Common use of Publicly-Available Provider Page Clause in Contracts

Publicly-Available Provider Page. The MCO must ensure that its provider page includes, at a minimum, the following information that the MCO must make accessible to providers and the general public without any log-in restrictions: The MCO's provider services contact information for provider issues; The MCO's provider manual as described in this appendix; Links to policies and prominent alerts that notify providers of changes to MCO coverage processes and policies: The MCO must provide notice of changes to MCO coverage requirements and services requiring prior authorization via its website at least 30 calendar days in advance. Pursuant to ORC section 5160.34, the MCO must notify providers, via email or standard mail, the specific location of coverage and prior authorization requirement changes on the website 30 calendar days prior to the implementation of the changes. The MCO's policies and procedures for all providers (in-and out-of-network providers) to seek payment of claims for emergency, post-stabilization, and any other services authorized by the MCO; Instructions for submitting claims and prior authorizations to the MCO and ODM-supplied provider instruction regarding submitting claims through the OMES; New edits or system changes related to claims adjudication or payment processing; The MCO's documentation requirements for prior authorization and details about Medicaid programs and the MCO's services requiring prior authorization pursuant to ORC section 5160.34; A sample network provider contract by provider type; and Links to Medicaid managed care requirements in the Ohio Administrative Code and Ohio Revised Code.

Publicly-Available Provider Page. 1. The MCO must ensure that its provider page includes, at a minimum, the following information that the MCO must make accessible to providers and the general public without any log-in restrictions: The MCO's provider services contact information for provider issues; The MCO's provider manual as described in this appendix; Links to policies and prominent alerts that notify providers of changes to MCO coverage processes and policies: The MCO must provide notice of changes to MCO coverage requirements and services requiring prior authorization via its website at least 30 calendar days in advance. Pursuant to ORC section 5160.34, the MCO must notify providers, via email or standard mail, the specific location of coverage and prior authorization requirement changes on the website 30 calendar days prior to the implementation of the changes. The MCO's policies and procedures for all providers (in-and out-of-network providers) to seek payment of claims for emergency, post-stabilization, and any other services authorized by the MCO; Instructions for submitting claims and prior authorizations to the MCO and ODM-supplied provider instruction regarding submitting the need to submit claims and prior authorization requests through the OMESfiscal intermediary; New edits or system changes related to claims adjudication or payment processing; The MCO's documentation requirements for prior authorization and details about Medicaid programs and the MCO's services requiring prior authorization pursuant to ORC section 5160.34; A sample network provider contract by provider type; and Links to Medicaid managed care requirements in the Ohio Administrative Code and Ohio Revised Code.