Issuance of Member Materials Sample Clauses

Issuance of Member Materials. The MCOP shall provide members with a variety of materials, including at a minimum those specified in OAC rules, this Agreement, and the Three-Way. The following provides clarification regarding the issuance of specific member materials.
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Issuance of Member Materials. The ID card, new member letter, and request postcard shall be mailed within 10 business days of receiving the 834C enrollment file, except during state cutoff when plans have the option to follow the 834 file loading process as specified by ODM. a. The MCP may mail ODM prior-approved postcards to new members in lieu of mailing printed advance directives, directories, and member handbooks. At a minimum, the postcards shall advise members to call the MCP or return the postcards to request a printed advance directive, provider directory, and/or member handbook. b. If the MCP does not use an ODM prior-approved postcard, the MCP shall mail printed advance directives, provider directories, and member handbooks to all new members, within 5 calendar days of receiving the 834C. c. If requested, a printed advance directive, provider directory, and member handbook shall be sent to a member within seven calendar days of the request. d. The MCP shall designate two MCP staff members to receive a copy of the new member materials on a monthly basis in order to monitor the timely receipt of these materials. At least one of the staff members shall receive the materials at their home address. e. The MCP ID card shall contain pharmacy information, as prescribed by ODM.
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Issuance of Member Materials. The MCOP must provide members with a variety of materials, including at a minimum those specified in the OAC rules, this Provider Agreement and the Three Way. The following provides clarification regarding the issuance of specific member materials. a. New Member Materials - Pursuant to OAC rules 5160-58-01.1 and 5160-26-08.2, MCOPs must provide to each member who selects or changes MCOPs, or changes Medicaid-only or dual benefit status, an MCOP identification (ID) card, a new member letter, a member handbook (including a waiver handbook if applicable), and provider panel information, as specified by ODM. i. The MCOP must use the model language specified by ODM and/or CMS for the new member letter and member handbooks. ii. The MCOP must mail ID cards to each member via a method that will ensure receipt no earlier than 15 days prior to the member’s effective date of coverage and no later than the day prior to the member’s effective date of coverage. a. An MCOP will meet the timeliness requirement for mailing ID cards to members who select or change MCOPs, or change Medicaid-only or dual benefit status within the five days prior to the end of the month, if the ID cards are mailed within: i. Five (5) working days of the MCOP receiving the ODM produced HIPAA 834C that lists the individual as a Medicaid- only member; or ii. Ten (10) working days of the MCOP receiving the ODM- produced HIPAA 834C that lists the individual as a dual benefits member. b. The MCOP ID card must contain pharmacy information, and the toll- free 24-hour behavioral health crisis and care management telephone numbers as prescribed by ODM. c. For Medicaid Only members when a contracted primary care provider (PCP) is not identified on the consumer contact record (CCR) and the member does not select a PCP, the ID card PCP field must read “Refer to Medicare PCP”. iii. The MCOP must mail the new member letter and member handbook, including the waiver handbook if applicable, separate from the ID card. An MCOP will meet the timeliness requirement for mailing these materials if they are mailed to members within five (5) working days of the MCOP receiving the ODM produced HIPAA 834C, that lists the individual as a new member. iv. The MCOP must provide access to provider panel information to members via the MCOP’s website and printed provider directories. a. MCOPs may mail ODM prior-approved provider directory notices to all new members in lieu of mailing printed directories. The notices must be mai...
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Related to Issuance of Member Materials

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