Health and Wellness Enrollee Support Process. Upon Contractor Plan certification, Contractor shall submit to the Exchange the following information:
(a) Health and wellness communication process to Enrollee and Participating Provider, or other caregiver;
(b) Process to ensure network adequacy required by State or Federal laws, rules and regulation given the focus on prevention and wellness and the impact it may have on network capacity; and
(c) Documentation of a process to incorporate Enrollee’s health and wellness information into Contractor’s data and information specific to each individual Enrollee. This Enrollee’s data is Contractor’s most complete information on each Enrollee and is distinct from the Enrollee’s medical record maintained by the providers.
Health and Wellness Enrollee Support Process. Contractor shall annually submit to the Exchange the following:
(a) Documentation of health and wellness communication process to Exchange Enrollees and appropriate Participating Providers;
(b) Documentation of process to ensure network adequacy required by State or Federal laws, rules and regulations - given the focus on prevention and wellness and the impact it may have on network capacity; and
(c) Documentation of a process to incorporate Enrollees health and wellness information into Contractor’s data and information specific to each individual Enrollee. This Enrollee’s data is Contractor’s most complete information on each Enrollee and is distinct from the Enrollee’s medical record maintained by the providers.
Health and Wellness Enrollee Support Process. Upon Contractor Plan certification, Contractor shall submit to the Exchange the following information:
(a) Health and wellness communication process to Enrollee and Participating Provider, or other caregiver;
(b) Process to ensure network adequacy required by State or Federal laws, rules and regulation given the focus on prevention and wellness and the impact it may have on network capacity ; and
(c) Documentation of a process to incorporate Enrollee’s health and wellness information into Contractor’s data and information specific to each individual Enrollee. This Enrollee’s data is Contractor’s most complete information on each Enrollee and is distinct from the Enrollee’s medical record maintained by the providers. Covered California – Final Health Plan Contract Attachments, May 6,20117, 2013 Attachment 7-11 The Exchange and Contractor recognize that access to care, coordination of care and early identification of high risk enrollees are central to the improvement of Enrollee health. Traditionally, Primary Care Providers have provided an entry point to the system (access), coordination of care and early identification of at risk patients, and the Exchange strongly encourages the full use of PCPs by Contractors. Contractor and the Exchange shall identify further ways to increase access and coordination of care and agree to work collaboratively to achieve these objectives.
