Enrollment Broker. The entity engaged by DCH to assist in outreach, education and Enrollment activities associated with the GF program. Enrollment Period: The twelve (12) month period commencing on the effective date of Enrollment.
Enrollment Broker. An entity contracted by the Michigan Department of Technology Management and Budget (DTMB) to contact, educate and perform general Enrollment, disenrollment, and changes of Enrollment functions for Medicaid and Medicare Beneficiaries eligible for the Demonstration.
Enrollment Broker. Entity contracted by DHCS through the Health Care Options Program to provide information and enrollment assistance to Medicare-Medi-Cal beneficiaries.
Enrollment Broker. The state will contract with an independent entity to assist beneficiaries with the Medicaid managed care enrollment and plan selection process.
Enrollment Broker. The state’s contracted or designated entity that performs functions related to outreach, education, enrollment, and disenrollment of potential enrollees into a Managed Care Plan. Enrollment Files — X-12 834 files sent by the Agency’s Medicaid fiscal agent to the Managed Care Plans to provide the Managed Care Plans with their official Medicaid recipient enrollment. Supplemental enrollment files are provided by the Agency’s Medicaid enrollment broker; these files contain additional demographic data and provider choice data not available on the X-12 834 enrollment files. Enrollment Specialists — Individuals, authorized through an Agency-approved process, who provide one-on-one information to Medicaid recipients to help them choose the Managed Care Plan that best meets the health care needs of them and their families.
Enrollment Broker. The entity engaged by DCH to assist in outreach, education and Enrollment activities associated with the GHF program. Enrollment Period: The twelve (12) month period commencing on the effective date of Enrollment. External Quality Review (EQR): The analysis and evaluation by an external quality review organization of aggregated information on quality, timeliness, and access to the Health Care services that a CMO or its Subcontractors furnish to Members and to DCH. External Quality Review Organization (EQRO): An organization that meets the competence and independence requirements set forth in 42 CFR 438.354 and performs external quality review, and other related activities. Federal Financial Participation (FFP): The funding contribution that the federal government makes to the Georgia Medicaid and PeachCare for Kids programs. Federally Qualified Health Center (FQHC): An entity that provides outpatient health programs pursuant to Section 1905(l)(2)(B) of the Social Security Act. Fee-for-Service (FFS): A method of reimbursement based on payment for specific services rendered to a Member.
Enrollment Broker. The state’s contracted or designated entity that performs functions related to outreach, education, enrollment, and disenrollment of potential enrollees into a managed care plan. Enrollment Specialists — Individuals, authorized through an Agency-approved process, who provide one-on-one information to Medicaid recipients to help them choose the managed care plan that best meets the health care needs of them and their families.
Enrollment Broker. An independent entity contracted with the State, which is responsible for processing all enrollment and disenrollment transactions. The Enrollment Broker will educate Participants on all potential plan choices and ensure ongoing customer service related to outreach, education, and support for individuals eligible for the Demonstration. The Enrollment Broker will incorporate the option of Program of All-Inclusive Care for the Elderly plan (PACE) enrollment into its scripts and protocols.
Enrollment Broker. The entity engaged by DCH to assist in outreach, education and Enrollment activities associated with the GF program.
Enrollment Broker. The State’s designated contractor that performs functions related to choice counseling, enrollment and disenrollment of potential enrollees and enrollees into an MCO. Evidence-Based Practice – Clinical interventions that have demonstrated positive outcomes in several research studies to assist consumers in achieving their desired goals of health and wellness. Excluded Populations – Medicaid beneficiaries who are excluded from MCO enrollment. Excluded Services* – Those services which enrollees may obtain under the Louisiana Medicaid State Plan and for which the Contractor is not financially responsible.
