Provider Network and Affiliation Files. The HMO will supply network provider data to the Enrollment Broker and Claims Administrator. This data will consist of a Provider Network File and a Provider Affiliation File. The HMO will submit the Provider Network File to the Enrollment Broker and the Provider Affiliation File to the Claims Administrator. Both files shall accomplish the following objectives: 1. Provide identifying information for all managed care providers (e.g. name, address, etc.). 2. Maintain history on provider enrollment/disenrollment. 3. Identify PCP capacity. 4. Identify any restrictions (e.g., age, sex, etc.). 5. Identify number and types of specialty providers available to Members. 6. Provide other information identified by HHSC.”
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Samples: Health Services Agreement (Amerigroup Corp), Amendment to the Agreement for Health Services to the Medicaid Star Program (Amerigroup Corp), Health Services Agreement (Amerigroup Corp)
Provider Network and Affiliation Files. The HMO will supply network provider data to the Enrollment Broker and Claims Administrator. This data will consist of a Provider Network File and a Provider Affiliation File. The HMO will submit the Provider Network File to the Enrollment Broker and the Provider Affiliation File to the Claims Administrator. Both files shall accomplish the following objectives:
1. Provide identifying information for all managed care providers (e.g. name, address, etc.).;
2. Maintain history on provider enrollment/disenrollment.;
3. Identify PCP capacity.;
4. Identify any restrictions (e.g., age, sex, etc.).;
5. Identify number and types of specialty providers available to Members.; and
6. Provide other Master Provider File information identified by HHSC.”
Appears in 1 contract
Provider Network and Affiliation Files. The HMO will supply network provider data to the Enrollment Broker and Claims Administrator. This data will consist of a Provider Network File and a Provider Affiliation File. The HMO will submit the Provider Network File to the Enrollment Broker and the Provider Affiliation File to the Claims Administrator. Both files shall accomplish the following objectives:
1. Provide identifying information for all managed care providers (e.g. name, address, etc.).
2. Maintain history on provider enrollment/disenrollment.
3. Identify PCP capacity.
4. Identify any restrictions (e.g., age, sex, etc.).
5. Identify number and types of specialty providers available to Members.
6. Provide other (Master Provider File) information identified by HHSC.”"
Appears in 1 contract
