Member Encounter Listings Sample Clauses

Member Encounter Listings. The Contractor must include, in its PCP Provider Agreements, language which requires PCPs to contact new Members Identified in the quarterly encounter lists who have not had an encounter during the first six (6) months of enrollment, or who have not complied with the scheduling requirements outlined in the RFP and this Agreement. The Contractor must require the PCP to contact Members identified in the quarterly encounter lists as not complying with EPSDT periodicity and immunization schedules for children. The PCP must be required to identify to the Contractor any such Members who have not come into compliance with the EPSDT periodicity and immunization schedules within one (1) month of such notification to the site by the Contractor. The PCP must also be required to document the reasons for non-compliance, and to document its efforts to bring the Member's care into compliance with the standards. The Contractor must distribute quarterly lists to each PCP in Its Provider networks which identify new Members and Members who have not had an encounter during the previous six (6) months or within the time frames set forth in Section V.F.11 of this Agreement, Services for New Members, or Members who have not complied with EPSDT periodicity and immunization schedules for children. PCPs shall be required to contact these Members to arrange appointments. The Contractor is responsible for contacting such Members, documenting the reasons for noncompliance and documenting its efforts for bringing the Member's care into compliance.
Sample 1
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Related to Member Encounter Listings

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