Common use of ODM-Designated Providers Clause in Contracts

ODM-Designated Providers. Per OAC rule 5160-26-03.1(A)(4), MCPs must share specific information with MHA-certified CMHCs, MHA-certified Medicaid providers, 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 5160-18-01 within the MCP’s service area and in bordering regions if appropriate based on member utilization information. The information must be shared within the first month after the MCP has been awarded a Medicaid provider agreement for a specific region and annually thereafter. At a minimum, the information must include the following: • the information’s purpose; • claims submission information including the MCP’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); • the MCP’s prior authorization and referral procedures; • a picture of the MCP’s member ID card (front and back); • contact numbers for obtaining information for eligibility verification, claims processing, referrals/prior authorization, post-stabilization care services and if applicable information regarding the MCP’s behavioral health administrator; • a listing of the MCP’s laboratories and radiology providers; and • a listing of the MCP’s contracting behavioral health providers and how to access services through them (this information is only required to be provided to non-panel MHA-certified CMHCs and MHA-certified Medicaid providers).

ODM-Designated Providers. Per OAC rule 5160-26-03.1(A)(4), MCPs must The MCP shall share specific information with MHA-certified CMHCs, MHA-certified Medicaid providers, 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 MCP’s service area and in bordering regions if appropriate based on member utilization information. The information must shall be shared within the first month after the MCP has been awarded a Medicaid provider agreement for a specific region and annually thereafter. At a minimum, the information must shall include the following: • the : i. The information’s purpose; • claims ; ii. Claims submission information including the MCP’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); • the ; iii. The MCP’s prior authorization and referral procedures; • a ; iv. A picture of the MCP’s member ID card (front and back); • contact ; v. Contact numbers for obtaining information for eligibility verification, claims processing, referrals/prior authorization, PA, post-stabilization care services services, and if applicable applicable, information regarding the MCP’s behavioral health administrator; • a and vi. A listing of the MCP’s laboratories and radiology providers; and • a listing of the MCP’s contracting behavioral health providers and how to access services through them (this information is only required to be provided to non-panel MHA-certified CMHCs and MHA-certified Medicaid providers).

ODM-Designated Providers. Per OAC rule 5160-26-03.1(A)(4), MCPs must The MCP shall share specific information with MHA-certified CMHCs, MHA-certified Medicaid providers, 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 MCP’s service area and in bordering regions if appropriate based on member utilization information. The information must shall be shared within the first month after the MCP has been awarded a Medicaid provider agreement for a specific region and annually thereafter. At a minimum, the information must shall include the following: • the : i. The information’s purpose; • claims ; ii. Claims submission information including the MCP’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); • the , iii. The MCP’s prior authorization and referral procedures; • a ; iv. A picture of the MCP’s member ID card (front and back); • contact ; v. Contact numbers for obtaining information for eligibility verification, claims processing, referrals/prior authorization, PA, post-stabilization care services services, and if applicable applicable, information regarding the MCP’s behavioral health administrator; • a and vi. A listing of the MCP’s laboratories and radiology providers; and • a listing of the MCP’s contracting behavioral health providers and how to access services through them (this information is only required to be provided to non-panel MHA-certified CMHCs and MHA-certified Medicaid providers).