Retroactive Coverage Requirements. The MCP shall pay for claims for covered services provided to members during retroactive enrollment periods. For services provided during retroactive enrollment periods that require FFS prior authorization as documented in Appendix DD of OAC rule 5160-1-60, OAC rule 5160-9-03 (regarding pharmacy claims), and all other FFS regulations that set forth prior authorization policy, the MCP may conduct a medical necessity review for payment. However, if the service was already reviewed and approved by FFS, the MCP shall also approve the service.
Appears in 18 contracts
Samples: Ohio Medical Assistance Provider Agreement for Managed Care Plan, Ohio Medical Assistance Provider Agreement for Managed Care Plan, Ohio Medical Assistance Provider Agreement for Managed Care Plan
Retroactive Coverage Requirements. The MCP shall must pay for claims for covered services provided to members during retroactive enrollment periods. For services provided during retroactive enrollment periods that require FFS prior authorization as documented in Appendix DD of OAC rule 5160-1-60, OAC rule 5160-9-03 12 (regarding pharmacy claims), and all other FFS regulations that set forth prior authorization policy, the MCP MCPs may conduct a medical necessity review for payment. However, if the service was already reviewed and approved by FFS, the MCP shall must also approve the service.
Appears in 4 contracts
Samples: Provider Agreement, Provider Agreement, Provider Agreement
Retroactive Coverage Requirements. The MCP shall pay for claims for covered services provided to members during retroactive enrollment periods. For services provided during retroactive enrollment periods that require FFS prior authorization as documented in Appendix DD of OAC rule 5160-1-60, OAC rule 5160-9-03 (regarding pharmacy claims), and all other FFS regulations that set forth prior authorization policy, the MCP may conduct a medical necessity review for payment. However, if the service was already reviewed and approved by FFS, the MCP shall also approve the service.
Appears in 2 contracts
Samples: Ohio Medical Assistance Provider Agreement for Managed Care Plan, Ohio Medical Assistance Provider Agreement for Managed Care Plan
