MCO Responsibilities. 1. In those instances where the Contractor directly receives disenrollment forms, the Contractor will forward these disenrollments to the LDSS for processing within five (5) business days (or according to Section F of this Appendix). During pulldown week, these forms may be faxed to the LDSS with the hard copy to follow.
MCO Responsibilities. 1. The Contractor must notify the LDSS in writing of any Enrollee that is pregnant within thirty (30) days of knowledge of the pregnancy. Notifications should be transmitted to the LDSS at least monthly. The notifications should contain the pregnant woman's name, Client ID Number (CIN), and the expected date of confinement (EDC).
MCO Responsibilities. When the MCO becomes aware that a member intends to change her or his residence, the MCO shall, in addition to updating its records when the change of address occurs, do the following:
MCO Responsibilities. 1. In those instances in which the Contractor is marketing to persons already in receipt of Medicaid, the Contractor will submit plan enrollments to the LDSS, within a maximum of five (5) business days from the day the enrollment is received by the Contractor (unless otherwise agreed to by SDOH and LDSS).
MCO Responsibilities. 1) The Contractor is also responsible for providing notification to individuals regarding their enrollment status as specified in Section A of this Appendix.
MCO Responsibilities. When the MCO becomes aware that a member intends to change the member’s residence, the MCO shall, in addition to updating its records when the change of address occurs, do the following: For Moves Within the Geographic Service Region: Inform the member of any changes in IDT staff, service providers or other aspects of the member's care plan that may result from the move. Complete Section D of the Family Care /Partnership /PACE Change Routing Form per instructions. The form is available at Family Care/Partnership/PACE/IRIS - Change Routing Form (F- 02404). Do not disenroll the member; only a transfer of Medicaid eligibility between income maintenance consortia is necessary if applicable. For Moves to Another Geographic Service Region Served by the MCO: Inform the member of any changes in IDT staff, service providers or other aspects of the member's care plan that will result from the move. Complete Section D of the Family Care /Partnership /PACE Change Routing Form per instructions. The form is available at Family Care/Partnership/PACE/IRIS - Change Routing Form (F- 02404). Do not disenroll the member; only a transfer of Medicaid eligibility between income maintenance consortia is necessary if applicable. Inform the member that options counseling is available from the ADRC or Tribal ADRS (if applicable) in the county to which the member is moving should the member wish to consider a change in MCO (if another MCO operates in the geographic service region) or in long-term care program. For Moves to Another Geographic Service Region Not Served by the MCO: Unless the move is due to an MCO-initiated placement in a nursing home or community residential facility, inform the member that she or he will be disenrolled, will need to select a different MCO, and that the IDT staff will help with this transition. Explain to the member that to assure uninterrupted services, and in the case of a member in the special home and community-based waiver eligibility group (Group B or B+) uninterrupted Medicaid eligibility, it is necessary to contact the ADRC or Tribal ADRS (if applicable) in the new county of residence to enroll in another MCO or another long-term care program, preferably with the same effective date as the disenrollment from the current MCO. The MCO should facilitate this contact and coordinate disenrollment/enrollment dates with the receiving ADRC or Tribal ADRS (if applicable). Complete Section D of the Family Care /Partnership /PACE Change Routing Form per i...
MCO Responsibilities. When an assessment is scheduled, the MCO shall:
MCO Responsibilities. The MCO shall be responsible for duplication, mailing and postage expenses related to said notification;
MCO Responsibilities. A. MCO agrees to do the following: (i) provide Service to Customer during the term of this Agreement; (ii) comply with applicable laws and standards with respect to the provision of the Service;
MCO Responsibilities. Each of the MCOs shall transfer to a zero balance bank account to be set up by the Contractor, sufficient funds to cover the total payment of Claims to Pharmacies that are required to be made by the Contractor under this Contract. The Contractor must inform the MCOs in writing the amount of Claims to be paid, at least two (2) Business Days prior to the date when the actual payment will be made. The MCOs will automatically cause the transfer of the funds for the payment of the Claims to the Contractor’s zero balance account upon presentation of payment instructions. The MCOs must provide adequate notice to Contractor and ASES as to the transfer of funds. The zero balance bank account shall be utilized by the Contractor exclusively for the purpose of paying Claims to Pharmacies. As required in 42 CFR 447.511(c), MCOs are to provide Physician Administered Drug (“PAD”) Encounter Data based on date of service to Contractor for DUR reporting and Rebate processing and reporting within forty-five (45) Calendar Days after each quarterly Rebate period. The MCOs will electronically submit on a daily basis a list of all MCO’s Network Providers and a list of Enrollees to the PBM.
