MCOs Sample Clauses

MCOs. MassHealth contracts with MCOs that provide comprehensive health coverage including behavioral health services to enrollees. MCO enrollees may receive family planning services from any provider without consulting their PCP or MCO and are not required to obtain prior approval from MassHealth. For family planning services provided by MassHealth providers not participating in the MCO network, MassHealth reimburses the provider on a FFS basis and recoups the funds from the MCO.
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MCOs predictable and expected levels of performance by a recognised leader in their industry and the lowest levels of acceptable performance nominated by RTA; and
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MCOs. Quality Management Team shall conduct a qualifying review to assess the provider’s compliance, competencies and qualifications. A minimum score of 85% must be achieved on the MCO qualification tool for the provider to be enrolled in MCO Network. If the provider does not achieve a score of 85%, the provider will be offered an opportunity to implement a Plan of Correction to address deficit areas. Failure to complete an appropriate plan of correction will result in a denial to enter the network. Within six months of enrollment, the provider must achieve a score of 100% on MCO required competencies to remain in the Network. If there is a competitive Request for Proposal, a scoring process will be developed to assess the provider’s competencies specific to the requirements of the Request for Proposal, the service definition, and enrollment requirements as delineated above. For all initial enrollment, MCO shall complete an on-site review within 6 months of service initiation. In order to achieve cultural competency, it is important for the MCO Network of Providers to have a diversity of providers and staff and ensure the cultural sensitivity of its staff. This can be accomplished by participation in MCO’s Cultural Competency Plan, which has been developed and approved by the MCO Provider Council. This requirement shall be met within the strictures of state and federal laws, which require equal opportunity in employment and bar illegal employment discrimination on the grounds of race, gender, religion, national origin or disability.
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MCOs. 1. Inform families about EPSDT. 2. Conduct outreach to ensure children receive EPSDT services. 3. Link children to primary care providers and dental providers. 4. Schedule EPSDT appointments for children. 5. Remind families when EPSDT exams are due. 6. Ensure that primary care providers participating in HUSKY A are knowledgeable about EPSDT.
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MCOs shall also comply with all other reporting requirements in this contract, including, but not limited to, the reporting requirements provided at
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Related to MCOs

  • Supplier Diversity Seller shall comply with ▇▇▇▇▇’s Supplier Diversity Program in accordance with Appendix V.

  • Medicaid If and when the Resident’s assets/funds have fallen below the Medicaid eligibility levels, and the Resident otherwise satisfies the Medicaid eligibility requirements and is not entitled to any other third party coverage, the Resident may be eligible for Medicaid (often referred to as the “payor of last resort”). THE RESIDENT, RESIDENT REPRESENTATIVE AND SPONSOR AGREE TO NOTIFY THE FACILITY AT LEAST THREE (3) MONTHS PRIOR TO THE EXHAUSTION OF THE RESIDENT’S FUNDS (APPROXIMATELY $50,000) AND/OR INSURANCE COVERAGE TO CONFIRM THAT A MEDICAID APPLICATION HAS OR WILL BE SUBMITTED TIMELY AND ENSURE THAT ALL ELIGIBILITY REQUIREMENTS HAVE BEEN MET. THE RESIDENT, RESIDENT REPRESENTATIVE AND/OR SPONSOR AGREE TO PREPARE AND FILE AN APPLICATION FOR MEDICAID BENEFITS PRIOR TO THE

  • Claims Review Population A description of the Population subject to the Claims Review.

  • Population The Population shall be defined as all Paid Claims during the 12-month period covered by the Claims Review.

  • Pharmacy Pharmacy hereby represents that neither Pharmacy, nor, to the best of Pharmacy’s knowledge, Pharmacist, Pharmacy’s employees, agents or independent