Common use of Pending Member Clause in Contracts

Pending Member. If a pending member (i.e., an eligible individual subsequent to MCO selection or assignment to an MCO, but prior to their membership effective date) contacts the selected MCO, the MCO must provide any membership information requested, including how to access services as an MCO member and assistance in determining whether the eligible individual’s current services require prior authorization. The MCO must ensure any care coordination (e.g., primary care provider [PCP] selection, prescheduled services, and transition of care) information provided by the pending member is logged in the MCO’s system and forwarded to the appropriate MCO staff for processing as required. The MCO may confirm any information provided on the Client Contact Record, or data provided by ODM, at the time the pending member contacts the MCO. Such communication does not constitute confirmation of membership. Upon receipt of the Client Contact Record or the HIPAA 834, the MCO may contact a pending member to confirm information provided on the Client Contact Record, data provided by ODM, or the HIPAA 834, assist with care coordination and transition of care, and inquire if the pending member has any membership questions.

Pending Member. If a pending member (i.e., an eligible individual subsequent to MCO selection or assignment to an MCO, but prior to their membership effective date) contacts the selected MCO, the MCO must provide any membership information requested, including how to access services as an MCO member and assistance in determining whether the eligible individual’s current services require prior authorization. The MCO must ensure any care coordination (e.g., primary care provider [PCP] selection, prescheduled services, and transition of care) information provided by the pending member is logged in the MCO’s system and forwarded to the appropriate MCO staff for processing as required. The MCO may confirm any information provided on the Client Consumer Contact Record, or data provided by ODM, at the time the pending member contacts the MCO. Such communication does not constitute confirmation of membership. Upon receipt of the Client Consumer Contact Record or the HIPAA 834, the MCO may contact a pending member to confirm information provided on the Client Consumer Contact Record, data provided by ODM, or the HIPAA 834, assist with care coordination and transition of care, and inquire if the pending member has any membership questions.

Pending Member. 1. If a pending member (i.e., an eligible individual subsequent to MCO selection or assignment to an MCO, but prior to their membership effective date) contacts the selected MCO, the MCO must provide any membership information requested, including how to access services as an MCO member and assistance in determining whether the eligible individual’s 's current services require prior authorization. 2. The MCO must ensure any care coordination (e.g., primary care provider [PCP] selection, prescheduled services, and transition of care) information provided by the pending member is logged in the MCO’s 's system and forwarded to the appropriate MCO staff for processing as required. 3. The MCO may confirm any information provided on the Client Contact Record, or data provided by ODM, Record at the time the pending member contacts the MCO. Such communication does not constitute confirmation of membership. Upon receipt of the Client Contact Record or the HIPAA 834, the MCO may contact a pending member to confirm information provided on the Client Contact Record, data provided by ODM, Record or the HIPAA 834, assist with care coordination and transition of care, and inquire if the pending member has any membership questions.