Identification and Services for At-Risk Enrollees. Contractor agrees to identify and proactively manage the Plan Enrollees with existing and newly diagnosed need for dental treatment beyond diagnostic and preventive dental services and Plan Enrollees with chronic conditions and who are most likely to benefit from well-coordinated care (“At-Risk Enrollees”). As described in Section 2.04, Contactor shall determine the health status of its new enrollees including identification of those with chronic conditions or other significant dental needs within the first one hundred twenty (120) days of enrollment, provided the Exchange has provided timely notification of enrollment. The Exchange will work with Contractor to develop a documented process, care management plan and strategy for targeting these specific Enrollees. Such documentation may include the following:
Identification and Services for At-Risk Enrollees. Contractor agrees to identify and proactively manage the Plan Enrollees with existing and newly diagnosed chronic conditions and who are most likely to benefit from well-coordinated care (“at-risk plan enrollees”). Contractor will target the highest risk individuals, typically with one or more conditions, including, but not limited to, diabetes, asthma, heart disease or hypertension. Contactor shall be required to identify Plan Enrollees with chronic conditions and other significant health needs within the first ninety (90) days of enrollment. Contractor will provide the Exchange with a documented process, care management plan and strategy for targeting these specific Enrollees, which will include the following:
Identification and Services for At-Risk Enrollees. Contractor agrees to identify and proactively manage the Plan Enrollees with existing and newly diagnosed chronic conditions and who are most likely to benefit from well-coordinated care (“At-Risk Enrollees”). Contractor will target the at risk enrollees, typically with one or more conditions, including, but not limited to, diabetes, asthma, heart disease or hypertension. As described in sections 3.06, Contactor shall determine the health status of its new enrollees that includes identification of chronic conditions and other significant health needs within the first one hundred twenty (120) days of enrollment, provided the Exchange has provided timely notification of enrollment. Contractor will provide the Exchange with a documented process, care management plan and strategy for targeting these specific Enrollees, which will include the following:
Identification and Services for At-Risk Enrollees. Contractor agrees to identify and proactively manage the Plan Enrollees with existing and newly diagnosed chronic conditions and who are most likely to benefit from well-coordinated care (“At-Risk Enrollees”). Contractor will target at-risk enrollees, typically with one or more conditions, including, but not limited to, diabetes, asthma, heart disease or hypertension. As described in Section 3.06, Contactor shall determine the health status of its new enrollees including identification of those with chronic conditions or other significant health needs. For Enrollees transitioning from state and federal programs such as the Major Risk Medical Insurance Program or Pre Existing Condition Insurance Plan, Contractor shall provide the Exchange with a documented process, care management plan and strategy for targeting these specific Enrollees. Such documentation may include the following:
Identification and Services for At-Risk Enrollees. Contractor agrees to identify and proactively manage the Plan Enrollees with existing and newly diagnosed chronic conditions and who are most likely to benefit from well-coordinated care (“At-Risk Enrollees”). Contractor will target the at risk enrollees, typically with one or more conditions, including, but not limited to, diabetes, asthma, heart disease or hypertension. As described in sections 3.06, Contactor shall determine the health status of its new enrollees that includes identification of chronic conditions and other significant health needs pursuant Contractor’s processes as described in Section 3.06. within the first one hundred twenty (120) days of enrollment, provided the Exchange shall provide has provided timely notification of enrollment and Contractor receives from the Exchange or other state agency any existing health conditions for transitioning at-risk enrollees from state programs such as the Major Risk Medical Insurance Program, Pre-Existing Condition Insurance Plan to the Exchange. Subsequent to identification, Contractor will provide the Exchange with a documented process, care management plan and strategy for targeting these specific Enrollees, which may include the following:
Identification and Services for At-Risk Enrollees. Contractor agrees to identify and proactively manage the Plan Enrollees with existing and newly diagnosed chronic conditions and who are most likely to benefit from well-coordinated care (“at-risk plan enrollees”). Contractor will target the highest risk individuals, typically with one or more conditions, including, but not limited to, diabetes, asthma, heart disease or hypertension. Contactor shall be required to identify Planencourage new Enrollees with to complete a Health Assessment that includes identification of chronic conditions and other significant health needs within the first one hundred twentyninety (90120) days of enrollment. Contractor will provide the Exchange with a documented process, care management plan and strategy for targeting these specific Enrollees, which will include the following:
Identification and Services for At-Risk Enrollees. Contractor agrees to identify and proactively manage Enrollees with existing and newly diagnosed need for dental treatment beyond diagnostic and preventive dental services and Enrollees with chronic conditions and who are most likely to benefit from well-coordinated care (“At-Risk Enrollees”). Contractor agrees to support disease management activities at the plan or dental provider level that meet standards of accrediting programs such as the Utilization Review Accreditation Commission (URAC). As described in Section 2.04, Contactor shall determine the health status of its new Enrollees including identification of those with chronic conditions or other significant dental needs within the first one hundred twenty (120) days of enrollment, provided Covered California has provided timely notification of enrollment. Covered California will work with Contractor to develop a documented process, care management plan, and strategy for targeting At-Risk Enrollees. Such documentation may include the following:
Identification and Services for At-Risk Enrollees. Contractor agrees to identify and proactively manage the Plan Enrollees with existing and newly diagnosed chronic conditions and who are most likely to benefit from well-coordinated care (“at- risk plan enrollees”). Contractor will target the highest risk individuals, typically with one or more conditions, including, but not limited to, diabetes, asthma, heart disease or hypertension.
