Contractor Notification of Disenrollments. a) Notwithstanding anything herein to the contrary, the Roster, along with any changes sent by the LDSS to the Contractor in writing or electronically, shall serve as official notice to the Contractor of disenrollment of an Enrollee. In cases of expedited and retroactive disenrollment, the Contractor shall be notified of the Enrollee's effective date of disenrollment by the LDSS. b) In the event that the LDSS intends to retroactively disenroll an Enrollee on a date prior to the first day of the month of the disenrollment request, the LDSS shall consult with the Contractor prior to disenrollment. Such consultation shall not be required for the retroactive disenrollment of SSI infants or in cases where it is clear that the Contractor was not a risk for the provision of Benefit Package services for any portion of the retroactive period. c) In all cases of retroactive disenrollment, including disenrollments effective the first day of the current month, the LDSS must notice the plan at the time of disenrollment, of the Contractor's responsibility to submit to the SDOH's Fiscal Agent voided premium claims for any months of retroactive disenrollment where the Contract was not at risk for the provision of Benefit Package services during the month.
Appears in 7 contracts
Samples: Medicaid Managed Care Model Contract (Wellcare Health Plans, Inc.), Medicaid Managed Care Model Contract (Wellcare Health Plans, Inc.), Medicaid Managed Care Model Contract (Wellcare Health Plans, Inc.)
Contractor Notification of Disenrollments. a) Notwithstanding anything herein to the contrary, the Roster, along with any changes sent by the LDSS to the Contractor in writing or electronically, shall serve as official notice to the Contractor of disenrollment of an Enrollee. In cases of expedited and retroactive disenrollment, the Contractor shall be notified of the Enrollee's ’s effective date of disenrollment by the LDSS.
b) In the event that the LDSS intends to retroactively disenroll an Enrollee on a date prior to the first day of the month of the disenrollment request, the LDSS shall consult is responsible for consulting with the Contractor prior to disenrollment. Such consultation shall not be required for the retroactive disenrollment of SSI infants or in cases where it is clear that the Contractor was not a at risk for the provision of Benefit Package services for any portion of the retroactive period.
c) In all cases of retroactive disenrollmentDisenrollment, including disenrollments Disenrollments effective the first day of the current month, the LDSS must notice is responsible for notifying the plan Contractor at the time of disenrollment, Disenrollment of the Contractor's ’s responsibility to submit to the SDOH's ’s Fiscal Agent voided premium claims for any months of retroactive disenrollment where the Contract Contractor was not at risk for the provision of Benefit Package services during the month.
Appears in 2 contracts
Samples: Hiv Special Needs Plan Model Contract, Hiv Special Needs Plan Model Contract
Contractor Notification of Disenrollments. a) Notwithstanding anything herein to the contrary, the Roster, along with any changes sent by the LDSS to the Contractor in writing or electronically, shall serve as official notice to the Contractor of disenrollment Disenrollment of an Enrollee. In cases of expedited and retroactive disenrollmentDisenrollment, the Contractor shall be notified of the Enrollee's effective date Effective Date of disenrollment Disenrollment by the LDSS.
b) In the event that the LDSS intends to retroactively disenroll an Enrollee on a date prior to the first day of the month of the disenrollment Disenrollment request, the LDSS shall consult is responsible for consulting with the Contractor prior to disenrollmentDisenrollment. Such consultation shall not be required for the retroactive disenrollment Disenrollment of SSI Supplemental Security Income (SSI) infants or in cases where it is clear that the Contractor was not a risk for the provision of Benefit Package services for any portion of the retroactive period.
c) In all cases of retroactive disenrollmentDisenrollment, including disenrollments Disenrollments effective the first day of the current month, the LDSS must notice is responsible for noticing the plan Contractor at the time of disenrollment, Disenrollment of the Contractor's responsibility to submit to the SDOH's Fiscal Agent voided premium claims for any months of retroactive disenrollment Disenrollment where the Contract Contractor was not at risk for the provision of Benefit Package services during the month.
Appears in 2 contracts
Samples: Medicaid Managed Care Contract (Wellcare Health Plans, Inc.), Medicaid Managed Care Agreement (Amerigroup Corp)
Contractor Notification of Disenrollments. a) Notwithstanding anything herein cretin to the contrary, the Roster, along with any changes sent by the LDSS to the Contractor in writing or electronically, shall serve as official notice to the Contractor of disenrollment of an Enrollee. In cases of expedited and retroactive disenrollment, the Contractor shall be notified of the Enrollee's effective date of disenrollment by the LDSS.
b) In the event that the LDSS intends to retroactively disenroll an Enrollee on a date prior to the first day of the month of the disenrollment request, the LDSS shall consult with the Contractor prior to disenrollment. Such consultation shall not be required for the retroactive disenrollment of SSI infants or in cases where it is clear that the Contractor was not a risk for the provision of Benefit Package services for any portion of the retroactive period.
c) In all cases of retroactive disenrollment, including disenrollments effective the first day of the current month, the LDSS must notice the plan at the time of disenrollment, of the Contractor's responsibility to submit to the SDOH's Fiscal Agent voided premium claims for any months of retroactive disenrollment where the Contract was not at risk for the provision of Benefit Package services during the that month.
Appears in 1 contract
Samples: Medicaid Managed Care Model Contract (Wellcare Health Plans, Inc.)
Contractor Notification of Disenrollments. a) Notwithstanding anything herein to the contrary, the Roster, along with any changes sent by the LDSS to the Contractor in writing or electronically, shall serve as official notice to the Contractor of disenrollment Disenrollment of an Enrollee. In cases of expedited and retroactive disenrollmentDisenrollment, the Contractor shall be notified of the Enrollee's effective date Effective Date of disenrollment Disenrollment by the LDSS.
b) In the event that the LDSS intends to retroactively disenroll an Enrollee on a date prior to the first day of the month of the disenrollment request, the LDSS shall consult with the Contractor prior to disenrollmentDisenrollment. Such consultation shall not be required for the retroactive disenrollment of SSI infants or in cases where it is clear that the Contractor was not a risk for the provision of the Medicaid Advantage Benefit Package services for any portion of the retroactive period.
c) In all cases of retroactive disenrollmentDisenrollment, including disenrollments Disenrollments effective the first day of the current month, the LDSS must notice is responsible for notifying the plan Contractor at the time of disenrollmentDisenrollment, of the Contractor's responsibility to submit to the SDOH's Fiscal Agent voided premium claims for any months of retroactive disenrollment Disenrollment where the Contract Contractor was not at risk for the provision of the Medicaid Advantage Benefit Package services during the month.
Appears in 1 contract
Samples: Medicaid Advantage Contract Attestation (Wellcare Health Plans, Inc.)
Contractor Notification of Disenrollments. a) Notwithstanding anything herein to the contrary, the Roster, along with any changes sent by the LDSS PRHIA to the Contractor in writing or electronically, shall serve as official notice to the Contractor of disenrollment of an Enrollee. In cases of expedited and retroactive disenrollment, the Contractor shall be notified of the Enrollee's effective date of disenrollment by the LDSSPRHIA.
b) In the event that the LDSS PRHIA intends to retroactively disenroll an Enrollee on a date prior to the first day of the month of the disenrollment request, the LDSS PRHIA shall consult with the Contractor prior to disenrollment. Such consultation shall not be required for the retroactive disenrollment of SSI infants or in cases where it is clear that the Contractor was not a risk for the provision of the Medicare Platino Benefit Package services for any portion of the retroactive period.
c) In all cases of retroactive disenrollment, including disenrollments effective the first day of the current month, the LDSS PRHIA must notice the plan at the time of disenrollment, of the Contractor's responsibility to submit to the SDOH's PRHIA Fiscal Agent voided premium claims for any months of retroactive disenrollment where the Contract Contractor was not at risk for the provision of the Medicare Platino Benefit Package services during the month.
Appears in 1 contract
Samples: Medicaid Wraparound Agreement
Contractor Notification of Disenrollments. a) Notwithstanding anything herein to the contrary, the Roster, along with any changes sent by the LDSS to the Contractor in writing or electronically, shall serve as official notice to the Contractor of disenrollment Disenrollment of an Enrollee. In cases of expedited and retroactive disenrollmentDisenrollment, the Contractor shall be notified of the Enrollee's effective date ’s Effective Date of disenrollment Disenrollment by the LDSS.
b) In the event that the LDSS intends to retroactively disenroll an Enrollee on a date prior to the first day of the month of the disenrollment Disenrollment request, the LDSS shall consult is responsible for consulting with the Contractor prior to disenrollmentDisenrollment. Such consultation shall not be required for the retroactive disenrollment Disenrollment of SSI infants or in cases where it is clear that the Contractor was not a risk for the provision of Benefit Package services for any portion of the retroactive period.
c) In all cases of retroactive disenrollmentDisenrollment, including disenrollments Disenrollments effective the first day of the current month, the LDSS must notice is responsible for noticing the plan Contractor at the time of disenrollment, Disenrollment of the Contractor's ’s responsibility to submit to the SDOH's ’s Fiscal Agent voided premium claims for any months of retroactive disenrollment Disenrollment where the Contract Contractor was not at risk for the provision of Benefit Package services during the month.
Appears in 1 contract
Samples: Primary Care Partial Capitation Provider (Pcpcp) Medicaid Managed Care Model Contract