Common use of Program Integrity Overpayment Recovery Clause in Contracts

Program Integrity Overpayment Recovery. Where the excluded individual is the provider of services or an owner of the provider, all amounts paid to the provider for services rendered following their exclusion shall be refunded. The Contractor shall be responsible for checking the lists of providers currently excluded by the State and the Federal Government every thirty (30) calendar days. The Contractor shall capture ownership and control information from its providers required under 00 XXX 000, including 42 CFR 455.104. In addition, Contractor shall also maintain a list of all rendering providers of providers enrolled, even if rendering providers are not required to enroll with IHCP. Rendering providers are defined as those providers that are performing the services for which a provider bills the Contractor or IHCP. The Contractor shall also verify that all rendering providers are not currently excluded by the State and the Federal Government every thirty (30) calendar days. The federal list is available at: xxxx://xxxxxxxxxx.xxx.xxx.xxx. FSSA reserves the right to immediately disenroll any provider if the provider becomes ineligible to participate in the IHCP. The Contractor shall immediately inform the OMPP Program Integrity Unit via a written communication should it disenroll, terminate or deny provider enrollment or credentialing for “program integrity” reasons (i.e., the detection and investigation of fraud and abuse). The Contractor shall follow established procedures to enroll and disenroll providers, including PMPs. The Hoosier Healthwise MCE Policies and Procedures Manual provides detailed information on PMP and provider enrollment and disenrollment procedures. To process provider enrollments and disenrollments with the Contractor, the Contractor shall submit the required information to the State fiscal agent through the Portal. The Contractor shall report PMP disenrollments to the State fiscal agent’s Provider Enrollment unit by mail, fax, e-mail or Portal. The Contractor shall first notify the State fiscal agent of the intent to disenroll a PMP within five (5) business days of the receipt/issuance of the PMP’s disenrollment. The fiscal agent shall receive enrollment/disenrollment requests at least five (5) business days prior to the 24th day of the month before the date the Contractor desires the enrollment or disenrollment to become effective. As noted above, the OMPP PI Unit should also receive disenrollment notices when they are program integrity related. When advanced notice is not feasible, including, but not limited to, in the event of provider death or exclusion due to fraud or abuse, the Contractor shall submit the disenrollment within five (5) business days of the provider’s termination effective date. OMPP shall have the right to take corrective actions if the Contractor does not notify the State fiscal agent in a timely manner. OMPP shall have the right to immediately disenroll any provider if the provider including the provider’s rendering providers – or provider’s owners/operators becomes ineligible to participate in IHCP. When a PMP disenrolls from Hoosier Healthwise, the Contractor shall be responsible for assisting members assigned to that PMP in selecting a new PMP within the Contractor’s network. If the member does not select another PMP, the Contractor shall assign the member to another PMP in the Contractor’s network before the original PMP’s disenrollment is effective. In accordance with 42 CFR 438.10(f), the Contractor shall make a good faith effort to provide written notice of a provider’s disenrollment to any member that has received primary care services from that provider or otherwise sees the provider on a regular basis. Such notice shall be provided within fifteen (15) calendar days of the Contractor’s receipt or issuance of the provider termination notice. If a PMP disenrolls from the Hoosier Healthwise program, but remains an IHCP provider, the Contractor shall assure that the PMP provides continuation of care for his/her Hoosier Healthwise members for a minimum of thirty (30) calendar days or until the member’s link to another PMP becomes effective.

Program Integrity Overpayment Recovery. Where the excluded individual is the provider of services or an owner of the provider, all amounts paid to the provider for services rendered following their exclusion shall be refunded. The Contractor shall be responsible for checking the lists of providers currently excluded by the State and the Federal Government every thirty (30) calendar days. The Contractor shall capture ownership and control information from its providers required under 00 XXX 000, including 42 CFR 455.104. In addition, Contractor shall also maintain a list of all rendering providers of providers enrolled, even if rendering providers are not required to enroll with IHCP. Rendering providers are defined as those providers that are performing the services for which a provider bills the Contractor or IHCP. The Contractor shall also verify that all rendering providers are not currently excluded by the State and the Federal Government every thirty (30) calendar days. The federal list is available at: xxxx://xxxxxxxxxx.xxx.xxx.xxx. FSSA reserves the right to immediately disenroll any provider if the provider becomes ineligible to participate in the IHCP. The Contractor shall immediately inform the OMPP Program Integrity Unit via a written communication should it disenroll, terminate or deny provider enrollment or credentialing for “program integrity” reasons (i.e., the detection and investigation of fraud and abuse). The Contractor shall follow established procedures to enroll and disenroll providers, including PMPs. The Hoosier Healthwise MCE Policies and Procedures Manual provides detailed information on PMP and provider enrollment and disenrollment procedures. To process provider enrollments and disenrollments with the Contractor, the Contractor shall submit the required information to the State fiscal agent through the Portal. The Contractor shall report PMP disenrollments to the State fiscal agent’s Provider Enrollment unit by mail, fax, e-mail or Portal. The Contractor shall first notify the State fiscal agent of the intent to disenroll a PMP within five (5) business days of the receipt/issuance of the PMP’s disenrollment. The fiscal agent shall receive enrollment/disenrollment requests at least five (5) business days prior to the 24th day of the month before the date the Contractor desires the enrollment or disenrollment to become effective. As noted above, the OMPP PI Unit should also receive disenrollment notices when they are program integrity related. When advanced notice is not feasible, including, but not limited to, in the event of provider death or exclusion due to fraud or abuse, the Contractor shall submit the disenrollment within five (5) business days of the provider’s termination effective date. OMPP shall have the right to take corrective actions if the Contractor does not notify the State fiscal agent in a timely manner. OMPP shall have the right to immediately disenroll any provider if the provider including the provider’s rendering providers – or provider’s owners/operators becomes ineligible to participate in IHCP. When a PMP disenrolls from Hoosier Healthwise, the Contractor shall be responsible for assisting members assigned to that PMP in selecting a new PMP within the Contractor’s network. If the member does not select another PMP, the Contractor shall assign the member to another PMP in the Contractor’s network before the original PMP’s disenrollment is effective. In accordance with 42 CFR 438.10(f), the Contractor shall make a good faith effort to provide written notice of a provider’s disenrollment to any member that has received primary care services from that provider or otherwise sees the provider on a regular basis. Such notice shall be provided within fifteen to members at least thirty (1530) calendar days prior to the effective date of the Contractor’s receipt termination. However, if the practice or issuance practitioner notifies the Contractor less than 30 days prior to the effective date of the provider termination noticetermination, the Contractor shall then notify members as soon as possible but no later than 30 calendar days after receipt of the notification from the practice or practitioner. If a PMP disenrolls from the Hoosier Healthwise program, but remains an IHCP provider, the Contractor shall assure that the PMP provides continuation of care for his/her Hoosier Healthwise members for a minimum of thirty (30) calendar days or until the member’s link to another PMP becomes effective.

Program Integrity Overpayment Recovery. Where the excluded individual is the provider of services or an owner of the provider, all amounts paid to the provider for services rendered following their exclusion shall be refunded. The Contractor shall be responsible for checking the lists of providers currently excluded by the State and the Federal Government every thirty (30) calendar days. The Contractor shall capture ownership and control information from its providers required under 00 XXX 000, including 42 CFR 455.104. In addition, Contractor shall also maintain a list of all rendering providers of providers enrolled, even if rendering providers are not required to enroll with IHCP. Rendering providers are defined as those providers that are performing the services for which a provider bills the Contractor or IHCP. The Contractor shall also verify that all rendering providers are not currently excluded by the State and the Federal Government every thirty (30) calendar days. The federal list is available at: xxxx://xxxxxxxxxx.xxx.xxx.xxx. FSSA reserves the right to immediately disenroll any provider if the provider becomes ineligible to participate in the IHCP. The Contractor shall immediately inform the OMPP Program Integrity Unit via a written communication should it disenroll, terminate or deny provider enrollment or credentialing for “program integrity” reasons (i.e., the detection and investigation of fraud and abuse). The Contractor shall follow established procedures to enroll and disenroll providers, including PMPs. The Hoosier Healthwise MCE Policies and Procedures Manual provides detailed information on PMP and provider enrollment and disenrollment procedures. To process provider enrollments and disenrollments with the Contractor, the Contractor shall submit the required information to the State fiscal agent through the Portal. The Contractor shall report PMP disenrollments to the State fiscal agent’s Provider Enrollment unit by mail, fax, e-mail or Portal. The Contractor shall first notify the State fiscal agent of the intent to disenroll a PMP within five (5) business days of the receipt/issuance of the PMP’s disenrollment. The fiscal agent shall receive enrollment/disenrollment requests at least five (5) business days prior to the 24th day of the month before the date the Contractor desires the enrollment or disenrollment to become effective. As noted above, the OMPP PI Unit should also receive disenrollment notices when they are program integrity related. When advanced notice is not feasible, including, but not limited to, in the event of provider death or exclusion due to fraud or abuse, the Contractor shall submit the disenrollment within five (5) business days of the provider’s termination effective date. OMPP shall have the right to take corrective actions if the Contractor does not notify the State fiscal agent in a timely manner. OMPP shall have the right to immediately disenroll any provider if the provider including the provider’s rendering providers – or provider’s owners/operators becomes ineligible to participate in IHCP. When a PMP disenrolls from Hoosier Healthwise, the Contractor shall be responsible for assisting members assigned to that PMP in selecting a new PMP within the Contractor’s network. If the member does not select another PMP, the Contractor shall assign the member to another PMP in the Contractor’s network before the original PMP’s disenrollment is effective. EXHIBIT 1.E HOOSIER HEALTHWISE SCOPE OF WORK In accordance with 42 CFR 438.10(f), the Contractor shall make a good faith effort to provide written notice of a provider’s disenrollment to any member that has received primary care services from that provider or otherwise sees the provider on a regular basis. Such notice shall be provided within fifteen to members at least thirty (1530) calendar days prior to the effective date of the Contractor’s receipt termination. However, if the practice or issuance practitioner notifies the Contractor less than 30 days prior to the effective date of the provider termination noticetermination, the Contractor shall then notify members as soon as possible but no later than 15 calendar days after receipt of the notification from the practice or practitioner. If a PMP disenrolls from the Hoosier Healthwise program, but remains an IHCP provider, the Contractor shall assure that the PMP provides continuation of care for his/her Hoosier Healthwise members for a minimum of thirty (30) calendar days or until the member’s link to another PMP becomes effective.

Program Integrity Overpayment Recovery. Where the excluded individual is the provider of services or an owner of the provider, all amounts paid to the provider for services rendered following their exclusion shall be refunded. The Contractor shall be responsible for checking the lists of providers currently excluded by the State and the Federal Government every thirty (30) calendar days. The Contractor shall capture ownership and control information from its providers required under 00 XXX 000, including 42 CFR 455.104. In addition, Contractor shall also maintain a list of all rendering providers of EXHIBIT 1.E SCOPE OF WORK – HOOSIER HEALTHWISE providers enrolled, even if rendering providers are not required to enroll with IHCP. Rendering providers are defined as those providers that are performing the services for which a provider bills the Contractor or IHCP. The Contractor shall also verify that all rendering providers are not currently excluded by the State and the Federal Government every thirty (30) calendar days. The federal list is available at: xxxx://xxxxxxxxxx.xxx.xxx.xxx. FSSA reserves the right to immediately disenroll any provider if the provider becomes ineligible to participate in the IHCP. The Contractor shall immediately inform the OMPP Program Integrity Unit via a written communication should it disenroll, terminate or deny provider enrollment or credentialing for “program integrity” reasons (i.e., the detection and investigation of fraud and abuse). The Contractor shall follow established procedures to enroll and disenroll providers, including PMPs. The Hoosier Healthwise MCE Policies and Procedures Manual provides detailed information on PMP and provider enrollment and disenrollment procedures. To process provider enrollments and disenrollments with the Contractor, the Contractor shall submit the required information to the State fiscal agent through the Portal. The Contractor shall report PMP disenrollments to the State fiscal agent’s Provider Enrollment unit by mail, fax, e-mail or Portal. The Contractor shall first notify the State fiscal agent of the intent to disenroll a PMP within five (5) business days of the receipt/issuance of the PMP’s disenrollment. The fiscal agent shall receive enrollment/disenrollment requests at least five (5) business days prior to the 24th day of the month before the date the Contractor desires the enrollment or disenrollment to become effective. As noted above, the OMPP PI Unit should also receive disenrollment notices when they are program integrity related. When advanced notice is not feasible, including, but not limited to, in the event of provider death or exclusion due to fraud or abuse, the Contractor shall submit the disenrollment within five (5) business days of the provider’s termination effective date. OMPP shall have the right to take corrective actions if the Contractor does not notify the State fiscal agent in a timely manner. OMPP shall have the right to immediately disenroll any provider if the provider including the provider’s rendering providers – or provider’s owners/operators becomes ineligible to participate in IHCP. When a PMP disenrolls from Hoosier Healthwise, the Contractor shall be responsible for assisting members assigned to that PMP in selecting a new PMP within the Contractor’s network. If the member does not select another PMP, the Contractor shall assign the member to another PMP in the Contractor’s network before the original PMP’s disenrollment is effective. In accordance with 42 CFR 438.10(f), the Contractor shall make a good faith effort to provide written notice of a provider’s disenrollment to any member that has received primary care services from that provider or otherwise sees the provider on a regular basis. Such notice shall be provided within fifteen to members at least thirty (1530) calendar days prior to the effective date of the Contractor’s receipt termination. However, if the practice or issuance practitioner notifies the Contractor less than 30 days prior to the effective date of the provider termination noticetermination, the Contractor shall then notify members as soon as possible but no later than 15 calendar days after receipt of the notification from the practice or practitioner. If a PMP disenrolls from the Hoosier Healthwise program, but remains an IHCP provider, the Contractor shall assure that the PMP provides continuation of care for his/her Hoosier Healthwise members for a minimum of thirty (30) calendar days or until the member’s link to another PMP becomes effective.. The Contractor shall provide the IHCP MCE Practitioner Enrollment Form, IHCP MCE Hospital/Ancillary Provider Enrollment Form or a Contractor specific Network Participation Request Form to providers to complete when requesting to join the Contractor’s network. If a Contractor Network Participation Request Form is utilized, it shall include all the information captured on the IHCP MCE Enrollment Forms. EXHIBIT 1.E

Program Integrity Overpayment Recovery. Where the excluded individual is the provider of services or an owner of the provider, all amounts paid to the provider for services rendered following their exclusion shall be refunded. The Contractor shall be responsible for checking the lists of providers currently excluded by the State and the Federal Government every thirty (30) calendar days. The Contractor shall capture ownership and control information from its providers required under 00 XXX 000, including 42 CFR 455.104. In addition, Contractor shall also maintain a list of all rendering providers of providers enrolled, even if rendering providers are not required to enroll with IHCP. Rendering providers are defined as those providers that are performing the services for which a provider bills the Contractor or IHCP. The Contractor shall also verify that all rendering providers are not currently excluded by the State and the Federal Government every thirty (30) calendar days. The federal list is available at: xxxx://xxxxxxxxxx.xxx.xxx.xxx. FSSA reserves the right to immediately disenroll any provider if the provider becomes ineligible to participate in the IHCP. The Contractor shall immediately inform the OMPP Program Integrity Unit via a written communication should it disenroll, terminate or deny provider enrollment or credentialing for “program integrity” reasons (i.e., the detection and investigation of fraud and abuse). The Contractor shall follow established procedures to enroll and disenroll providers, including PMPs. The Hoosier Healthwise MCE Policies and Procedures Manual provides detailed information on PMP and provider enrollment and disenrollment procedures. To process provider enrollments and disenrollments with the Contractor, the Contractor shall submit the required information to the State fiscal agent through the Portal. The Contractor shall report PMP disenrollments to the State fiscal agent’s Provider Enrollment unit by mail, fax, e-mail or Portal. The Contractor shall first notify the State fiscal agent of the intent to disenroll a PMP within five (5) business days of the receipt/issuance of the PMP’s disenrollment. The fiscal agent shall receive enrollment/disenrollment requests at least five (5) business days prior to the 24th day of the month before the date the Contractor desires the enrollment or disenrollment to become effective. As noted above, the OMPP FSSA PI Unit should also receive disenrollment notices when they are program integrity related. When advanced notice is not feasible, including, but not limited to, in the event of provider death or exclusion due to fraud or abuse, the Contractor shall submit the disenrollment within five (5) business days of the provider’s termination effective date. OMPP shall have the right to take corrective actions if the Contractor does not notify the State fiscal agent in a timely manner. OMPP shall have the right to immediately disenroll any provider if the provider including the provider’s rendering providers – or provider’s owners/operators becomes ineligible to participate in IHCP. When a PMP disenrolls from Hoosier Healthwise, the Contractor shall be responsible for assisting members assigned to that PMP in selecting a new PMP within the Contractor’s network. If the member does not select another PMP, the Contractor shall assign the member to another PMP in the Contractor’s network before the original PMP’s disenrollment is effective. In accordance with 42 CFR 438.10(f), the Contractor shall make a good faith effort to provide written notice of a provider’s disenrollment to any member that has received primary care services from that provider or otherwise sees the provider on a regular basis. Such notice shall be provided within fifteen (15) calendar days of the Contractor’s receipt or issuance of the provider termination notice. If a PMP disenrolls from the Hoosier Healthwise program, but remains an IHCP provider, the Contractor shall assure that the PMP provides continuation of care for his/her Hoosier Healthwise members for a minimum of thirty (30) calendar days or until the member’s link to another PMP becomes effective.

Program Integrity Overpayment Recovery. Where the excluded individual is the provider of services or an owner of the provider, all amounts paid to the provider for services rendered following their exclusion shall be refunded. The Contractor shall be responsible for checking the lists of providers currently excluded by the State and the Federal Government every thirty (30) calendar days. The Contractor shall capture ownership and control information from its providers required under 00 XXX 000, including 42 CFR 455.104. In addition, Contractor shall also maintain a list of all rendering providers of EXHIBIT 1.E SCOPE OF WORK – HOOSIER HEALTHWISE providers enrolled, even if rendering providers are not required to enroll with IHCP. Rendering providers are defined as those providers that are performing the services for which a provider bills the Contractor or IHCP. The Contractor shall also verify that all rendering providers are not currently excluded by the State and the Federal Government every thirty (30) calendar days. The federal list is available at: xxxx://xxxxxxxxxx.xxx.xxx.xxx. FSSA reserves the right to immediately disenroll any provider if the provider becomes ineligible to participate in the IHCP. The Contractor shall immediately inform the OMPP Program Integrity Unit via a written communication should it disenroll, terminate or deny provider enrollment or credentialing for “program integrity” reasons (i.e., the detection and investigation of fraud and abuse). The Contractor shall follow established procedures to enroll and disenroll providers, including PMPs. The Hoosier Healthwise MCE Policies and Procedures Manual provides detailed information on PMP and provider enrollment and disenrollment procedures. To process provider enrollments and disenrollments with the Contractor, the Contractor shall submit the required information to the State fiscal agent through the Portal. The Contractor shall report PMP disenrollments to the State fiscal agent’s Provider Enrollment unit by mail, fax, e-mail or Portal. The Contractor shall first notify the State fiscal agent of the intent to disenroll a PMP within five (5) business days of the receipt/issuance of the PMP’s disenrollment. The fiscal agent shall receive enrollment/disenrollment requests at least five (5) business days prior to the 24th day of the month before the date the Contractor desires the enrollment or disenrollment to become effective. As noted above, the OMPP PI Unit should also receive disenrollment notices when they are program integrity related. When advanced notice is not feasible, including, but not limited to, in the event of provider death or exclusion due to fraud or abuse, the Contractor shall submit the disenrollment within five (5) business days of the provider’s termination effective date. OMPP shall have the right to take corrective actions if the Contractor does not notify the State fiscal agent in a timely manner. OMPP shall have the right to immediately disenroll any provider if the provider including the provider’s rendering providers – or provider’s owners/operators becomes ineligible to participate in IHCP. When a PMP disenrolls from Hoosier Healthwise, the Contractor shall be responsible for assisting as sisting members assigned to that PMP in selecting a new PMP within the Contractor’s network. If the member does not select another PMP, the Contractor shall assign the member to another PMP in the Contractor’s network before the original PMP’s disenrollment is effective. In accordance with 42 CFR 438.10(f), the Contractor shall make a good faith effort to provide written notice of a provider’s disenrollment to any member that has received primary care services from that provider or otherwise sees the provider on a regular basis. Such notice shall be provided within fifteen to members at least thirty (1530) calendar days prior to the effective date of the Contractor’s receipt termination. However, if the practice or issuance practitioner notifies the Contractor less than 30 days prior to the effective date of the provider termination noticetermination, the Contractor shall then notify members as soon as possible but no later than 15 calendar days after receipt of the notification from the practice or practitioner. If a PMP disenrolls from the Hoosier Healthwise program, but remains an IHCP provider, the Contractor shall assure that the PMP provides continuation of care for his/her Hoosier Healthwise members for a minimum of thirty (30) calendar days or until the member’s link to another PMP becomes effective.. The Contractor shall provide the IHCP MCE Practitioner Enrollment Form, IHCP MCE Hospital/Ancillary Provider Enrollment Form or a Contractor specific Network Participation Request Form to providers to complete when requesting to join the Contractor’s network. If a Contractor Network Participation Request Form is utilized, it shall include all the information captured on the IHCP MCE Enrollment Forms. EXHIBIT 1.E

Program Integrity Overpayment Recovery. Where the excluded individual is the provider of services or an owner of the provider, all amounts paid to the provider for services rendered following their exclusion shall be refunded. The Contractor shall be responsible for checking the lists of providers currently excluded by the State and the Federal Government every thirty (30) calendar days. The Contractor shall capture ownership and control information from its providers required under 00 XXX 000, including 42 CFR 455.104. In addition, Contractor shall also maintain a list of all rendering providers of providers enrolled, even if rendering providers are not required to enroll with IHCP. Rendering providers are defined as those providers that are performing the services for which a provider bills the Contractor or IHCP. The Contractor shall also verify that all rendering providers are not currently excluded by the State and the Federal Government every thirty (30) calendar days. The federal list is available at: xxxx://xxxxxxxxxx.xxx.xxx.xxx. FSSA reserves the right to immediately disenroll any provider if the provider becomes ineligible to participate in the IHCP. The Contractor shall immediately inform the OMPP Program Integrity Unit via a written communication should it disenroll, terminate or deny provider enrollment or credentialing for “program integrity” reasons (i.e., the detection and investigation of fraud and abuse). The Contractor shall follow established procedures to enroll and disenroll providers, including PMPs. The Hoosier Healthwise MCE Policies and Procedures Manual provides detailed information on PMP and provider enrollment and disenrollment procedures. To process provider enrollments and disenrollments with the Contractor, the Contractor shall submit the required information to the State fiscal agent through the Portal. The Contractor shall report PMP disenrollments to the State fiscal agent’s Provider Enrollment unit by mail, fax, e-mail or Portal. The Contractor shall first notify the State fiscal agent of the intent to disenroll a PMP within five (5) business days of the receipt/issuance of the PMP’s disenrollment. The fiscal agent shall receive enrollmentrollment/disenrollment requests at least five (5) business days prior to the 24th day of the month before the date the Contractor desires the enrollment or disenrollment to become effective. As noted above, the OMPP PI Unit should also receive disenrollment notices when they are program integrity related. When advanced notice is not feasible, including, but not limited to, in the event of provider death or exclusion due to fraud or abuse, the Contractor shall submit the disenrollment within five (5) business days of the provider’s termination effective date. OMPP shall have the right to take busin corrective actions if the Contractor does not notify the State fiscal agent in a timely manner. OMPP shall have the right to immediately disenroll any provider if the provider including the provider’s rendering providers – or provider’s owners/operators becomes ineligible to participate in IHCP. When a PMP disenrolls from Hoosier Healthwise, the Contractor shall be responsible for assisting members assigned to that PMP in selecting a new PMP within the Contractor’s P network. If the member does not select another PMP, the Contractor shall assign the member to another PMP in the Contractor’s network before the original PMP’s disenrollment is effective. In accordance with 42 CFR 438.10(f), the Contractor shall make a good faith effort to provide written notice of a provider’s disenrollment to any member that has received primary care services from that provider or otherwise sees the provider on a regular basis. Such notice shall be provided within fifteen (15) calendar days of the Contractor’s receipt or issuance of the provider termination notice. If a PMP disenrolls from the Hoosier Healthwise program, but remains an IHCP provider, the Contractor shall assure that the PMP provides continuation of care for his/her Hoosier Healthwise members for a minimum of thirty (30) calendar days or until the member’s link to another PMP becomes effective.or

Program Integrity Overpayment Recovery. Where the excluded individual is the provider of services or an owner of the provider, all amounts paid to the provider for services rendered following their exclusion shall be refunded. The Contractor shall be responsible for checking the lists of providers currently excluded by the State and the Federal Government every thirty (30) calendar days. The Contractor shall capture ownership and control information from its providers required under 00 XXX 42 CXX 000, including xxcluding 42 CFR 455.104. In addition, Contractor shall also maintain a list of all rendering providers of providers enrolled, even if rendering providers are not required to enroll with IHCP. Rendering providers are defined as those providers that are performing the services for which a provider bills the Contractor or IHCP. The Contractor shall also verify that all rendering providers are not currently excluded by the State and the Federal Government every thirty (30) calendar days. The federal list is available at: xxxx://xxxxxxxxxx.xxx.xxx.xxx. FSSA OMPP reserves the right to immediately disenroll any provider if the provider becomes ineligible to participate in the IHCP. The Contractor shall immediately inform the OMPP Program Integrity Unit via a written communication should it disenroll, terminate or deny provider enrollment or credentialing for “program integrity” reasons (i.e., the detection and investigation of fraud and abuse). The Contractor shall follow established procedures to enroll and disenroll providers, including PMPs. Contractor will provide training to call center care coordination and 24 hour nurse call line staff on locations and hours of urgent care clinics in the plan’s network. The Hoosier Healthwise HIP MCE Policies and Procedures Manual provides detailed information on PMP and provider enrollment and disenrollment procedures. To process provider enrollments and disenrollments with the Contractor, the Contractor shall submit the required information to the State fiscal agent through the Portal. Portal The Contractor shall report PMP disenrollments to the State fiscal agent’s Provider Enrollment unit by mail, fax, e-mail or Portal. The Contractor shall first notify the State fiscal agent of the intent to disenroll a PMP within five (5) business days of the receipt/issuance of the PMP’s disenrollment. The fiscal agent shall receive enrollment/disenrollment requests at least five (5) business days prior to the 24th day of the month before the date the Contractor desires the enrollment or disenrollment to become effective. As noted above, the OMPP FSSA PI Unit should also receive disenrollment notices when they are program integrity related. When advanced notice is not feasible, including, but not limited to, in the event of provider death or exclusion due to fraud or abuse, the Contractor shall submit the disenrollment within five (5) business days of the provider’s termination effective date. OMPP shall have the right to take corrective actions if the Contractor does not notify the State fiscal agent in a timely manner. OMPP shall have the right to immediately disenroll any provider if the provider including the provider’s rendering providers – or provider’s owners/operators becomes ineligible to participate in IHCP. When a PMP disenrolls from Hoosier HealthwiseHIP, the Contractor shall be responsible for assisting members assigned to that PMP in selecting a new PMP within the Contractor’s network. If the member does not select another PMP, the Contractor shall assign the member to another PMP in the Contractor’s network before the original PMP’s disenrollment is effective. In accordance with 42 CFR 438.10(f), the Contractor shall make a good faith effort to provide written notice of a provider’s disenrollment to any member that has received primary care services from that provider or otherwise sees the provider on a regular basis. Such notice shall be provided within fifteen (15) calendar days of the Contractor’s receipt or issuance of the provider termination notice. If a PMP disenrolls from the Hoosier Healthwise HIP program, but remains an IHCP provider, the Contractor shall assure that the PMP provides continuation of care for his/her Hoosier Healthwise and/or HIP members for a minimum of thirty (30) calendar days or until the member’s link to another PMP becomes effective.