Common use of Provider Services Clause in Contracts

Provider Services. The CHC-MCO must operate Provider service functions at a minimum during regular business hours (9:00 a.m. to 5:00 p.m., Monday through Friday). Provider services functions include, but are not limited to, the following:  Assisting Providers with questions concerning Participant eligibility status.  Assisting Providers with CHC-MCO Prior Authorization and referral procedures.  Assisting Providers with PCSP and PCPT Procedures.  Assisting Providers with Claims payment procedures and handling Provider Disputes and issues.  Facilitating transfer of Participant medical records among Providers, as necessary.  Providing to PCPs a monthly list of Participants who are under their care, including identification of new and deleted Participants. An explanation guide detailing use of the list must also be provided to PCPs.  Developing a process to respond to Provider inquiries regarding current Enrollment.  Coordinating the administration of Out-of-Plan Services.

Provider Services. The CHC-MCO must operate Provider service functions at a minimum during regular business hours (9:00 a.m. to 5:00 p.m., Monday through Friday). Provider services functions include, but are not limited to, the following:  • Assisting Providers with questions concerning Participant eligibility status.  • Assisting Providers with CHC-MCO Prior Authorization and referral procedures.  • Assisting Providers with PCSP and PCPT Procedures.  • Assisting Providers with Claims payment procedures and handling Provider Disputes and issues.  • Facilitating transfer of Participant medical records among Providers, as necessary.  • Providing to PCPs a monthly list of Participants who are under their care, including identification of new and deleted Participants. An explanation guide detailing use of the list must also be provided to PCPs.  • Developing a process to respond to Provider inquiries regarding current Enrollment.  • Coordinating the administration of Out-of-Plan Services.

Provider Services. ‌ The CHC-MCO must operate Provider service functions functions, at a minimum minimum, during regular business hours (9:00 a.m. to 5:00 p.m., Monday through Friday). Provider services functions include, but are not limited to, the following:  • Assisting Providers with questions concerning Participant eligibility status.  • Assisting Providers with CHC-MCO Prior Authorization and referral procedures.  • Assisting Providers with PCSP and PCPT Procedures.  • Assisting Providers with Claims payment procedures and handling Provider Disputes and issues.  • Facilitating transfer of Participant medical records among Providers, as necessary.  • Providing to PCPs a monthly list of Participants who are under their care, including identification of new and deleted Participants. An explanation guide detailing use of the list must also be provided to PCPs.  • Developing a process to respond to Provider inquiries regarding current Enrollment.  • Coordinating the administration of Out-of-Plan Services.

Provider Services. ‌ The CHC-MCO must operate Provider service functions functions, at a minimum minimum, during regular business hours (9:00 a.m. to 5:00 p.m., Monday through Friday). Provider services functions include, but are not limited to, the following:  Assisting Providers with questions concerning Participant eligibility status.  Assisting Providers with CHC-MCO Prior Authorization and referral procedures.  Assisting Providers with PCSP and PCPT Procedures.  Assisting Providers with Claims payment procedures and handling Provider Disputes and issues.  Facilitating transfer of Participant medical records among Providers, as necessary.  Providing to PCPs a monthly list of Participants who are under their care, including identification of new and deleted Participants. An explanation guide detailing use of the list must also be provided to PCPs.  Developing a process to respond to Provider inquiries regarding current Enrollment.  Coordinating the administration of Out-of-Plan Services.