State Hearing Process. The MCOP shall develop and implement written policies and procedures that ensure the MCOP's compliance with the state hearing provisions specified in division 5101:6 of the Administrative Code. Upon request, the MCOP's state hearing policies and procedures shall be made available for review by ODM. When the MCOP is notified by BSH that a member has requested a state hearing, the MCOP shall review the state hearing request and within two business days of receipt of the BSH notice, confirm via email to ▇▇▇▇▇_▇▇▇▇▇▇▇▇_▇▇▇▇▇▇▇▇▇▇@▇▇▇.▇▇▇▇.▇▇▇ one of the following: i. The MCOP has no record that the member has requested a plan appeal pertaining to the state hearing request; ii. The MCOP made an adverse appeal resolution pertaining to the state hearing request, whether or not the appeal was expedited, and attach a copy of the State Hearing Notice issued to the member; iii. The MCOP made a decision to authorize the services pertaining to the state hearing request and identify the date the member and provider were notified of the authorization; or iv. The MCOP has not yet made a decision on the appeal request pertaining to the state hearing request and identify the date the MCOP received the appeal request and the date the MCOP is currently required to decide an appeal resolution. Unless the timeframe for a member to file an appeal to the MCOP is exhausted in accordance with OAC 5160-58-08.4, if the MCOP confirms to BSH that there is no record of the member requesting a plan appeal, the MCOP shall attempt to contact the member to initiate the plan appeal process.
Appears in 20 contracts
Sources: Provider Agreement, Provider Agreement, Provider Agreement
State Hearing Process. The MCOP MCP shall develop and implement written policies and procedures that ensure the MCOPMCP's compliance with the state hearing provisions specified in division 5101:6 of the Administrative Code. Upon request, the MCOPMCP's state hearing policies and procedures shall be made available for review by ODM. When the MCOP MCP is notified by BSH that a member has requested a state hearing, the MCOP MCP shall review the state hearing request and within two business days of receipt of the BSH notice, confirm via email to ▇▇▇▇▇_▇▇▇▇▇▇▇▇_▇▇▇▇▇▇▇▇▇▇@▇▇▇.▇▇▇▇.▇▇▇ one of the following:
i. The MCOP MCP has no record that the member has requested a plan appeal pertaining to the state hearing request;
ii. The MCOP MCP made an adverse appeal resolution pertaining to the state hearing request, whether or not the appeal was expedited, and attach a copy of the State Hearing Notice issued to the member;
iii. The MCOP MCP made a decision to authorize the services pertaining to the state hearing request and identify the date the member and provider were notified of the authorization; or
iv. The MCOP MCP has not yet made a decision on the appeal request pertaining to the state hearing request and identify the date the MCOP MCP received the appeal request and the date the MCOP MCP is currently required to decide an appeal resolution. Unless the timeframe for a member to file an appeal to with the MCOP MCP is exhausted in accordance with OAC rule 5160-5826-08.4, if the MCOP MCP confirms to BSH that there is no record of the member requesting a plan appeal, the MCOP MCP shall attempt to contact the member to initiate the plan appeal process.
Appears in 17 contracts
Sources: Provider Agreement, Provider Agreement, Provider Agreement
State Hearing Process. The MCOP shall MCO must develop and implement written policies and procedures that ensure the MCOPMCO's compliance with the state hearing provisions specified in pursuant to division 5101:6 of the Administrative Code. Upon request, the MCOP's The MCO must submit its state hearing policies and procedures shall be made available for review and approval by ODM upon ODM's request. When the MCOP MCO is notified by BSH the Bureau of State Hearings that a member has requested a state hearing, the MCOP shall MCO must review the state hearing request and within two business days of receipt of the BSH Bureau of State Hearings notice, confirm via email to ▇▇▇▇▇_▇▇▇▇▇▇▇▇_▇▇▇▇▇▇▇▇▇▇@▇▇▇.▇▇▇▇.▇▇▇ one of the following:
i. : The MCOP MCO has no record that the member has requested a plan an MCO appeal pertaining to the state hearing request;
ii. In this event, the MCO must attempt to contact the member to initiate the MCO appeal process unless the timeframe for a member to file an appeal with the MCO has been exhausted in accordance with OAC rule5160-26- 08.4. The MCOP MCO made an adverse appeal resolution pertaining to the state hearing request, whether or not the appeal was expedited, and attach a copy of the State Hearing Notice issued to the member;
iii. The MCOP MCO made a decision to authorize the services pertaining to the state hearing request and identify the date the member and provider were notified of the authorization; or
iv. The MCOP MCO has not yet made a decision on the appeal request pertaining to the state hearing request request, identify the date the MCO received the appeal request, and identify the date the MCOP received the appeal request and the date the MCOP is MCO must currently required to decide an issue a timely appeal resolution. Unless the timeframe for a member to file an appeal to the MCOP is exhausted in accordance with OAC 5160-58-08.4, if the MCOP confirms to BSH that there is no record of the member requesting a plan appeal, the MCOP shall attempt to contact the member to initiate the plan appeal process.
Appears in 4 contracts
Sources: Ohio Medicaid Provider Agreement for Managed Care Organization, Ohio Medicaid Provider Agreement for Managed Care Organization, Ohio Medicaid Provider Agreement for Managed Care Organization
State Hearing Process. The MCOP shall MCO must develop and implement written policies and procedures that ensure the MCOPMCO's compliance with the state hearing provisions specified in pursuant to division 5101:6 of the Administrative Code. Upon request, the MCOP's The MCO must submit its state hearing policies and procedures shall be made available for review and approval by ODM upon ODM's request. When the MCOP MCO is notified by BSH the Bureau of State Hearings that a member has requested a state hearing, the MCOP shall MCO must review the state hearing request and within two business days of receipt of the BSH Bureau of State Hearings notice, confirm via email to ▇▇▇▇▇_▇▇▇▇▇▇▇▇_▇▇▇▇▇▇▇▇▇▇@▇▇▇.▇▇▇▇.▇▇▇ one of the following:
i. : The MCOP MCO has no record that the member has requested a plan an MCO appeal pertaining to the state hearing request;.
iia. In this event, the MCO must attempt to contact the member to initiate the MCO appeal process unless the timeframe for a member to file an appeal with the MCO has been exhausted in accordance with OAC rule5160-26-08.4. The MCOP MCO made an adverse appeal resolution pertaining to the state hearing request, whether or not the appeal was expedited, and attach a copy of the State Hearing Notice issued to the member;
iii. The MCOP MCO made a decision to authorize the services pertaining to the state hearing request and identify the date the member and provider were notified of the authorization; or
iv. The MCOP MCO has not yet made a decision on the appeal request pertaining to the state hearing request request, identify the date the MCO received the appeal request, and identify the date the MCOP received the appeal request and the date the MCOP is MCO must currently required to decide an issue a timely appeal resolution. Unless the timeframe for a member to file an appeal to the MCOP is exhausted in accordance with OAC 5160-58-08.4, if the MCOP confirms to BSH that there is no record of the member requesting a plan appeal, the MCOP shall attempt to contact the member to initiate the plan appeal process.
Appears in 3 contracts
Sources: Ohio Medicaid Provider Agreement for Managed Care Organization, Ohio Medicaid Provider Agreement for Managed Care Organization, Ohio Medicaid Provider Agreement for Managed Care Organization
State Hearing Process. The MCOP MCP shall develop and implement written policies and procedures that ensure the MCOPMCP's compliance with the state hearing provisions specified in division 5101:6 of the Administrative Code. Upon request, the MCOPMCP's state hearing policies and procedures shall be made available for review by ODM. When the MCOP MCP is notified by BSH that a member has requested a state hearing, the MCOP MCP shall review the state hearing request and within two business days of receipt of the BSH notice, confirm via email to ▇▇▇▇▇_▇▇▇▇▇▇▇▇_▇▇▇▇▇▇▇▇▇▇@▇▇▇.▇▇▇▇.▇▇▇ one of the following:
i. The MCOP MCP has no record that the member has requested a plan appeal pertaining to the state hearing request;
ii. The MCOP MCP made an adverse appeal resolution pertaining to the state hearing request, whether or not the appeal was expedited, and attach a copy of the State Hearing Notice issued to the member;
iii. The MCOP MCP made a decision to authorize the services pertaining to the state hearing request and identify the date the member and provider were notified of the authorization; or
iv. The MCOP MCP has not yet made a decision on the appeal request pertaining to the state hearing request and identify the date the MCOP MCP received the appeal request and the date the MCOP is currently required to decide an appeal resolution. Unless the timeframe for a member to file an appeal to with the MCOP MCP is exhausted in accordance with OAC rule 5160-5826-08.4, if the MCOP MCP confirms to BSH that there is no record of the member requesting a plan appeal, the MCOP MCP shall attempt to contact the member to initiate the plan appeal process.
Appears in 2 contracts
Sources: Provider Agreement, Provider Agreement
State Hearing Process. The MCOP shall MCO must develop and implement written policies and procedures that ensure the MCOPMCO's compliance with the state hearing provisions specified in pursuant to division 5101:6 of the Administrative Code. Upon request, the MCOP's The MCO must submit its state hearing policies and procedures shall be made available for review and approval by ODM upon ODM's request. When the MCOP MCO is notified by BSH the Bureau of State Hearings that a member has requested a state hearing, the MCOP shall MCO must review the state hearing request and within two business days of receipt of the BSH Bureau of State Hearings notice, confirm via email to ▇▇▇▇▇_▇▇▇▇▇▇▇▇_▇▇▇▇▇▇▇▇▇▇@▇▇▇.▇▇▇▇.▇▇▇ one of the following:
i. : The MCOP MCO has no record that the member has requested a plan an MCO appeal pertaining to the state hearing request;.
iia. In this event, the MCO must attempt to contact the member to initiate the MCO appeal process unless the timeframe for a member to file an appeal with the MCO has been exhausted in accordance with OAC rule5160-26- 08.4. The MCOP MCO made an adverse appeal resolution pertaining to the state hearing request, whether or not the appeal was expedited, and attach a copy of the State Hearing Notice issued to the member;
iii. The MCOP MCO made a decision to authorize the services pertaining to the state hearing request and identify the date the member and provider were notified of the authorization; or
iv. The MCOP MCO has not yet made a decision on the appeal request pertaining to the state hearing request request, identify the date the MCO received the appeal request, and identify the date the MCOP received the appeal request and the date the MCOP is MCO must currently required to decide an issue a timely appeal resolution. Unless the timeframe for a member to file an appeal to the MCOP is exhausted in accordance with OAC 5160-58-08.4, if the MCOP confirms to BSH that there is no record of the member requesting a plan appeal, the MCOP shall attempt to contact the member to initiate the plan appeal process.
Appears in 2 contracts
Sources: Ohio Medicaid Provider Agreement for Managed Care Organization, Ohio Medicaid Provider Agreement for Managed Care Organization
State Hearing Process. The MCOP MCP shall develop and implement written policies and procedures that ensure the MCOPMCP's compliance with the state hearing provisions specified in division 5101:6 of the Administrative Code. Upon request, the MCOPMCP's state hearing policies and procedures shall be made available for review by ODM. When the MCOP MCP is notified by BSH that a member has requested a state hearing, the MCOP MCP shall review the state hearing request and within two business days of receipt of the BSH notice, confirm via email to ▇▇▇▇▇_▇▇▇▇▇▇▇▇_▇▇▇▇▇▇▇▇▇▇@▇▇▇.▇▇▇▇.▇▇▇ one of the following:
i. The MCOP MCP has no record that the member has requested a plan appeal pertaining to the state hearing request;
ii. The MCOP MCP made an adverse appeal resolution pertaining to the state hearing request, whether or not the appeal was expedited, and attach a copy of the State Hearing Notice issued to the member;
iii. The MCOP MCP made a decision to authorize the services pertaining to the state hearing request and identify the date the member and provider were notified of the authorization; or
iv. The MCOP MCP has not yet made a decision on the appeal request pertaining to the state hearing request and identify the date the MCOP MCP received the appeal request and the date the MCOP MCP is currently required to decide an appeal resolution. Unless the timeframe for a member to file an appeal to with the MCOP MCP is exhausted in accordance with OAC 5160-5826-08.4, if the MCOP MCP confirms to BSH that there is no record of the member requesting a plan appeal, the MCOP MCP shall attempt to contact the member to initiate the plan appeal process.
Appears in 2 contracts
Sources: Provider Agreement, Provider Agreement
State Hearing Process. The MCOP shall develop and implement written policies and procedures that ensure the MCOP's compliance with the state hearing provisions specified in division 5101:6 of the Administrative Code. Upon request, the MCOP's state hearing policies and procedures shall be made available for review by ODM. When the MCOP is notified by BSH that a member has requested a state hearing, the MCOP shall review the state hearing request and within two business days of receipt of the BSH notice, confirm via email to ▇▇▇▇▇_▇▇▇▇▇▇▇▇_▇▇▇▇▇▇▇▇▇▇@▇▇▇.▇▇▇▇.▇▇▇ one of the following:
i. The MCOP has no record that the member has requested a plan appeal pertaining to the state hearing request;
ii. The MCOP made an adverse appeal resolution pertaining to the state hearing request, whether or not the appeal was expedited, and attach a copy of the State Hearing Notice issued to the member;
iii. The MCOP made a decision to authorize the services pertaining to the state hearing request and identify the date the member and provider were notified of the authorization; or
iv. The MCOP has not yet made a decision on the appeal request pertaining to the state hearing request and identify the date the MCOP received the appeal request and the date the MCOP is currently required to decide an appeal resolution. Unless the timeframe for a member to file an appeal to the MCOP is exhausted in accordance with OAC 5160-58-08.45160‐58‐08.4, if the MCOP confirms to BSH that there is no record of the member requesting a plan appeal, the MCOP shall attempt to contact the member to initiate the plan appeal process.
Appears in 1 contract
Sources: Provider Agreement