Membership Selection and Premium Payment. a. The Medicaid Consumer Hotline (henceforth referred to as the “Hotline”) - The ODM- contracted Hotline is responsible for providing unbiased education and selection services for the Medicaid managed care program. The Hotline operates a statewide toll-free telephone center to assist eligible individuals in selecting an MCP or choosing a health care delivery option. b. Auto-Assignment Eligible individuals that fail to select a plan will be assigned to an MCP in accordance with 42 CFR 438.50 and at the discretion of ODM. c. Consumer Contact Record (CCR): ODM or their designated entity shall provide CCRs to MCPs on no less than a weekly basis. The CCRs are a record of each consumer initiated MCP enrollment, change, or termination, and each Hotline initiated MCP assignment processed through the Hotline. d. ODM verifies MCP enrollment via a membership roster. ODM or its designated entity provides a full member roster (F) and a change roster (C) via HIPAA 834 compliant transactions. e. Monthly Premiums - ODM will remit payment to the MCPs via an electronic funds transfer (EFT), or at the discretion of ODM, by paper warrant. f. Remittance Advice (RA) - ODM will confirm all premium payments paid to the MCP during the month via a monthly RA. ODM or its designated entity will provide a record of each recipient detail level payment via HIPAA 820 compliant transactions. ODM or its designee will keep a record of each MCPs Accounts Payable (i.e. Pay 4 Performance, Primary Care Rate Increase, and Health Insurance Provider Fee) and Accounts Receivable (i.e. PCRI Reconciliation, Penalty, Credit Balance) transaction on the MITS Provider Portal Report Tab.
Appears in 5 contracts
Samples: Provider Agreement, Provider Agreement, Provider Agreement
Membership Selection and Premium Payment. a. The Medicaid Consumer Hotline (henceforth referred to as the “Hotline”) - The ODM- contracted Hotline is responsible for providing unbiased education and selection services for the Medicaid managed care program. The Hotline operates a statewide toll-free telephone center to assist eligible individuals in selecting an MCP or choosing a health care delivery option.
b. Auto-Assignment Eligible individuals that fail to select a plan will be assigned to an MCP in accordance with 42 CFR 438.50 and at the discretion of ODM.
c. Consumer Contact Record (CCR): ODM or their designated entity shall provide CCRs to MCPs on no less than a weekly basis. The CCRs are a record of each consumer initiated MCP enrollment, change, or termination, and each Hotline initiated MCP assignment processed through the Hotline.
d. ODM verifies MCP enrollment via a membership roster. ODM or its designated entity provides a full member roster (F) and a change roster (C) via HIPAA 834 compliant transactions.
e. Monthly Premiums - ODM will remit payment to the MCPs via an electronic funds transfer (EFT), or at the discretion of ODM, by paper warrant.
f. Remittance Advice (RA) - ODM will confirm all premium payments paid to the MCP during the month via a monthly RA. ODM or its designated entity will provide a record of each recipient detail level payment via HIPAA 820 compliant transactions. ODM or its designee will keep a record of each MCPs Accounts Payable (i.e. Pay 4 Performance, Primary Care Rate Increase, and Health Insurance Provider Fee) and Accounts Receivable (i.e. PCRI Reconciliation, Penalty, Credit Balance) transaction on the MITS Provider Portal Report Tab.
Appears in 3 contracts
Samples: Provider Agreement, Provider Agreement, Provider Agreement
