Inquiries/Claims Filed By Enrollees. The Contractor shall provide a timely response to all inquiries received from enrollees or on behalf of enrollees while ensuring HIPAA compliance. Additionally, in any instance where the Contractor receives a claim for payment filed by the enrollee, the Contractor shall respond to the enrollee, in writing, and at the time of any action affecting the claim. This response to the enrollee is required regardless of any response that the Contractor sends to the provider of service. The response shall inform the enrollee regarding approval or denial of coverage and shall detail any further action that is required in order to process the claim.
Appears in 5 contracts
Samples: Contract Between the State of Mississippi Division of Medicaid and a Care Coordination Organization (Cco), Contract, Contract
