Enrollment and Education Activities.
A. Member Enrollment The Contractor shall:
1. Assist EOHHS with activities related to enrollment of Enrollees, as directed by XXXXX, including, but not limited to, activities such as making preliminary assignments of Enrollees to Participating PCPs and reporting such assignments to EOHHS in a form and format specified by EOHHS;
2. Accept for enrollment all Members, as further specified by EOHHS, referred by EOHHS in the order in which they are referred without restriction; and
3. Accept for enrollment in the Contractor’s Plan, all Members identified by EOHHS at any time without regard to income status, physical or mental condition (such as cognitive, intellectual, mobility, psychiatric, and sensory disabilities as further defined by EOHHS), age, gender, sexual orientation, religion, creed, race, color, physical or mental disability, national origin, ancestry, status as a Member, pre-existing conditions, expected health status, or need for health care services.
4. For new Enrollees enrolled pursuant to Section 2.2.A.5, the Contractor shall collaborate with and support EOHHS in ensuring uninterrupted care. Such collaboration and support shall include, but not be limited to, participating in Enrollee outreach; and identifying specific issues and working with EOHHS to resolve those issues.
B. Identification Card The Contractor shall provide new Enrollees with an identification card for the Contractor’s plan. The Contractor shall:
1. Mail an identification card to all Enrollees no later than 15 business days after the Enrollee’s Effective Date of Enrollment;
2. Ensure (pursuant to 42 USC 1396u-2(g)) that all identification cards issued by the Contractor to Enrollees include a code or some other means of allowing a hospital and other providers to identify the Enrollee as a MassHealth Member. The Enrollee identification card must also include:
a. The name of the Contractor;
b. The Enrollee’s name;
c. A unique identification number for the Enrollee other than the Enrollee’s social security number;
d. The Enrollee’s MassHealth identification number;
e. The name and relevant telephone number(s) of the Contractor’s customer service number; and
f. The name and customer service number of the Behavioral Health Vendor.
C. New Enrollee Information The Contractor shall provide New Enrollees with Enrollee Information that meets the requirements of Section 2.8.C including a Provider directory that meets the requirements of Section 2.5.C and an Enrollee handbook based o...
Enrollment and Education Activities. A. Eligibility Verification The Contractor shall:
1. Upon receipt of an enrollment, verify that the Enrollee is not already enrolled under the Contractor’s commercial plan or a qualified health plan offered through the Exchange. If the Enrollee is covered under the Contractor’s commercial plan or a Qualified Health Plan offered through the Exchange, the Contractor shall promptly submit to EOHHS a completed TPL Indicator Form in accordance with EOHHS’s specifications; and
2. Instruct and assist the Contractor’s Providers in the process and need for verifying an Enrollee’s MassHealth eligibility and enrollment prior to providing any service at each point of service, through EOHHS’s Eligibility Verification System (EVS); provided, however, the Contractor and its Providers shall not require such verification prior to providing Emergency Services.
Enrollment and Education Activities. A. Eligibility Verification The Contractor shall:
1. Upon receipt of an enrollment, verify that the Enrollee is not already enrolled under the Contractor’s commercial plan or a qualified health plan offered through the Exchange. If the Enrollee is covered under the Contractor’s commercial plan or a Qualified Health Plan offered through the Exchange, the Contractor shall promptly submit to EOHHS a completed TPL Indicator Form in accordance with EOHHS’s specifications; and
2. Instruct and assist the Contractor’s Providers in the process and need for verifying an Enrollee’s MassHealth eligibility and enrollment prior to providing any service at each point of service, through EOHHS’s Eligibility Verification System (EVS); provided, however, the Contractor and its Providers shall not require such verification prior to providing Emergency Services.
B. Enrollment
1. Enrollment in the Contractor’s Plan shall occur at the sole discretion of the Member or EOHHS except as provided in Section 2.4.C. below. The Contractor shall provide EOHHS with sufficient enrollment packages and Marketing materials to use as training materials and reference guides for EOHHS’s CSC Enrollment Vendor staff and to be distributed by EOHHS’s CSC Enrollment Vendor to Members and Enrollees upon request.
2. The Contractor shall:
a. On each business day, obtain from EOHHS, via the HIPAA 834 Enrollment File and process information pertaining to all enrollments in the Contractor’s Plan including the Effective Date of Enrollment;
b. Accept for enrollment all Members, as described in Section 4.1. of the Contract, referred by EOHHS in the order in which they are referred without restriction, except that the Contractor shall not accept for enrollment any individual who is currently enrolled with the Contractor through its commercial plan or a Qualified Health Plan offered through the Exchange and shall notify EOHHS of such third party liability in accordance with Section 2.19;
c. Accept for enrollment in the Contractor’s Plan, all Members identified by EOHHS at any time without regard to income status, physical or mental condition (such as cognitive, intellectual, mobility, psychiatric, and sensory disabilities as further defined by EOHHS), age, gender, sexual orientation, religion, creed, race, color, physical or mental disability, national origin, ancestry, status as a Member, pre- existing conditions, expected health status, or need for health care services;
d. Be responsible to provide or arra...
Enrollment and Education Activities. A. Member Enrollment The Contractor shall:
1. Assist EOHHS with activities related to enrollment of Enrollees, as directed by XXXXX, including, but not limited to, activities such as making preliminary assignments of Enrollees to Participating PCCs and reporting such assignments to EOHHS in a form and format specified by EOHHS;
2. Accept for enrollment all Members, as further specified by EOHHS, referred by EOHHS in the order in which they are referred without restriction; and
3. Accept for enrollment in the Contractor’s Plan, all Members identified by EOHHS at any time without regard to income status, physical or mental condition (such as cognitive, intellectual, mobility, psychiatric, and sensory disabilities as further defined by EOHHS), age, gender, sexual orientation, religion, creed, race, color, physical or mental disability, national origin, ancestry, status as a Member, pre-existing conditions, expected health status, or need for health care services.
B. Identification Card The Contractor shall provide new Enrollees with an identification card for the Contractor’s plan. The Contractor shall:
1. Mail an identification card to all Enrollees no later than 15 business days after the Enrollee’s Effective Date of Enrollment;
2. Ensure (pursuant to 42 USC 1396u-2(g)) that all identification cards issued by the Contractor to Enrollees include a code or some other means of allowing a hospital and other providers to identify the Enrollee as a MassHealth Member. The Enrollee identification card must also include:
a. The name of the Contractor;
b. The Enrollee’s name;
c. A unique identification number for the Enrollee other than the Enrollee’s social security number;
d. The Enrollee’s MassHealth identification number;
e. The name and relevant telephone number(s) of the Contractor’s customer service number; and
f. The name and customer service number of the Behavioral Health Vendor.
