Common use of ODM-Designated Providers Clause in Contracts

ODM-Designated Providers. The MCOP shall share specific information with FQHCs/RHCs, qualified family planning providers (QFPPs), hospitals, and if applicable, certified nurse midwives (CNMs), certified nurse practitioners (CNPs), and free-standing birth centers (FBCs) as defined in OAC rule 5160-18-01 within the MCOP’s service area and in bordering regions if appropriate based on member utilization information. The information shall be shared within the first month after the MCOP has been awarded a Medicaid provider agreement for a specific region and annually thereafter. At a minimum the information shall include: i. The information’s purpose; ii. Claims submission information including the MCOP’s Medicaid provider number for each region (this information is only required to be provided to non-panel FQHCs/RHCs, QFPPs, CNMs, CNPs, and hospitals); iii. The MCOP’s prior authorization and referral procedures; iv. A picture of the MCOP’s member ID card (front and back); v. Contact numbers for obtaining information for eligibility verification, claims processing, referrals, prior authorization, post-stabilization care services, and if applicable, information regarding the MCOP’s behavioral health administrator; and vi. A listing of the MCOP’s pharmacies, laboratories, and radiology providers.

ODM-Designated Providers. The MCOP shall must share specific information with FQHCs/RHCs, qualified family planning providers (QFPPs), hospitals, hospitals and if applicable, certified nurse midwives (CNMs), certified nurse practitioners (CNPs), and free-standing birth centers (FBCs) as defined in OAC rule 5160-18-01 within the MCOP’s service area and in bordering regions if appropriate based on member utilization information. The information shall must be shared within the first month after the MCOP has been awarded a Medicaid provider agreement for a specific region and annually thereafter. At a minimum minimum, the information shall includemust include the following: i. The information’s purpose; ii. Claims submission information including the MCOP’s Medicaid provider number for each region (this information is only required to be provided to non-panel FQHCs/RHCs, QFPPs, CNMs, CNPs, CNPs and hospitals); iii. The MCOP’s prior authorization and referral procedures; iv. A picture of the MCOP’s member ID card (front and back); v. Contact numbers for obtaining information for eligibility verification, claims processing, referrals, prior authorization, post-stabilization care services, services and if applicable, applicable information regarding the MCOP’s behavioral health administrator; and vi. A listing of the MCOP’s pharmacies, laboratories, laboratories and radiology providers.

ODM-Designated Providers. The MCOP shall must share specific information with FQHCs/RHCs, qualified family planning providers (QFPPs), hospitals, hospitals and if applicable, certified nurse midwives (CNMs), certified nurse practitioners (CNPs), and free-standing free‐standing birth centers (FBCs) as defined in OAC rule 5160-18-01 5160‐18‐01 within the MCOP’s service area and in bordering regions if appropriate based on member utilization information. The information shall must be shared within the first month after the MCOP has been awarded a Medicaid provider agreement for a specific region and annually thereafter. At a minimum minimum, the information shall includemust include the following: i. The information’s purpose; ii. Claims submission information including the MCOP’s Medicaid provider number for each region (this information is only required to be provided to non-panel non‐panel FQHCs/RHCs, QFPPs, CNMs, CNPs, CNPs and hospitals); iii. The MCOP’s prior authorization and referral procedures; iv. A picture of the MCOP’s member ID card (front and back); v. Contact numbers for obtaining information for eligibility verification, claims processing, referrals, prior authorization, post-stabilization post‐stabilization care services, services and if applicable, applicable information regarding the MCOP’s behavioral health administrator; and vi. A listing of the MCOP’s pharmacies, laboratories, laboratories and radiology providers.