Information for ODM-Designated Providers. The MCO must share specific information with federally qualified health centers (FQHCs)/rural health clinics (RHCs), qualified family planning providers, hospitals, and if applicable, certified nurse midwives, certified nurse practitioners, and free-standing birth centers as defined in OAC rule 5160-18-01 within the MCO's service area and in bordering regions, if appropriate, based on member utilization information. The information must be shared within the first month after the MCO has been awarded a Medicaid provider agreement for a specific region and annually thereafter. The information's purpose; Claims submission information, including the MCO's Medicaid provider number for each region (this information must only be provided to out-of- network FQHCs/RHCs, qualified family planning providers, certified nurse midwives, certified nurse practitioners, and hospitals). Claims submission information must include 30 calendar day advance notice to providers of any new edits or system changes related to claims adjudication or payment keyprocessing; The MCO's prior authorization and referral procedures; A picture of the MCO ID card (front and back); Contact numbers for obtaining information for eligibility verification, claims processing, referrals, prior authorization, post-stabilization care services, and if applicable, information regarding the MCO's behavioral health administrator; and A listing of the MCO's laboratories and radiology providers.
Appears in 3 contracts
Samples: Ohio Medicaid Provider Agreement for Managed Care Organization, Ohio Medicaid Provider Agreement for Managed Care Organization, Ohio Medicaid Provider Agreement for Managed Care Organization
Information for ODM-Designated Providers. The MCO must share specific information with federally qualified health centers (FQHCs)/rural health clinics (RHCs), qualified family planning providers, hospitals, and if applicable, certified nurse midwives, certified nurse practitioners, and free-standing birth centers as defined in OAC rule 5160-18-01 within the MCO's service area and in bordering regions, if appropriate, based on member utilization information. The information must be shared within the first month after the MCO has been awarded a Medicaid provider agreement for a specific region and annually thereafter. The information's purpose; Claims submission information, including the MCO's Medicaid provider number for each region (this information must only be provided to out-of- network FQHCs/RHCs, qualified family planning providers, certified nurse midwives, certified nurse practitioners, and hospitals). Claims submission information must include 30 calendar day advance notice to providers of any new edits or system changes related to claims adjudication or payment keyprocessingkey processing; The MCO's prior authorization and referral procedures; A picture of the MCO ID card (front and back); Contact numbers for obtaining information for eligibility verification, claims processing, referrals, prior authorization, post-stabilization care services, and if applicable, information regarding the MCO's behavioral health administrator; and A listing of the MCO's laboratories and radiology providers.
Appears in 1 contract
Samples: Ohio Medicaid Provider Agreement for Managed Care Organization
