Risk Sharing Services. For purposes of Section 4.5.I and Appendix D, the following services as set forth in Appendix C: Residential Rehabilitation Services, Recovery Support Navigator, and Recovery Coaching. TPL Indicator Form – forms supplied to inpatient hospitals by EOHHS used to notify the Contractor when the hospital discovers that an Enrollee is enrolled in another health plan and used by the Contractor to notify EOHHS that an Enrollee is covered under the Contractor’s commercial plan or a Qualified Health Plan offered through the Exchange.. Transitional Care Management – the evaluation of an Enrollee’s medical care needs and coordination of any other support services in order to arrange for safe and appropriate care after discharge from one level of care to another level of care, including referral to appropriate services, as described in Section 2.5.C.2. Urgent Care – services that are not Emergency Services or routine services. Utilization Management – a process of evaluating and determining coverage for, and appropriateness of, medical care services and Behavioral Health Services, as well as providing needed assistance to clinicians or patients, in cooperation with other parties, to ensure appropriate use of resources, which can be done on a prospective or retrospective basis, including service authorization and prior authorization. Virtual Gateway (or EOHHS Web Portal) – an internet portal designed and maintained by EOHHS to provide the general public, medical providers, community-based organizations, MassHealth Managed Care contractors, and EOHHS staff with online access to health and human services. Wellness Initiatives – planned health education activities intended to promote healthy behaviors and lifestyle changes.
Risk Sharing Services. For purposes of Section 4.5.I and Appendix D, the following services as set forth in Appendix C: Residential Rehabilitation Services, Recovery Support Navigator, and Recovery Coaching.
