Monthly File. The Department will provide a Monthly 834 Eligibility File to the PH-MCO on the next to the last Saturday of each month. The file will contain the MA Eligibility Period, PH-MCO coverage, BH-MCO coverage and other Recipient demographic information. It will contain only the most current record for each HealthChoices Recipient where the Member is both MA and Managed Care eligible at some point in the following month. The PH-MCO must reconcile this membership file against its internal membership information. If discrepancies are found, the PH-MCO must first check eCIS and the Daily 834 file to see if the discrepancy has been resolved prior to reaching out to the Department. If the discrepancy persists the MCO must notify the Department within thirty (30) business days. Recipients not included on the Monthly 834 file with an indication of prospective coverage will not be the responsibility of the PH-MCO unless a subsequent Daily 834 Membership File indicates otherwise.
Appears in 2 contracts
Sources: Healthchoices Physical Health Grant Agreement, Healthchoices Agreement