Retroactive Eligibility Period. The Contractor shall not be responsible for any payments owed to Providers for services that were rendered prior to the effective date of a Member's enrollment into the PH-MCO.
Retroactive Eligibility Period. The PCO shall not be responsible for any payments owed to Providers for services that were rendered prior to the effective date of a Member's Enrollment into the PCO.
Retroactive Eligibility Period. 114 5. In-Network Services .............................................114
Retroactive Eligibility Period. Contractor shall not be responsible for any payments owed to providers for services that were rendered prior to a member’s enrollment, even if they fell within any applicable period of retroactive eligibility for Medicaid.
Retroactive Eligibility Period. 117 5. In-Network Services.......................................................................117 6. Payments for Out-of-Network Providers.....................................................117 7. Payments to FQHCs and Rural Health Centers (RHCs).........................................118 8. Liability During an Active Grievance or Appeal............................................118 9. Financial Responsibility for Dual Eligibles...............................................118 10. Third Party Liability (TPL)..............................................................119 11. Health Insurance Premium Payment (XXXX) Program..........................................122 12. Requests for Additional Data.............................................................122 13. Accessibility to TPL Data................................................................123 14.
Retroactive Eligibility Period. The PH-MCO shall not be responsible for any payments owed to Providers for services that were rendered prior to the effective date of a Member's Enrollment into the PH-MCO.
