Secure Provider Portal. The MCO must have a secure website for network providers through which providers can perform the following functions: Access relevant member information to: 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. 1. The MCO must have a secure website for network providers through which providers can perform the following functions: Access relevant member information to: 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.
Secure Provider Portal. 1. The OhioRISE Plan must have a secure website for network providers through which providers can perform the following functions: Access relevant member information to: 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.
