Department’s Responsibility. The Department will provide the PH-MCO with immediate notice via electronic transmission or access to Medicheck listings or upon request if a Provider with whom the PH-MCO has entered into an agreement is subsequently suspended or terminated from participation in the Medicaid or Medicare Programs. Upon notification from the Department that a Provider with whom the PH-MCO has entered into an agreement is suspended or terminated from participation in the Medicaid or Medicare Programs, the PH-MCO must immediately act to terminate the Provider from participation. Terminations for loss of licensure and criminal convictions must coincide with the MA effective date of the action.
Department’s Responsibility. The Department will provide the CHC-MCO with immediate notice via electronic transmission or access to Medicheck listings or upon request if a Network Provider is subsequently suspended or terminated from participation in the MA or Medicare Programs. Upon notification from the Department, the CHC-MCO must immediately act to terminate the Provider from its Network. A CHC-MCO’s termination must coincide with the MA effective date of termination for loss of licensures and criminal convictions.
Department’s Responsibility. The Department will provide the CHC-MCO with prompt notice via electronic transmission oraccess to Medicheck listings or upon request if a Network Provider is subsequently suspended or terminated from participation in the MA or Medicare Programs. Upon notification from the Department, the CHC-MCO must immediately act to terminate the Provider from its Network. A CHC-MCO’s termination must coincide with the MA effective date of termination for loss of licensures and criminal convictions. The CHC-MCO is required to check the Social Security Administration’s Death Master File (SSADMF), and National Plan and Provider Enumeration System (NPPES) at the time of initial enrollment and re-enrollment as well as providers, owners, agents, and managing employees against the U.S. Department of Health and Human Services-Office of Inspector General’s (HHS-OIG) List of Excluded Individuals and Entities (LEIE), the Excluded Party List System (EPLS) on the System for Award Management (XXX), and the PA Medicheck list on a monthly basis as required in 42 CFR. §455.436.
Department’s Responsibility. The Department will provide the PH-MCO with immediate notice via electronic transmission or access to Medicheck listings or upon request if a Provider with whom the PH-MCO has entered into an Provider Agreement is subsequently suspended or terminated from participation in the MA or Medicare Programs. Upon notification from the Department that a Network Provider is suspended or terminated from participation in the MA or Medicare Programs, the PH-MCO must immediately act to terminate the Provider from its Network. Terminations for loss of licensure and criminal convictions must coincide with the MA effective date of the action. The PH-MCO is required to check the SSADM, and NPPES at the time of initial enrollment and re- enrollment as well as providers, owners, agents, and managing employees against the HHS-OIG LEIE, the EPLS on the XXX, and the PA Medicheck list on a monthly basis as required in 42 CFR §455.436.
Department’s Responsibility for the Performance reporting and spending for contractor
