Enrollee Eligibility. Managed Care Plan with which ILS Community Network has contracted will provide Enrollees with identification cards indicating their enrollment in a benefit agreement with Managed Care Plan. Enrollees' benefit agreements will require them to present their identification cards when seeking Covered Services from Participating Providers. Managed Care Plan shall furnish Participating Providers with access to Enrollee eligibility information through electronic or other means. Managed Care Plan shall also provide assistance to Provider in identifying Enrollees eligible to receive Covered Services. As Payors may retroactively disenroll individuals, Enrollee eligibility status is subject to change retroactively. In the event of such retroactive disenrollment, and if the Managed Care Plan has authorized Covered Services, Managed Care Plan shall be responsible for payments to Provider and shall not be permitted to recover payments made to Provider by Managed Care Plan for Covered Services rendered on or after the date of an individual's ineligibility. Provider may obtain payment directly from certain other responsible third parties for Covered Services other than authorized by the Managed Care Plan or services which are not included in the Medicaid Program as Covered Services.
Enrollee Eligibility. The continued eligibility of Enrollees to obtain Chiropractic Services shall be in accordance with the pertinent health plan company Benefit Contract. Before providing Chiropractic Services to an Enrollee, Doctor shall verify eligibility in accordance with the applicable Plan Summary. Doctor shall not be entitled to payment from any Payor for services provided to any person who is not an eligible Enrollee at the time such services were delivered. Health plan company retains the right of final verification of eligibility. A health plan company’s verification supersedes any authorization of care, Plan Summary and/or claims payment review made by CCMI.
