Certified Plan-Based Enroller Program Sample Clauses

The Certified Plan-Based Enroller Program clause establishes a framework for designating and regulating individuals or entities authorized to enroll participants in a specific plan. Typically, this clause outlines the qualifications, training requirements, and ongoing responsibilities for enrollers, ensuring they meet certain standards before assisting with plan enrollment. By setting these criteria, the clause helps maintain the integrity of the enrollment process and ensures that only qualified representatives can guide participants, thereby reducing errors and protecting both the plan sponsor and enrollees.
Certified Plan-Based Enroller Program. Contractor shall meet all eligibility requirements of the Plan-Based Enroller (PBE) Program in Title 10, California Code of Regulations, Chapter 12, § 6700 et seq. to be eligible to participate in the PBE Program. If selected as a Certified Plan- Based Enrollment Entity by Covered California, Contractor agrees to adhere to all rules and regulations of the program, as specified in 10 CCR § 6700 et seq.

Related to Certified Plan-Based Enroller Program

  • Medical Benefits - Prescription Drugs Administered by a Provider (other than a pharmacist)

  • Resident Educator Program The four-year program is designed to provide newly licensed Ohio educators quality mentoring and guidance. Successful completion of the residency program is required to advance to a five-year professional educator license.

  • How to File an Appeal of a Prescription Drug Denial For denials of a prescription drug claim based on our determination that the service was not medically necessary or appropriate, or that the service was experimental or investigational, you may request an appeal without first submitting a request for reconsideration. You or your physician may file a written or verbal prescription drug appeal with our pharmacy benefits manager (PBM). The prescription drug appeal must be submitted to us within one hundred and eighty (180) calendar days of the initial determination letter. You will receive written notification of our determination within thirty (30) calendar days from the receipt of your appeal. Your appeal may require immediate action if a delay in treatment could seriously jeopardize your health or your ability to regain maximum function, or would cause you severe pain. To request an expedited appeal of a denial related to services that have not yet been rendered (a preauthorization review) or for on-going services (a concurrent review), you or your healthcare provider should call: • our Grievance and Appeals Unit; or • our pharmacy benefits manager for a prescription drug appeal. Please see Section 9 for contact information. You will be notified of our decision no later than seventy-two (72) hours after our receipt of the request. You may not request an expedited review of covered healthcare services already received.

  • Enrolled Nurse (With Notation) Pay point 4 (a) Pay point 4 refers to the pay point to which an EN has been appointed.

  • Medicaid Enrollment Treatment Grantees shall enroll as a provider with Texas Medicaid and Healthcare Partnership (TMHP) and all Medicaid Managed Care organizations in Grantee’s service region within the first quarter of this procurement term and maintain through the procurement term.