Common use of Non-PCP Provider Termination Clause in Contracts

Non-PCP Provider Termination. If a non-PCP provider, including but not limited to a specialist or hospital, ceases participation in the CONTRACTOR’s MCO, the CONTRACTOR shall provide written notice to members who have been seen and/or treated by the non-PCP provider within the last six (6) months. Notice shall be issued no less than thirty (30) days prior to the effective date of the termination of the non-PCP provider when possible or immediately upon the CONTRACTOR becoming aware of the termination. 21. Section 2.11.8.2.3.1 shall be amended by adding new text and shall read as follows: 2.11.8.2.3.1 The CONTRACTOR shall notify TENNCARE of any provider termination and shall submit an excel spreadsheet that includes the provider’s name, TennCare provider identification number, NPI number, and the number of enrollees affected within five (5) business days of the provider’s termination. If the termination was initiated by the provider, the notice to TENNCARE shall include a copy of the provider’s notification to the CONTRACTOR. The CONTRACTOR shall maintain documentation of all information, including a copy of the actual member notice(s) on-site. Upon request, the CONTRACTOR shall provide TENNCARE a copy of the following: one or more of the actual member notices mailed, an electronic listing in Excel identifying each member to whom a notice was sent,. a transition plan for the enrollees affected, and documentation from the CONTRACTOR's mail room or outside vendor indicating the quantity and date member notices were mailed as proof of compliance with the member notification requirements. 22. Section 2.12.7 shall be amended by adding a new Section 2.12.7.53 and renumbering existing subparts accordingly, including any references thereto.