Medicaid Plans. The Contractor must accept requests for Medicare or Medi-Cal coverage, including Medicare coverage determinations /redeterminations, outside of normal business hours, but is not required to have live enrollee service representatives available to accept such requests outside normal business hours. Voicemail may be used outside of normal business hours provided the message:
Medicaid Plans. B) The “
Medicaid Plans. We are participating with North Carolina Medicaid and by law are required to follow their policies and procedures. Some NC Medicaid plans require you to obtain a referral from the designated Primary Care Provider (PCP) listed on your NC Medicaid card. PLEASE NOTE: Rosedale Health & Wellness is NOT considered a PCP with North Carolina Medicaid. Per NC Medicaid guidelines, you cannot be seen by our providers unless a valid referral is in place. We are not participating with any out of state Medicaid plans. • NC Medicaid requires you to pay a $3.00 copay at each visit.
Medicaid Plans. Where Company is the responsible payor for Medicare and Medicaid Covered Services, rates for each service are determined by whether CMS and other applicable Government Sponsors regard that service as a Medicare Covered Service or a Medicaid Covered Service when and as provided by a particular provider, and by a Member’s benefit limits under each program. For Covered Services that are Medicare Covered Services when and as provided by Provider (inclusive of Member copayment or coinsurance), Company shall compensate Provider at the AMMPMFS rate. For Covered Services that are only covered under Medicaid when and as provided by Provider (such as, but not limited to, long-term care and home and community based waiver services), Company shall compensate Provider at the AMMFS rate. When a service is covered under both Medicare and Medicaid, Company will determine the rate (Medicare or Medicaid) according to applicable law, coordination-of-benefit principles, and the terms of Member’s Plan. Rates do not include, and Company is not responsible for, supplemental or wrap-around payments unless required by Company’s contracts with Government Sponsor.
Medicaid Plans. The Contractor shall not prohibit a Provider from informing Enrollees of the Provider’s affiliation or change in affiliation.
