Responsibilities of Disenrolling MCO a. When the MCO learns of a currently hospitalized member’s intent to disenroll through the Consumer Contact Record or the HIPAA 834, the disenrolling MCO must notify the hospital/inpatient facility and treating providers as well as the enrolling MCO, if applicable, of the change in enrollment.
Responsibilities of Disenrolling MCO. When the MCO learns of a currently hospitalized member's intent to disenroll through the Client Contact Record or the HIPAA 834, the disenrolling MCO must notify the hospital/inpatient facility and treating providers as well as the enrolling MCO, if applicable, of the change in enrollment. The disenrolling MCO must notify the hospital/inpatient facility that it will remain responsible for the inpatient facility charges through the date of discharge and must notify the treating providers that it will remain responsible for provider charges through the date of disenrollment. The disenrolling MCO must not request or require that a disenrolled member be discharged from the hospital/inpatient facility for transfer to another hospital/inpatient facility. Should a discharge and transfer to another hospital/inpatient facility be medically necessary, the disenrolling MCO must notify the treating providers to work with the enrolling MCO or ODM as applicable to facilitate the discharge, transfer, and authorization of services as needed.
