Panel Listing Requirements. BB. Provider Network...............................................................................
Panel Listing Requirements. The PH-MCO is required to give its Network Providers panel listings of Members who receive EPSDT services. The PH-MCO must provide electronic panel listings at the request of a Provider, in a format determined by the PH-MCO. Panel listings supplied to Providers must include, at least, the following data elements: Member identification (Last, First and Middle Name) Date of birth Age Telephone number Address Identification of new patients Date of last EPSDT Screen Screen Due or Overdue S. Provider Network The PH-MCO must establish and maintain adequate Provider Networks to serve all of the eligible HealthChoices populations in each HealthChoices Zone covered by this Agreement. Provider Networks must include, but not be limited to: hospitals, children’s tertiary care hospitals, specialty clinics, trauma centers, facilities for high-risk deliveries and neonates, specialists, dentists, orthodontists, physicians, pharmacies, emergency transportation services, long-term care facilities, rehab facilities, home health agencies, certified hospice providers and DME suppliers in sufficient numbers to make available all services in a timely manner. Detailed requirements related to the composition of Provider Networks and members’ access to services from the providers in those networks are located in Exhibit AAA, Provider Network Composition/Service Access, as applicable. If the PH-MCO’s Provider Network is unable to provide necessary medical services covered under the Agreement, to a particular Member, the PH MCO must adequately and timely cover these services out-of-network, for the Member for as long as the PH-MCO is unable to provide them and must coordinate with the Out-of-Network Provider with respect to payment.
