Enrollment Rosters. The Department will promptly notify the HMO of all BadgerCare Plus and/or Medicaid SSI members enrolled in the HMO under this Contract. Notification will be effected through the HMO Enrollment Rosters. These rosters shall be available through electronic file transfer capability and will include medical status codes. For each month of coverage through the term of the Contract, the Department will transmit “HMO Enrollment Rosters” to the HMO. These rosters will provide the HMO with ongoing information about its BadgerCare Plus and/or Medicaid SSI enrollees and disenrollees and will be used as the basis for the monthly capitation claim payments to the HMO. The HMO Enrollment Rosters will be generated in the following sequence:
Enrollment Rosters. The State fiscal agent notifies each MCE of all members enrolled in the MCE. The State fiscal agent generates MCE Member Enrollment Rosters using information obtained from the DFR’s ICES transmissions, and MCE assignments entered into the Indiana MMIS system. The MCE Member Enrollment Rosters provide the MCE with a detailed listing of all members for whom the MCE is or has been responsible and identifies each enrollee’s benefit package. The enrollment roster also identifies deleted enrollees who appeared as eligible members on the previous roster, but whose eligibility terminated prior to the actual effective date with the MCE. The MCE is responsible for reconciling the eligibility rosters with capitation payments received and, for HIP members, the State’s POWER Account contributions. If an MCE receives either eligibility information or capitation for a member, and/or the State’s POWER Account contribution for a HIP member, the MCE is financially responsible for the member. The State fiscal agent’s eligibility verification systems, which are updated daily, must be used in the event of any discrepancies. The MCE discovering eligibility/capitation/POWER Account contribution discrepancies shall notify the fiscal agent within thirty (30) calendar days of discovering the discrepancy and no more than ninety (90) calendar days after the MCE receives the eligibility records. Refer to the HIP MCE Policies and Procedures Manual for detail about the eligibility roster process.
Enrollment Rosters. The Department will promptly notify the County PIHP of all members enrolled in the County PIHP under this contract. Notification will be effected through the County PIHP Enrollment Rosters. These rosters shall available through electronic file transfer capability and will include medical status codes. For each month of coverage through the term of the contract, the Department will transmit “County PIHP Enrollment Rosters” to the County PIHP. These rosters will provide the County PIHP with ongoing information about its members and disenrolless and will be used as the basis for the monthly capitation claim payments to the County PIHP.
