Enrollment with the State. All network providers that order, refer, or render Medicaid covered services must enroll with BMS, through the fiscal agent, as a Medicaid provider, as required by 42 CFR §438.602(b). Enrollment with BMS does not obligate the MCO provider to offer services under the FFS delivery system. The MCO is not required to contract with a provider enrolled with BMS that does not meet their credentialing or other requirements. As part of the provider enrollment process, the fiscal agent, on behalf of BMS, will perform monthly federal databases checks as required by 42 CFR §455.436 and share results with the MCO. The MCO must collaborate with the fiscal agent to ensure compliance of all entities per Article II, Section 8.7. The MCO may execute a provider agreement, pending the outcome of this screening, enrollment, and revalidation, for up to one hundred twenty (120) days. However, the MCO must terminate the network provider immediately upon notification from the state that the network provider cannot be enrolled, or if the one hundred twenty (120) day period expired without state enrollment of the provider. Upon termination of the provider from the MCO’s network, the MCO must notify all affected enrollees.
Enrollment with the State. All network providers that order, refer, or render Medicaid and WVCHIP covered services must enroll with BMS, through the fiscal agent, as a Medicaid/WVCHIP provider, as required by 42 CFR §438.602(b). Enrollment with BMS does not obligate the MCO provider to offer services under the FFS delivery system. The MCO is not required to contract with a provider enrolled with BMS that does not meet their credentialing or other requirements. As part of the provider enrollment process, the fiscal agent, on behalf of BMS, will perform monthly federal databases checks as required by 42 CFR §455.436 and share results with the MCO. The MCO must collaborate with the fiscal agent to ensure compliance of all entities per Article II, Section 8.7. The MCO may execute a provider agreement, pending the outcome of this screening, enrollment, and revalidation, for up to one hundred twenty (120) days. However, the MCO must terminate the network provider immediately upon notification from the state that the network provider cannot be enrolled, or if the one hundred twenty (120) day period expired without state enrollment of the provider. Upon termination of the provider from the MCO’s network, the MCO must notify all affected enrollees.
Enrollment with the State. All network providers that order, refer, or render covered services must enroll with the Department, through the fiscal agent, as a Medicaid provider, as required by 42 CFR 438.602(b). Enrollment with the Department does not obligate the MCO provider to offer services under the fee-for-service delivery system. The MCO is not required to contract with a provider enrolled with the Department that does not meet their credentialing or other requirements. As part of the provider enrollment process, the fiscal agent, on behalf of the Department, will perform monthly federal databases checks as required by 42 CFR 455.436 and share results with the MCO. The MCO must collaborate with the fiscal agent to ensure compliance of all entities per Article II, Section 8.6.
