Common use of Initial Coverage Clause in Contracts

Initial Coverage. 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 Enrollment is entered into the Department's database. Enrollment can occur only upon the Prospective Beneficiary's selection of a Site and the communication of that Site by the Contractor to the Department. The Contractor shall provide reasonable coordination of care assistance to Prospective Beneficiaries to access a Primary Care Provider or Women's Health Care Provider before the Contractor's coverage becomes effective, if requested to do so by Prospective Beneficiaries or if the Contractor has knowledge of the need for such assistance. The Primary Care Provider or Women's Health Care Provider selected by the Prospective Beneficiary must provide necessary service including providing pregnant women with priority services in an expedient manner in order for such Prospective Beneficiaries to establish a relationship with the Primary Care Provider or Women's Health Care Provider, promoting and ensuring continuity of care, and determining any special needs as early in the pregnancy as possible. Any payment for those services rendered to Prospective Beneficiaries described herein shall be made directly by the Department to such Providers under the provisions of the Medical Assistance Program or KidCare.