Common use of ENROLLMENT PROCESSING Clause in Contracts

ENROLLMENT PROCESSING. 2.4.6.1.1. Enrollment and disenrollment shall be processed through the One Care Plan, consistent with the Effective Enrollment Date requirements outlined in Section 2.4.6.2, and the requirements for marketing, education, and enrollment activities described in Section 2.12.1. 2.4.6.1.2. At EOHHS’s discretion, EOHHS may require the Contractor to opt into the Medicare Online Enrollment Center (OEC) to receive Medicare Enrollment and Disenrollment requests for its One Care Plan; upon such direction from EOHHS, the Contractor shall opt in and maintain participation in the OEC throughout the Contract Term. 2.4.6.1.3. The Contractor shall: 2.4.6.1.3.1. Have a mechanism for sending and receiving timely information about all Enrollees, including confirmation of the Effective Enrollment Date, from CMS and MassHealth systems; 2.4.6.1.3.2. Submit enrollment requests to EOHHS via the Provider Online Service Center on behalf of MassHealth Members eligible for, and seeking to enroll in, the Contractor’s One Care Plan; 2.4.6.1.3.3. Submit and receive aligned enrollment transactions to CMS or its designee for Medicare coverage through the Contractor’s One Care Plan, in accordance with CMS requirements; 2.4.6.1.3.4. Maintain aligned Medicare and Medicaid enrollments in the Contractor’s One Care Plan; 2.4.6.1.3.5. On each business day, obtain from EOHHS, the daily and monthly (as available) via the HIPAA 834 Enrollment Files, and process information pertaining to all enrollments in the Contractor’s Plan, including the Effective Date of Enrollment; 2.4.6.1.3.6. The Contractor’s internal enrollment system shall be configured to automatically ingest these files and use them for the following purposes:

ENROLLMENT PROCESSING. 2.4.6.1.1. Enrollment and disenrollment shall be processed through the One Care SCO Plan, consistent with the Effective Enrollment Date requirements outlined in Section 2.4.6.2, and the requirements for marketing, education, and enrollment activities described in Section 2.12.1. 2.4.6.1.2. At EOHHS’s discretion, EOHHS may require the Contractor to opt into the Medicare Online Enrollment Center (OEC) to receive Medicare Enrollment and Disenrollment requests for its One Care SCO Plan; upon such direction from EOHHS, the Contractor shall opt in and maintain participation in the OEC throughout the Contract Term. 2.4.6.1.3. The Contractor shall: 2.4.6.1.3.1. Have a mechanism for sending and receiving timely information about all Enrollees, including confirmation of the Effective Enrollment Date, from CMS and MassHealth systems; 2.4.6.1.3.2. Submit enrollment requests to EOHHS via the Provider Online Service Center on behalf of MassHealth Members eligible for, and seeking to enroll in, the Contractor’s One Care SCO Plan; 2.4.6.1.3.3. Submit and receive aligned enrollment transactions to CMS or its designee for Medicare coverage through the Contractor’s One Care SCO Plan, in accordance with CMS requirements; 2.4.6.1.3.4. Maintain aligned Medicare and Medicaid enrollments in the Contractor’s One Care SCO Plan;. 2.4.6.1.3.5. On each business day, obtain from EOHHS, the daily and monthly (as available) via the HIPAA 834 Enrollment Files, and process information pertaining to all enrollments in the Contractor’s Plan, including the Effective Date of Enrollment; 2.4.6.1.3.6. The Contractor’s internal enrollment system shall be configured to automatically ingest these files and use them for the following purposes: