Provider Network Information. The Enrollment Packet shall include information on where to find information about the Contractor’s provider network. Additionally, the Contractor shall include a current provider directory and/or information on how to find a network provider near the member’s residence on-line and via the Member Helpline. In accordance with 42 CFR 438.10(h), the provider directory must include the following information: ▪ Primary care physicians, specialists and hospitals; ▪ Name, location and telephone number of providers; ▪ Identification of non-English language spoken by providers; ▪ Provider web sites, if applicable; ▪ If the provider has accommodations for people with physical disabilities; ▪ Pharmacies and behavioral health providers; ▪ Contact information for all brokers contracted with the MCE; and ▪ Identification of providers that are not accepting new patients. A printed copy of the provider directory must also be available to members and FSSA upon request. The Contractor must include the aforementioned provider network information, by county, on its member website. The information must be updated, at minimum, every two (2) weeks. Network provider information must be available to print from a remote user location.
Provider Network Information. The MCO will submit to the STATE a complete listing of its provider network in accordance with the specifications outlined in the STATE’s provider network template posted on the STATE’s website. The MCO will submit its entire provider network on the fifth of every month to the STATE’s provider data repository. The MCO will work with the STATE to ensure that its monthly provider network data submission is complete, accurate, and timely and will resolve any issues necessary to successfully submit the data.
Provider Network Information. The Enrollment Packet shall include information on where to find information about the Contractor’s provider network. Additionally, the Contractor shall include a current provider directory and/or information on how to find a network provider near the member’s residence on-line and via the Member Helpline. In accordance with 42 CFR 438.10(h), the provider directory must include the following information for all network providers, including but not limited to, all types of PMPs, specialists, hospitals, pharmacies, behavioral health providers: ▪ Name, group affiliation, location, telephone number and specialty of providers; ▪ Whether PMPs will accept new enrollees; ▪ Cultural and linguistic capabilities, including languages (including ASL) spoken by the provider or the provider’s office personnel (including skilled medical interpreters, if applicable); ▪ Whether the provider has completed cultural competence training; ▪ Provider web sites, if applicable; ▪ If the provider has accommodations for people with physical disabilities, including offices, exam rooms and equipment; ▪ Pharmacies and behavioral health providers; and ▪ Contact information for all brokers contracted with the MCE; and ▪ Identification of providers that are not accepting new patients. A printed copy of the provider directory must also be available to members and FSSA upon request. The Contractor shall include the aforementioned provider network information in an FSSA-approved format (compliant with Section 508 of the US Rehabilitation Act) on its member website. The Contractor shall list provider network information by county on the Contractor’s website and update the information every two (2) weeks. As required by 42 CFR 438.10(h)(3)(i) and 42 CFR 438.10(h)(3)(ii), provider network information on the Contractor’s website must be updated no later than thirty (30) calendar days after the Contractor receives updated provider information. Network provider information shall be available to print from a remote user location and in a machine-readable file and format as specified by the Secretary per 42 CFR 457.1207 and 42 CFR 438.10(h)(4). Paper provider network directories must be updated at least monthly if the Contractor does not have a mobile-enabled, electronic directory; or quarterly if the Contractor has a mobile-enabled electronic directory (42 CFR 438.10(h)(3)).
Provider Network Information. The Contractor shall submit a quarterly Provider Enrollment File report that includes information on all providers of the SNP Plan’s covered health benefits. This includes but is not limited to, PCPs, physician specialists, hospitals and home health agencies. The report shall include contract providers as well as all non-contract providers with whom the Contractor has a relationship. This list need not include retail pharmacies. The Contractor shall submit this report by the 15th of the following months: February, May, August and November. Each quarterly Provider Enrollment File shall include information on all providers of health benefits and shall provide a complete replacement for any previous Provider Enrollment Files submission. Any changes in the provider’s contract status from the previous submission shall be indicated in the file generated in the quarter the change became effective and shall be submitted in the next quarterly file. The provider network information shall be updated regularly as specified by TennCare. Contractor will contact TennCare’s Office of Provider Networks for the proper format for the submission. The Contractor shall develop a network of providers that specifically targets overlap of providers in its network with providers that are also enrolled with one or more TennCare MCOs in order to ensure seamless access to care for FBDE members across the Medicare and Medicaid programs.
Provider Network Information i. The MCOP must submit provider network information, including provider additions and deletions, to ODM in the format and at the frequency specified by ODM to ODM's provider network management system.
ii. As directed by ODM, the MCOP must provide documentation verifying the accuracy of information submitted to ODM's provider network management system.
iii. ODM will use the information provided by MCOP and uploaded into ODM's provider network management system to determine if the MCOP meets the provider network access standards specified in this Agreement, which includes Sections 2.6 and 2.7 of the Three-Way with the exception of independent providers.
iv. The MCOP must immediately notify ODM of any discrepancy between the MCOP's provider network information in ODM's provider network management system and the MCOP's system and resubmit the correct information within one business day of becoming aware of the discrepancy.
Provider Network Information. The Enrollment Packet shall include information on where to find information about the Contractor’s provider network. Additionally, the Contractor shall include a current provider directory and/or information on how to find a network provider near the member’s residence on-line and via the Member Helpline. In accordance with 42 CFR 438.10(h), the provider directory must include the following information for all network providers, including but not limited to, all types of PMPs, specialists, hospitals, pharmacies, behavioral health providers: • Name, group affiliation, location, telephone number and specialty of providers; • Whether PMPs will accept new enrollees; • Cultural and linguistic capabilities, including languages (including ASL) spoken by the provider or the provider’s office personnel (including skilled medical interpreters, if applicable); • Whether the provider has completed cultural competence training; • Provider web sites, if applicable; • If the provider has accommodations for people with physical disabilities, including offices, exam rooms and equipment; • Pharmacies and behavioral health providers; and • Contact information for all brokers contracted with the MCE; and Identification of providers that are not accepting new patients. A printed copy of the provider directory must also be available to members and FSSA upon request. The Contractor shall include the aforementioned provider network information in an FSSA-approved format (compliant with Section 508 of the US Rehabilitation Act) on its member website. The Contractor shall list provider network information by county on the Contractor’s website and update the information every two (2) weeks. As required by 42 CFR 438.10(h)(3)(ii), provider network information on the Contractor’s website must be updated no later than thirty (30) calendar days after the Contractor receives updated provider information. Network provider information shall be available to print from a remote user location and in a machine-readable file and format as specified by the Secretary per 42 CFR 457.1207 and 42 CFR 438.10(h)(4). Paper provider network directories must be updated at least monthly if the Contractor does not have a mobile-enabled, electronic directory; or quarterly if the Contractor has a mobile-enabled electronic directory (42 CFR 438.10(h)(3)).
Provider Network Information. (1) The MCO must submit to MDH annually by April 1st of the Contract Year a complete list of Participating Providers, including name, specialty, and address, in a format specified and provided by MDH. For MSHO, providers of Medicare and Medicaid services must be included. This requirement excludes pharmacies, transportation providers, and interpreters. The STATE will obtain the participating provider list from MDH.
(2) The MCO must include in the report in 3.7.2(E)(1) above the Home and Community-Based Service and Nursing Facility Providers it uses for delivery of MSHO and MSC+ services, including county Participating Providers. The MCO shall also submit an update of its list of Community-Based Service and Nursing Facility Providers, in the same format but to the STATE, by October 15th of the Contract Year. This list is used for federal waiver reporting purposes.
(3) Upon request by the STATE, the MCO will provide information about the qualifications of mental health and chemical dependency Providers, with at least sixty (60) days’ notice.
(4) The MCO will notify the STATE of terminations or additions to its contracted Care System, County Care Coordination System and Case Management System entities by April 15th of the Contract Year.
Provider Network Information. (1) The MCO will submit to the STATE a complete listing of its Provider network in accordance with the specifications outlined in the STATE’s provider network template posted on the STATE’s website. The MCO will submit its entire Provider network on the fifth of every month to the STATE’s provider data repository. The MCO will work with the STATE to ensure that its monthly Provider network data submission is complete, accurate, and timely and will resolve any issues necessary to successfully submit the data. For MSHO, contracted Home and Community-Based Services, and Nursing Facility providers; and providers of Medicare and Medicaid services must be included.
(2) Upon request by the STATE and with at least sixty (60) days’ notice, the MCO will provide information about the qualifications of mental health and chemical dependency Providers.
Provider Network Information. (1) The MCO will submit to the STATE a complete listing of its Provider network in accordance with the specifications outlined in the STATE’s provider network template posted on the STATE’s website. The MCO will submit its entire Provider network on the fifth of every month to the STATE’s provider data repository. The MCO will work with the STATE to ensure that its monthly provider network data submission is complete, accurate, and timely and will resolve any issues necessary to successfully submit the data.
(2) Upon request by the STATE and with at least sixty (60) days’ notice, the MCO will provide information about the qualifications of mental health and chemical dependency Providers.
Provider Network Information. The Enrollment Packet shall include information on where to find information about the Contractor’s provider network. Additionally, the Contractor shall include a current provider directory and/or information on how to find a network provider near the member’s residence on-line and via the Member Helpline. In accordance with 42 CFR 438.10(h), the provider directory must include the following information for all network providers, including but not limited to, all types of PMPs, specialists, hospitals, pharmacies, behavioral health providers: • Name, group affiliation, location, telephone number and specialty of providers; • Whether PMPs will accept new enrollees; • Cultural and linguistic capabilities, including languages (including ASL) spoken by the provider or the provider’s office personnel (including skilled medical interpreters, if applicable); • Whether the provider has completed cultural competence training;
EXHIBIT 1. E SCOPE OF WORK
