Common use of Provider Services Function Clause in Contracts

Provider Services Function. (A) The Contractor shall operate Provider Services function during regular business hours. (B) At a minimum, Provider Services staff shall be responsible for the following: (1) training, including ongoing training, of the Contractor’s Providers on Medicaid rules and regulations that shall enable Providers to appropriately render services to Enrollees; (2) assisting Providers to verify whether an individual is enrolled with the Health Plan; (3) assisting Providers with prior authorizations and referral protocols; (4) assisting Providers with claims payment procedures, including training Providers on how to bill using the National Provider Identification Number or the Department- assigned atypical provider identification number that is known to Medicaid to avoid rejection of Encounters; and (5) Xxxxxxxx and responding to Provider questions and the Grievance and Appeals System.

Provider Services Function. (A) The Contractor shall operate Provider Services function during regular business hours. (B) At a minimum, Provider Services staff shall be responsible for the following: (1) training, including ongoing training, of the Contractor’s Providers on Medicaid rules and regulations that shall enable Providers to appropriately render services to Enrollees; (2) assisting Providers to verify whether an individual is enrolled with the Health Plan; (3) assisting Providers with prior authorizations and referral protocols; (4) assisting Providers with claims payment procedures, including training Providers on how to bill using the National Provider Identification Number or the Department- assigned atypical provider identification number that is known to Medicaid to avoid rejection of Encounters; and (5) Xxxxxxxx and xxx responding to Provider questions and the Grievance and Appeals System.