Verification of Enrollment. a. The Managed Care Plan shall review its X12-834 enrollment files to ensure that all enrollees are eligible to receive services from the Managed Care Plan, including that: (1) Each enrollee of the Managed Care Plan is residing in the same region in which they were enrolled; and (2) Each enrollee of the Managed Care Plan is not ineligible for services under the MMA, Specialty, or Comprehensive LTC Managed Care Plan, respectively, in accordance with this section and the applicable Exhibits. b. The Managed Care Plan shall notify the Agency of any discrepancies in enrollment, including enrollees not residing in the same region in which they were enrolled and enrollees not eligible for the Managed Care Plan, within five (5) business days of receipt of the enrollment file.
Appears in 2 contracts