessary, the disenrolling MCP MCOP shall notify the treating providers to work with the enrolling MCP MCOP or ODM as applicable to facilitate the discharge, transfer, transfer and authorization of services as needed. When the enrolling MCP MCOP learns through the disenrolling MCPMCOP, through ODM or other means, that a new member who was previously enrolled with another MCP MCOP was admitted prior to the effective date of enrollment and remains an inpatient on the effective date of enrollment, the enrolling MCP MCOP shall contact the hospital/ inpatient facility. The enrolling MCP MCOP shall verify that it is responsible for all medically necessary Medicaid covered services from the effective date of MCP MCOP membership, including professional charges related to the inpatient stay; additionally, the enrolling MCP The MCOP shall inform the hospital/inpatient facility that the admitting/disenrolling MCP MCOP remains responsible for the hospital/inpatient facility charges through the date of discharge. The enrolling MCP MCOP shall work with the hospital/inpatient facility to facilitate discharge planning and authorize services as needed. When the MCP MCOP learns that a new member who was previously on Medicaid fee-for-service was admitted prior to the effective date of enrollment and remains an inpatient on the effective date of enrollment, the MCP MCOP shall notify the hospital/inpatient facility and treating providers that the MCP MCOP is responsible for the professional charges effective on the date of enrollment, and shall work to ensure discharge planning provides continuity using MCPMCOP-contracted or authorized providers. If an individual has been admitted to a hospital prior to the first day of Medicaid eligibility and no retroactive eligibility occurs, the MCP is responsible for reimbursement of the inpatient hospital claim for the days the member is enrolled in the MCP. The days prior to eligibility would be considered non-covered days, and the claim should be processed for payment as partial eligibility.

Change in Enrollment During Hospital/Inpatient Facility Stay. When the MCP an MCOP learns of a currently hospitalized member’s intent to disenroll through the CCR or the HIPAA 834, the disenrolling MCP MCOP shall notify the hospital/inpatient facility and treating providers as well as the enrolling MCPMCOP, if applicable, of the change in enrollment. The disenrolling MCP MCOP shall notify the inpatient facility that it will remain responsible for the inpatient facility charges through the date of discharge; and shall notify the treating providers that it will remain responsible for provider charges through the date of disenrollment. The disenrolling MCP MCOP shall not request and/or require that a disenrolled member be discharged from the inpatient facility for transfer to another inpatient facility. Should a discharge and transfer to another inpatient facility be medically necessary, the disenrolling MCP MCOP shall notify the treating providers to work with the enrolling MCP MCOP or ODM as applicable to facilitate the discharge, transfer, transfer and authorization of services as needed. When the enrolling MCP MCOP learns through the disenrolling MCPMCOP, through ODM or other means, that a new member who was previously enrolled with another MCP MCOP was admitted prior to the effective date of enrollment and remains an inpatient on the effective date of enrollment, the enrolling MCP MCOP shall contact the hospital/ inpatient facility. The enrolling MCP MCOP shall verify that it is responsible for all medically necessary Medicaid covered services from the effective date of MCP MCOP membership, including professional charges related to the inpatient stay; additionally, the enrolling MCP The MCOP shall inform the hospital/inpatient facility that the admitting/disenrolling MCP MCOP remains responsible for the hospital/inpatient facility charges through the date of discharge. The enrolling MCP MCOP shall work with the hospital/inpatient facility to facilitate discharge planning and authorize services as needed. When the MCP MCOP learns that a new member who was previously on Medicaid fee-for-service was admitted prior to the effective date of enrollment and remains an inpatient on the effective date of enrollment, the MCP MCOP shall notify the hospital/inpatient facility and treating providers that the MCP MCOP is responsible for the professional charges effective on the date of enrollment, and shall work to ensure discharge planning provides continuity using MCPMCOP-contracted or authorized providers. If an individual has been admitted to a hospital prior to the first day of Medicaid eligibility and no retroactive eligibility occurs, the MCP is responsible for reimbursement of the inpatient hospital claim for the days the member is enrolled in the MCP. The days prior to eligibility would be considered non-covered days, and the claim should be processed for payment as partial eligibility.