HMO Responsibilities. (1) HMO must identify care coordinators who will be available to assist public health providers and PCPs in getting efficient referrals of Members to the public health providers, specialists, and health-related service providers either within or outside HMO's network.
HMO Responsibilities a. Provide HealthCheck services as a continuing care provider as defined in Article I, and according to policies and procedures in the Wisconsin Medicaid HealthCheck Provider Handbook related to covered services.
HMO Responsibilities. 1. Routine assess the effectiveness and efficiency of its utilization review program.
HMO Responsibilities. Provide services as a continuing care provider as defined in Article I, and according to policies and procedures in Part D of the Wisconsin Medicaid Provider Handbook related to covered services. Provide HealthCheck screens upon request. For enrollees over 1 year of age, if an enrollee, parent or guardian of an enrollee requests a HealthCheck screen, HMO shall provide such screen within 60 days, if a screen is due according to the periodicity schedule. If the screen is not due within 60 days, then the HMO shall schedule the appointment in accordance with the periodicity schedule. For enrollees up to one (1) year of age, if a parent or guardian of an enrollee's requests a HealthCheck screen, HMO shall provide such screen within 30 days, if a screen is due according to the periodicity schedule. If the screen is not due HMO Contract for January 1, 2002 - December 31, 2003 within 30 days, then the HMO shall schedule the appointment in accordance with the periodicity schedule. Provide HealthCheck screens at a rate equal to or greater than 80 percent of the expected number of screens. The rate of HealthCheck screens will be determined by the calculation in the HealthCheck Worksheet in Addendum XI. The HMO may complete the worksheet on its own, periodically, as a means to monitor its HealthCheck screening performance. HealthCheck data provided by the HMO must agree with its medical record documentation. For the purpose of the HealthCheck recoupment process the Department will not include any additional HealthCheck encounter records that are received after January 16, 2004 and 2005 for the year under consideration. (Please note: This is a thirteen-month period of time from the end of the years under consideration. (For example, for dates of service in 2002 the cut-off period will be January 16, 2004).
HMO Responsibilities. A. Offer qualified individuals HMO coverage under which services are to be provided by the PRACTICE and other Participating Providers. Upon enrollment in the HMO, each Member must choose a Primary Care Physician participating in the HMO Provider Network. Each Member may elect to change his/her Primary Care Physician participating in the HMO Provider Network in accordance with HMO provisions, Laws and the IHFS Contract.
HMO Responsibilities
