Common use of Enrollment Rosters Clause in Contracts

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: a. BadgerCare Plus and Medicaid SSI 1) The Initial HMO Enrollment Roster will list all of the HMO’s members and disenrollees for the enrollment month that are known on the date of roster generation. The Initial HMO Enrollment Roster will be available to the HMO on or about the twenty-first of each month. A capitation claim shall be generated for each member listed as an ADD or CONTINUE on this roster. Members who appear as PENDING on the Initial Roster and are reinstated into the HMO by the last business day of the month will appear as a CONTINUE on the Final Roster and a capitation claim will be generated at that time. 2) The final HMO Enrollment Roster will list all of the HMO’s members for the enrollment month, who were not included in the Initial HMO Enrollment Roster. The Final HMO Enrollment Roster will be available to the HMO by the first day of the capitation month. A capitation claim will be generated for every member listed as an ADD or CONTINUE on this roster. Members in PENDING status will not be included on the final roster. b. The Department will provide the HMO with effective dates for medical status code changes, county changes and other address changes in each enrollment roster to the extent that the income maintenance agency reports these to the Department.

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: a. a) BadgerCare Plus and Medicaid SSI 1) The Initial HMO Enrollment Roster will list all of the HMO’s members and disenrollees for the enrollment month that are known on the date of roster generation. The Initial HMO Enrollment Roster will be available to the HMO on or about the twenty-first of each month. A capitation claim shall be generated for each member listed as an ADD or CONTINUE on this roster. Members who appear as PENDING on the Initial Roster and are reinstated into the HMO by the last business day of the month will appear as a CONTINUE on the Final Roster and a capitation claim will be generated at that time. 2) The final HMO Enrollment Roster will list all of the HMO’s members for the enrollment month, who were not included in the Initial HMO Enrollment Roster. The Final HMO Enrollment Roster will be available to the HMO by the first day of the capitation month. A capitation claim will be generated for every member listed as an ADD or CONTINUE on this roster. Members in PENDING status will not be included on the final roster. b. b) The Department will provide the HMO with effective dates for medical status code changes, county changes and other address changes in each enrollment roster to the extent that the income maintenance agency reports these to the Department.

Enrollment Rosters. The Department will promptly notify the HMO County PIHP of all BadgerCare Plus and/or Medicaid SSI members enrolled in the HMO County PIHP under this Contractcontract. Notification will be effected through the HMO County PIHP 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 Contractcontract, the Department will transmit “HMO County PIHP Enrollment Rosters” to the HMOCounty PIHP. These rosters will provide the HMO County PIHP with ongoing information about its BadgerCare Plus and/or Medicaid SSI enrollees members and disenrollees disenrolless and will be used as the basis for the monthly capitation claim payments to the HMO. County PIHP. a. The HMO Enrollment County PIHP Rosters will be generated in the following sequence: a. BadgerCare Plus and Medicaid SSI 1) i. The Initial HMO initial County PIHP Enrollment Roster Rosters will list all of the HMOCounty PIHP’s members and disenrollees for the enrollment month that are known on the date of roster generation. The Initial HMO County PIHP Enrollment Roster Rosters will be available to the HMO County on or about the twenty-twenty first of each month. A capitation claim shall be generated for each member listed as an ADD or CONTINUE on this roster. Members who appear as PENDING on the Initial Roster and are reinstated into the HMO PIHP by the last business day of the month will appear as a CONTINUE on the Final Roster and a capitation claim will be generated at that time. 2) ii. The final HMO Enrollment County PIHP Enrolment Roster will list all of the HMOCounty PIHP’s members for the enrollment enrolment month, who were not included in the Initial HMO County PIHP Enrollment Roster. The Final HMO Enrollment County PIHP Enrolment Roster will be available to the HMO County PIHP by the first day of the capitation month. A capitation claim will be generated for every member listed as an ADD or CONTINUE on this roster. Members in PENDING status STATUS will not be included on the final roster. b. The Department will provide the HMO County PIHP with effective dates for medical status code changes, county changes changes, and other address changes in each enrollment roster to the extent that the income maintenance agency reports report these to the Department.