Common use of Enrollee Identification Card Clause in Contracts

Enrollee Identification Card. a. Enrollment Verification The Division, or its duly authorized representative, shall provide the Contractor on a monthly basis a listing of all Coordinated Care enrollees who have selected or been assigned to the Contractor’s plan. The listing, or “enrollment report,” shall be provided to the Contractor sufficiently in advance of the enrollee’s enrollment effective date to permit the Contractor to fulfill its identification card issuance and primary care provider notification responsibilities, described elsewhere in this Contract. Should the enrollment report be delayed in its delivery to the Contractor, the applicable timeframes for identification card issuance and primary care provider notification shall be extended by one (1) business day for each day the enrollment report is delayed. The Division and the Contractor shall reconcile each enrollment report as expeditiously as is feasible. The Contractor must have in place policies and procedures that are acceptable to the Division for notifying primary care providers of the enrollees assigned to them within five (5) business days of the date on which the CCO receives the enrollment report from the Division. The Contractor must have in place policies and procedures to ensure that out-of- network providers can verify enrollment in the Contractor’s plan prior to treating a patient for non-emergency services. The Contractor must provide within five

Enrollee Identification Card. a. Enrollment Verification The Division, or its duly authorized representative, shall provide the Contractor on a monthly basis a listing of all Coordinated Care enrollees who have selected or been assigned to the Contractor’s plan. The listing, or “enrollment report,” shall be provided to the Contractor sufficiently in advance of the enrollee’s enrollment effective date to permit the Contractor to fulfill its identification card issuance and primary care provider notification responsibilities, described elsewhere in this Contract. Should the enrollment report be delayed in its delivery to the Contractor, the applicable timeframes for identification card issuance and primary care provider notification shall be extended by one (1) business day for each day the enrollment report is delayed. The Division and the Contractor shall reconcile each enrollment report as expeditiously as is feasible. The Contractor must have in place policies and procedures that are acceptable to the Division for notifying primary care providers of the enrollees assigned to them within five (5) business days of the date on which the CCO Contractor receives the enrollment report from the Division. The Contractor must have in place policies and procedures to ensure that out-of- network providers can verify enrollment in the Contractor’s plan prior to treating a patient for non-emergency services. The Contractor must provide within five