Common use of Enrollment and Education Activities Clause in Contracts

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.