Provider Screening and Enrollment Sample Clauses

Provider Screening and Enrollment. All Network Providers must be screened and enrolled in accordance with Title 42 CFR 438.602(b), and APL 19-004. A. DHCS, and other designated State departments, are required to enroll Network Providers in accordance with 42 CFR Section 438.602(b), APL 19-004. DHCS has provided Contractor with the option to enroll Network Providers under delegated authority in accordance with APL 19-004. B. If Contractor elects to enroll Network Providers under its delegated authority, Contractor must screen and enroll Provider types for which there is an existing Medi-Cal Fee-For-Service state-level pathway. Contractor must also screen and enroll Provider types that are not currently enrolled in Medi-Cal FFS if those Provider types are necessary to maintain an adequate Network. Contractor shall confirm that a Provider is enrolled, or not subject to enrollment, prior to contracting with the Provider. If Contractor elects to enroll Network Providers, Contractor shall implement and maintain requirements for the screening and enrollment of Network Providers consistent with 42 CFR Section 438.602(b), and APL 19-004.
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Related to Provider Screening and Enrollment

  • Medicaid Enrollment Treatment Grantees shall enroll as a provider with Texas Medicaid and Healthcare Partnership (TMHP) and all Medicaid Managed Care organizations in Grantee’s service region within the first quarter of this procurement term and maintain through the procurement term.

  • Medical Verification The Town may require medical verification of an employee’s absence if the Town perceives the employee is abusing sick leave or has used an excessive amount of sick leave. The Town may require medical verification of an employee’s absence to verify that the employee is able to return to work with or without restrictions.

  • Contract for Professional Services of Physicians, Optometrists, and Registered Nurses In accordance with Senate Bill 799, Acts 2021, 87th Leg., R.S., if Texas Government Code, Section 2254.008(a)(2) is applicable to this Contract, Contractor affirms that it possesses the necessary occupational licenses and experience.

  • Open Enrollment KFHPWA will allow enrollment of Subscribers and Dependents who did not enroll when newly eligible as described above during a limited period of time specified by the Group and KFHPWA.

  • Screening The Health Plan must work with contracted providers to conduct interperiodic EPSDT screens on RIte Care and all ACA Adult Expansion Population members under age 21 (i.e. 19 and 20-year old under this Agreement) to identify health and developmental problems in conformance with ATTACHMENT ED to this Agreement. Additional screens should be provided as Medically Necessary. At a minimum, these screens must include: • A comprehensive health and developmental history, including health education, nutrition assessment, immunization history, and developmental assessment • Immunizations according to the Rhode Island EPSDT Periodicity Schedule • An unclothed physical examination • Laboratory tests including lead, TB, and newborn screenings as medically indicated • Vision testing • Hearing testing • Dental screening oral examination by PCP as part of a comprehensive examination required before age one (1) • All other medically indicated screening services • And provide EOHHS with a list of established CPT/HCPC codes used to identify all billable services included in the EPSDT schedule.