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. 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 arrange all ACO Covered Services required to be provided by the Contractor to Enrollees under this Contract to each Enrollee as of 12:01 a.m. on the Effective Date of Enrollment, as specified by EOHHS, until such time as provided in Section 2.4.

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. 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. 3.3 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- pre-existing conditions, expected health status, or need for health care services; d. Be responsible to provide or arrange all ACO MCO Covered Services required to be provided by the Contractor to Enrollees under this Contract to each Enrollee as of 12:01 a.m. on the Effective Date of Enrollment, as specified by EOHHS, until such time as provided in Section 2.4.

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- pre-existing conditions, expected health status, or need for health care services; d. Be responsible to provide or arrange all ACO Covered Services required to be provided by the Contractor to Enrollees under this Contract to each Enrollee as of 12:01 a.m. on the Effective Date of Enrollment, as specified by EOHHS, until such time as provided in Section 2.4.

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. 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. 3.3 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- pre-existing conditions, expected health status, or need for health care services; d. Be responsible to provide or arrange all ACO Covered Services required to be provided by the Contractor to Enrollees under this Contract to each Enrollee as of 12:01 a.m. on the Effective Date of Enrollment, as specified by EOHHS, until such time as provided in Section 2.4.