Secure Provider Portal. The MCO must have a secure website for network providers through which providers can perform the following functions: View member eligibility and enrollment, including information when members are enrolled in OhioRISE; Confirm member primary language information and any other special communication needs; and Access claims and utilization history. File and track the status of pending provider claim disputes. The MCO's secure provider portal must comply with all state and federal requirements relating to PHI, including compliance with 45 CFR Parts 160 and 164 (the HIPAA Security and Privacy Rule) and 42 CFR Part 2. The MCO must obtain, maintain, and track all applicable authorizations and consent forms related to the secure provider portal. In the event a member revokes or limits their authorization or consent, the MCO must exclude the revoked or limited PHI from being shared via the secured provider portal, unless otherwise permitted by law.
Secure Provider Portal. The MCO must have a secure website for network providers through which providers can perform the following functions:
Secure Provider Portal. The MCO must have a secure portal that allows providers to submit and receive responses to referrals, request prior authorization for services, and review claims status. The portal must comply with all requirements of West Virginia Code § 9-5-32.
Secure Provider Portal. 1. The MCO must have a secure website for network providers through which providers can perform the following functions: View member eligibility and enrollment; Confirm member primary language information and any other special communication needs; and Access claims and utilization history. File and track the status of pending provider claim disputes and external medical reviews.
2. The MCO's secure provider portal must comply with all state and federal requirements relating to PHI, including compliance with 45 CFR Parts 160 and 164 (the HIPAA Security and Privacy Rule) and 42 CFR Part 2.
3. The MCO’s secure provider portal must be accessible by Public Children’s Service Agencies and IV-E Courts for children and youth in their custody who are enrolled in the MCO. The provider portal must allow each Public Children’s Service Agency and IV- E court to access information about all children and youth in their custody through a single login. At a minimum, information about each child or youth must include: Authorized services, The child or youth member’s current care coordinator; and Explanation of benefits for MCO, SPBM, and OhioRISE claims.
4. The MCO must obtain, maintain, and track all applicable authorizations and consent forms related to the secure provider portal. In the event a member revokes or limits their authorization or consent, the MCO must exclude the revoked or limited PHI from being shared via the secured provider portal, unless otherwise permitted by law.
Secure Provider Portal. 1. The OhioRISE Plan must have a secure website for network providers through which providers can perform the following functions: View member eligibility and enrollment; Confirm member primary language information and any other special communication needs; Access to child- and family-centered care plans for OhioRISE Plan's members; and Access claims and utilization history. File and track the status of pending provider claim disputes and EMRs. Update their address and contact information.
2. The OhioRISE Plan's secure provider portal must be accessible by Public Children's Service Agencies (PCSAs) and IV-E Courts for children and youth in their custody who are enrolled in the OhioRISE Program. The provider portal must allow each PCSA and IV-E court to access information about all children and youth in their custody through a single login. The OhioRISE Plan must work with PCSAs and IV-E Courts to determine the information about each child and youth that will be made available through their login. At a minimum, information about each child or youth must include: CME responsible for care coordination, or designation that care coordination is the responsibility of the OhioRISE Plan; Contact information for the child or youth’s assigned care coordinator at the CME or OhioRISE Plan; and The Child and Family Centered Plan.
3. The OhioRISE Plan's secure provider portal must comply with all state and federal requirements relating to PHI, including compliance with 45 CFR Parts 160 and 164 (the HIPAA Security and Privacy Rule) and 42 CFR Part 2.
4. The OhioRISE Plan must obtain, maintain, and track all applicable authorizations and consent forms related to the secure provider portal. In the event a member revokes or limits their authorization or consent, the OhioRISE Plan must exclude the revoked or limited PHI from being shared via the secured provider portal unless otherwise permitted by law.
