Common use of Enrollment Process Clause in Contracts

Enrollment Process. (a) The Contractor and the Department, acting directly or through its agent, shall be responsible for the Enrollment of Potential Enrollees. (1) When the Contractor enrolls a Potential Enrollee, the Contractor shall initiate the processing of the Enrollment by submitting a Managed Care Enrollment ▇▇▇▇, ▇▇▇▇ ▇▇. ▇▇▇ ▇▇▇▇▇, completed in accordance with Department instructions for completing such forms, and signed by the individual who is recognized as the Head of Case by the Department. This form will be supplied to the Contractor by the Department. The Contractor is responsible for submitting such forms to the Department or its agent, as directed. The Department agrees to act in good faith and use its best efforts to see that Managed Care Enrollment Forms submitted for Potential Enrollees are processed within fifteen (15) business days of receipt by the Department or its agent. At some point during the term of this Contract, but in no event later than October 16, 2003, the Contractor shall be required to submit all enrollment information electronically to the Department and retain the original forms for at least six (6) years. The Department shall provide the Contractor with specific file submission requirements. (2) Only a Head of Case may enroll another Potential Enrollee. A Head of Case may enroll all other Potential Enrollees in his Case. An adult Potential Enrollee, who is not a Head of Case, may enroll himself only. (3) A member of the Contractor's management staff may correct a Managed Care Enrollment Form only in accordance with Department instructions. The corrections must be initialed by the Contractor's manager or his designated staff person. (b) The Department may enroll Potential Enrollees with the Contractor by means of any process the Department uses for the Enrollment of Potential Enrollees into managed care. This may include any program the Department implements during the term of this Contract whereby Potential Enrollees who do not affirmatively choose between enrollment in an MCO or the alternative delivery system offered by the Department will be enrolled in MCOs. (c) The Contractor shall conduct Enrollment activities that include the information distribution requirements of Article V, Section 5.4 hereof and are designed and implemented so as to maximize Eligible Enrollees' understanding of the following: (1) that all Covered Services must be received from or through the Plan with the exception of family planning and other Medical Assistance services as described in Article V, Section 5.1(e) with provisions made to clarify when such services may also be obtained elsewhere; (2) that once enrolled, the Enrollees will receive a card from the Department which identifies such Enrollees as enrolled in an MCO; and (3) that the Contractor must inform Potential Enrollees of any Covered Services that will not be offered by the Contractor due to the Contractor's exercise of a right of conscience. (d) Upon the Contractor's request, the Department may refuse Enrollment for at least a six-month period to those former Enrollees previously terminated from coverage by the Contractor for "good cause," as specified in Article IV, Section 4.4(a)(1). (e) When an Enrollee, who is a Head of Case, gives birth and the newborn is added to a Case before the newborn is forty-five (45) days old, coverage shall be retroactive to the date of birth. Coverage for all other newborns shall be prospective according to standard Enrollment terms of this Contract. (f) From birth through age eighteen (18), Potential Enrollees who are added to a Case in which all members of the Case are enrolled with the Contractor, will also be enrolled with the Contractor automatically. Coverage shall begin as designated by the Department on the first day of a calendar month no later than three (3) calendar months from the date the Potential Enrollee was added to the Case. (g) No later than ten (10) business days following receipt of the Prelisting Report, the Contractor must send new Enrollees an identification card bearing the name of the Contractor's Plan; the effective date of coverage; the twenty-four-hour telephone number to confirm eligibility for benefits and authorization for services and the name and phone number of the Primary Care Provider and, if applicable, the Women's Health Care Provider. Samples of the identification cards described herein shall be submitted for Department approval by the Contractor prior to use by the Contractor and as revised. The Contractor shall not be required to submit for prior approval format changes, provided there is no change in the information conveyed. (1) If the Contractor requires a female Enrollee who wishes to use a Women's Health Care Provider to designate a specific Women's Health Care Provider and if a female Enrollee does so designate a Women's Health Care Provider, the name and phone number of that Women's Health Care Provider must appear on the identification card. (h) Within three (3) business days following receipt of the Prelisting Report, the Contractor must update the Enrollees' eligibility in all electronic systems maintained by the Contractor.

Enrollment Process. (a) The Contractor and the Department, acting directly or through its agent, shall be responsible for the Enrollment enrollment of Potential Enrollees. (1) When the Contractor enrolls a Potential Enrollee, the Contractor shall initiate the processing of the Enrollment enrollment by submitting completing a Managed Care Enrollment ▇▇▇▇, ▇▇▇▇ ▇▇. ▇▇▇ ▇▇▇▇▇, completed Form in accordance with Department instructions for completing such forms, and signed by the individual who is recognized as the Head of Case by the Department. This form will be supplied to the Contractor by the Department. The Contractor is responsible for submitting such forms may enroll a Potential Enrollee without a completed and signed Managed Care Enrollment Form prior to September 30, 2006 if the Potential Enrollee was enrolled with an MCO that ended its contract with the Department on July 31, 2006. The Contractor shall submit a weekly report to the Department or its agent, as directedof all enrollments submitted without a signed form. The Department agrees to act in good faith and use its best efforts to see that Managed Care Enrollment Forms submitted for Potential Enrollees are processed within fifteen (15) business days of receipt by the Department or its agent. At some point during the term of this Contract, but in no event later than October 16, 2003, the Contractor shall be required to submit all enrollment information electronically to the Department or its designee and retain the original forms for at least six (6) years. The Department Contractor shall provide submit enrollments via the Contractor with specific file submission requirements834 Daily File. (2) Only a Head of Case may enroll another Potential Enrollee. A Head of Case may enroll all other Potential Enrollees in his Case. An adult Potential Enrollee, who is not a Head of Case, may enroll himself only. (3) A member of the Contractor's management staff may correct a Managed Care Enrollment Form only in accordance with Department instructions. The corrections must be initialed by the Contractor's manager or his designated staff person. (b) The Department may enroll Potential Enrollees with It is the Contractor by means intent of any process the Department uses for the to contract with a Client Enrollment of Potential Enrollees into managed care. This may include any program the Department implements Broker (CEB) during the term of this Contract whereby contract. The CEB enrollment process shall serve to enhance and facilitate Potential Enrollees' choice of health coverage program options, and shall not act to give preference to one option over others. Department shall collaborate with Contractor on the design of the CEB enrollment and disenrollment processes and subsequent changes that affect Contractor's outreach, marketing, enrollment and disenrollment functions. The Department shall monitor the CEB process and consult with the Contractor to identify any unintended obstacles that hinder Potential Enrollees who do not affirmatively choose between enrollment in from selecting an MCO or and work in good faith with the alternative delivery system offered CEB to remove those obstacles. When the CEB is ready to implement its enrollment process, the process set forth in subsection (a) will be replaced by the Department will be enrolled in MCOsCEB process. (c) The Contractor shall conduct Enrollment enrollment activities that include the information distribution requirements of Article V, Section 5.4 5.5 hereof and are designed and implemented so as to maximize Eligible Enrollees' understanding of the following: (1) that all Covered Services must be received from or through the Plan with the exception of family planning and other Medical Assistance services as described in Article V, Section 5.1(e) with provisions made to clarify when such services may also be obtained elsewhere; (2) that once enrolled, the Enrollees will receive a card from the Department which identifies such Enrollees as enrolled in an MCODepartment; and (3) that the Contractor must inform Potential Enrollees of any Covered Services that will not be offered by the Contractor due to the Contractor's exercise of a right of conscience. (d) Upon the Contractor's request, the Department may refuse Enrollment enrollment for at least a six-month period to those former Enrollees previously terminated from coverage by the Contractor for "good cause," as specified in Article IV, Section 4.4(a)(14.4(a)(l). (e) When an Enrollee, who is a Head of Case, gives birth and the newborn is added to a the Case before the newborn is forty-five (45) days old, coverage the newborn shall be automatically enrolled with the Contractor. Coverage shall be retroactive to the date of birth. (f) Potential Enrollees age 46 days through age 1 who are added to a Case in which the mother is the Head of Case and an Enrollee will be enrolled with the Contractor automatically. Coverage for all other newborns shall be prospective according to standard Enrollment terms as described in Article IV, Section 4.2 of this Contract. (fg) From birth Potential Enrollees through age eighteen (18), Potential Enrollees ) who are added to a Case in which all members of the Case are enrolled with the Contractor, Contractor will also be enrolled with the Contractor automatically. Coverage shall begin be prospective as designated by the Department on the first day described in Article IV, Section 4.2 of a calendar month no later than three (3) calendar months from the date the Potential Enrollee was added to the Casethis Contract. (gh) No later than ten (10) business days following receipt of the Prelisting Report834 Audit File, the Contractor must send new Enrollees an identification card bearing the name of the Contractor's Plan; the effective date of coverage; the twenty-four-four hour telephone number to confirm eligibility for benefits and authorization for services and the name and phone number of the Primary Care Provider and, if applicable, the Women's Health Care Provider. The Contractor shall make reasonable efforts to send the identification cards no later than five (5) business days following receipt of the 834 Audit File. Samples of the identification cards described herein shall be submitted for Department approval by the Contractor prior to use by the Contractor and as revised. The Contractor shall not be required to submit for prior approval format changes, provided there is no change in the information conveyed. (1) If the Contractor requires a female Enrollee who wishes to use a Women's Health Care Provider to designate a specific Women's Health Care Provider and if a female Enrollee does so designate a Women's Health Care Provider, the name and phone number of that Women's Health Care Provider must appear on the identification card. (hi) Within three (3) business days following receipt of the Prelisting Report834 Daily File, the Contractor must update the Enrollees' eligibility in all electronic systems maintained by the ContractorContractor to reflect the information contained in the 834 Daily File.

Enrollment Process. (a) The Contractor and the Department, acting directly or through its agent, shall be responsible for the Enrollment of Potential Eligible Enrollees. (1) . When the Contractor enrolls a Potential an Eligible Enrollee, the Contractor shall initiate the processing of the Enrollment by submitting a Managed Care Enrollment ▇▇▇▇Form, ▇▇▇▇ ▇▇. ▇▇▇ ▇▇▇▇▇, completed ▇▇mpleted in accordance with Department instructions for completing such forms, and signed by the individual who is recognized as the Head of Case caretaker relative by the Department. This form will be supplied to the Contractor by the Department. The Contractor is responsible for submitting such forms to the Department or its agent, as directed. The Department agrees to act in good faith and use its best efforts to see that Managed Care Enrollment Forms submitted for Potential Eligible Enrollees are processed within fifteen (15) business days of receipt by the Department or its agent. At some point during the term of this Contract, but in no event later than October 16, 2003, the Contractor shall be required to submit all enrollment information electronically to the Department and retain the original forms for at least six (6) years. The Department shall provide the Contractor with specific file submission requirements. (2) Only a Head of Case caretaker relative may enroll another Potential Eligible Enrollee. A Head of Case caretaker relative may enroll all other Potential Eligible Enrollees in his Case. An adult Potential Eligible Enrollee, who is not a Head of Casecaretaker relative, may enroll himself only. (3) . A member of the Contractor's management staff may correct a Managed Care Enrollment Form only in accordance with Department instructions. The corrections must be initialed by the Contractor's manager or his designated staff person. (b) The Department may enroll Potential Eligible Enrollees with the Contractor by means of any process the Department uses for the Enrollment of Potential Eligible Enrollees into managed care. This may include any program the Department implements during the term of this Contract whereby Potential Eligible Enrollees who do not affirmatively choose between enrollment in an MCO or the alternative delivery system offered by the Department will be enrolled in MCOs. (c) The Contractor shall conduct Enrollment activities that include the information distribution requirements of Article V, Section 5.4 hereof and are designed and implemented so as to maximize Eligible Enrollees' understanding of the following: (1) that all Covered Services must be received from or through the Plan with the exception of family planning and other Medical Assistance services as described in Article V, Section 5.1(e) with provisions made to clarify when such services may also be obtained elsewhere; (2) that once enrolled, the Enrollees will receive a card from When the Department which identifies such Enrollees as enrolled in receives an MCO; and (3) that the Contractor must inform Potential Enrollees of any Covered Services that will not be offered by the Contractor due to the ContractorEligible Enrollee's exercise of a right of conscience. (d) Upon the Contractor's requestselection directly, the Department may refuse Enrollment will electronically communicate a request for at least a six-month period Site assignment to those former Enrollees previously terminated from coverage by the Contractor for "good cause," as specified in Article IV, Section 4.4(a)(1). (e) When an Enrollee, who is a Head of Case, gives birth and on the newborn is added to a Case before the newborn is forty-five (45) days old, coverage shall be retroactive to the date of birth. Coverage for all other newborns shall be prospective according to standard Enrollment terms of this Contract. (f) From birth through age eighteen (18), Potential Enrollees who are added to a Case in which all members of the Case are enrolled with the Contractor, will also be enrolled with the Contractor automatically. Coverage shall begin as designated by day after the Department on enters the first day of a calendar month no later than three (3) calendar months from the date the Potential Enrollee was added to the Case. (g) No later than ten (10) business days following receipt of the Prelisting Report, the Contractor must send new Enrollees an identification card bearing the name of the Contractor's Plan; the effective date of coverage; the twenty-four-hour telephone number to confirm eligibility for benefits and authorization for services and the name and phone number of the Primary Care Provider and, if applicable, the Women's Health Care Provider. Samples of the identification cards described herein shall be submitted for Department approval by the Contractor prior to use by the Contractor and as revisedselection in its records. The Contractor shall not be required to submit for prior approval format changessubsequently contact the Eligible Enrollee, provided there is no change assist the Eligible Enrollee in the information conveyed. (1) If the Contractor requires selecting a female Enrollee who wishes to use a Women's Health Site, Primary Care Provider to designate a specific or Women's Health Care Provider and if a female Enrollee does so designate a Women's Health Care Providerprovide education in accordance with this Article IV, the name and phone number of that Women's Health Care Provider must appear on the identification card. (h) Within three (3) business days following receipt of the Prelisting ReportSection 4.1(d). Once selected, the Contractor must update shall electronically communicate the Enrollees' eligibility in all electronic systems maintained by the Contractor.Site to the

Enrollment Process. (a) The Contractor and the Department, acting directly or through its agent, shall be responsible for the Enrollment of Potential Eligible Enrollees. (1) . When the Contractor enrolls a Potential an Eligible Enrollee, the Contractor shall initiate the processing of the Enrollment by submitting a Managed Care Enrollment ▇▇▇▇Form, ▇▇▇▇ ▇▇Form No. ▇▇▇ ▇▇▇▇▇DPA 2575A, completed in accordance with Department instructions for completing such forms, and signed by the individual who is recognized as the Head of Case caretaker relative by the Department. This form will be supplied to the Contractor by the Department. The Contractor is responsible for submitting such forms to the Department or its agent, as directed. The Department agrees to act in good faith and use its best efforts to see that Managed Care Enrollment Forms submitted for Potential Eligible Enrollees are processed within fifteen (15) business days of receipt by the Department or its agent. At some point during the term of this Contract, but in no event later than October 16, 2003, the Contractor shall be required to submit all enrollment information electronically to the Department and retain the original forms for at least six (6) years. The Department shall provide the Contractor with specific file submission requirements. (2) Only a Head of Case caretaker relative may enroll another Potential Eligible Enrollee. A Head of Case caretaker relative may enroll all other Potential Eligible Enrollees in his Case. An adult Potential Eligible Enrollee, who is not a Head of Casecaretaker relative, may enroll himself only. (3) . A member of the Contractor's management staff may correct a Managed Care Enrollment Form only in accordance with Department instructions. The corrections must be initialed by the Contractor's manager or his designated staff person. (b) The Department may enroll Potential Eligible Enrollees with the Contractor by means of any process the Department uses for the Enrollment of Potential Eligible Enrollees into managed care. This may include any program the Department implements during the term of this Contract whereby Potential Eligible Enrollees who do not affirmatively choose between enrollment in an MCO or the alternative delivery system offered by the Department will be enrolled in MCOs. (c) When the Department receives an Eligible Enrollee's selection directly, the Department will electronically communicate a request for Site assignment to the Contractor on the day after the Department enters the selection in its records. The Contractor shall subsequently contact the Eligible Enrollee, assist the Eligible Enrollee in selecting a Site, Primary Care Provider or Women's Health Care Provider and provide education in accordance with this Article IV, Section 4.1(d). Once selected, the Contractor shall electronically communicate the Site to the Department. Upon one hundred and twenty (120) days notice to Contractor, the Department may require that the Contractor electronically communicate the Primary Care Provider or Women's Health Care Provider selection to the Department. When the Site, and in the future the Provider, selection is received from the Contractor, the Department will enroll the Eligible Enrollee with the Contractor. (d) The Contractor shall conduct Enrollment activities that include the information distribution requirements of Article V, Section 5.4 5.5 hereof and are designed and implemented so as to maximize Eligible Enrollees' understanding of the following: (1) that all Covered Services must be received from or through the Plan with the exception of family planning and other Medical Assistance services as described in Article V, Section 5.1(e) with provisions made to clarify when such services may also be obtained elsewhere; (2) that once enrolled, the Enrollees Beneficiaries will receive a card from the Department which identifies such Enrollees Beneficiaries as enrolled in an MCO; and (3) that the Contractor must inform Potential ▇▇▇▇▇▇▇▇ Enrollees of any Covered Services that will not be offered by the Contractor due to the Contractor's exercise of a right of conscience. (de) Upon the Contractor's request, the Department may refuse Enrollment for at least a six-month period to those former Enrollees Beneficiaries previously terminated from coverage by the Contractor for "good cause," as specified in Article IV, Section 4.4(a)(1). (ef) When an Enrolleea Beneficiary, who is a Head of Casecaretaker relative, gives birth and the newborn is added to a Case before the newborn is forty-five (45) days old, coverage shall be retroactive to the date of birth. Coverage for all other newborns shall be prospective according to standard Enrollment terms of this Contract. (fg) From birth through age eighteen (18), Potential Eligible Enrollees who are added to a Case in which all members of the Case are enrolled with the Contractor, will also be enrolled with the Contractor automatically. Coverage shall begin as designated by the Department on the first day of a calendar month no later than three (3) calendar months from the date the Potential Eligible Enrollee was added to the Case. (gh) No later than ten (10) business days following receipt of the Prelisting Report, the Contractor must send provide new Enrollees Beneficiaries with an identification card bearing the name of the Contractor's Plan; the effective date of coverage; the twenty-four-hour telephone number to confirm eligibility for benefits and authorization for services and the name and phone number of the Primary Care Provider and, if applicable, the or Women's Health Care Provider. The identification of the Site must appear on the card until such time as the name and phone number of the Primary Care Provider and Women's Health Care Provider can be placed on the card. (1) If the Contractor requires a female Beneficiary who wishes to use a Women's Health Care Provider to designate a specific Women's Health Care Provider and if a female Beneficiary does so designate a Women's Health Care Provider, the name and phone number of that Women's Health Care Provider must appear on the identification card. (2) Where the Contractor can make a compelling argument to the Department that due to its Plan design it is unable to place the name of the Primary Care Provider on the card, the Department in its discretion may allow the Contractor to place the name of a clinic or Site on the card. Samples of the identification cards described herein above shall be submitted for Department approval by the Contractor prior to use by the Contractor and as revised. The Contractor shall not be required to submit for prior approval format changes, provided there is no change in the information conveyed. (1) If the Contractor requires a female Enrollee who wishes to use a Women's Health Care Provider to designate a specific Women's Health Care Provider and if a female Enrollee does so designate a Women's Health Care Provider, the name and phone number of that Women's Health Care Provider must appear on the identification card. (h) Within three (3) business days following receipt of the Prelisting Report, the Contractor must update the Enrollees' eligibility in all electronic systems maintained by the Contractor.

Enrollment Process. (a) The Contractor and the Department, acting directly or through its agent, shall be responsible for the Enrollment of Potential Enrollees. (1) When the Contractor enrolls a Potential Enrollee, the Contractor shall initiate the processing of the Enrollment by submitting a Managed Care Enrollment ▇▇▇▇Form, ▇▇▇▇ ▇▇Form No. ▇▇▇ ▇▇▇▇▇DPA 2575A, completed in accordance with Department instructions for completing such forms, and signed by the individual who is recognized as the Head of Case by the Department. This form will be supplied to the Contractor by the Department. The Contractor is responsible for submitting such forms to the Department or its agent, as directed. The Department agrees to act in good faith and use its best efforts to see that Managed Care Enrollment Forms submitted for Potential Enrollees are processed within fifteen (15) business days of receipt by the Department or its agent. At some point during the term of this Contract, but in no event later than October 16, 2003, the Contractor shall be required to submit all enrollment information electronically to the Department and retain the original forms for at least six (6) years. The Department shall provide the Contractor with specific file submission requirements. (2) Only a Head of Case may enroll another Potential Enrollee. A Head of Case may enroll all other Potential Enrollees in his Case. An adult Potential Enrollee, who is not a Head of Case, may enroll himself only. (3) A member of the Contractor's management staff may correct a Managed Care Enrollment Form only in accordance with Department instructions. The corrections must be initialed by the Contractor's manager or his designated staff person. (b) The Department may enroll Potential Enrollees with the Contractor by means of any process the Department uses for the Enrollment of Potential Enrollees into managed care. This may include any program the Department implements during the term of this Contract whereby Potential Enrollees who do not affirmatively choose between enrollment in an MCO or the alternative delivery system offered by the Department will be enrolled in MCOs. (c) The Contractor shall conduct Enrollment activities that include the information distribution requirements of Article V, Section 5.4 hereof and are designed and implemented so as to maximize Eligible Enrollees' understanding of the following: (1) that all Covered Services must be received from or through the Plan with the exception of family planning and other Medical Assistance services as described in Article V, Section 5.1(e) with provisions made to clarify when such services may also be obtained elsewhere; (2) that once enrolled, the Enrollees will receive a card from the Department which identifies such Enrollees as enrolled in an MCO; and (3) that the Contractor must inform Potential Enrollees of any Covered Services that will not be offered by the Contractor due to the Contractor's exercise of a right of conscience. (d) Upon the Contractor's request, the Department may refuse Enrollment for at least a six-month period to those former Enrollees previously terminated from coverage by the Contractor for "good cause," as specified in Article IV, Section 4.4(a)(1). (e) When an Enrollee, who is a Head of Case, gives birth and the newborn is added to a Case before the newborn is forty-five (45) days old, coverage shall be retroactive to the date of birth. Coverage for all other newborns shall be prospective according to standard Enrollment terms of this Contract. (f) From birth through age eighteen (18), Potential Enrollees who are added to a Case in which all members of the Case are enrolled with the Contractor, will also be enrolled with the Contractor automatically. Coverage shall begin as designated by the Department on the first day of a calendar month no later than three (3) calendar months from the date the Potential Enrollee was added to the Case. (g) No later than ten (10) business days following receipt of the Prelisting Report, the Contractor must send new Enrollees an identification card bearing the name of the Contractor's Plan; the effective date of coverage; the twenty-four-hour telephone number to confirm eligibility for benefits and authorization for services and the name and phone number of the Primary Care Provider and, if applicable, the Women's Health Care Provider. Samples of the identification cards described herein shall be submitted for Department approval by the Contractor prior to use by the Contractor and as revised. The Contractor shall not be required to submit for prior approval format changes, provided there is no change in the information conveyed. (1) If the Contractor requires a female Enrollee who wishes to use a Women's Health Care Provider to designate a specific Women's Health Care Provider and if a female Enrollee does so designate a Women's Health Care Provider, the name and phone number of that Women's Health Care Provider must appear on the identification card. (h) Within three (3) business days following receipt of the Prelisting Report, the Contractor must update the Enrollees' eligibility in all electronic systems maintained by the Contractor.