Common use of MCO-Requested Disenrollment Procedure Clause in Contracts

MCO-Requested Disenrollment Procedure. a) The MCO shall complete and submit to the Department contract coordinator form F-02403 requesting the member’s disenrollment along with documentation of the basis for the request, a thorough review of issues leading to the request and evidence that supports the request. For disenrollment requests based on a member no longer accepting services authorized by the MCO, this documentation must include the last date on which services were provided to the member, a copy of the certified letter sent to the member and relevant case notes.

MCO-Requested Disenrollment Procedure. a) The MCO shall complete and submit to the Department contract coordinator form F-02403 F-00221B requesting the member’s disenrollment along with documentation of the basis for the request, a thorough review of issues leading to the request and evidence that supports the request. For disenrollment requests based on a member no longer accepting services authorized by the MCO, this documentation must include the last date on which services were provided to the member, a copy of the certified letter sent to the member and relevant case notes.

MCO-Requested Disenrollment Procedure. a) The MCO shall complete and submit to the Department contract coordinator form F-02403 requesting a written request to process the member’s disenrollment along with disenrollment, which includes documentation of the basis for the request, a thorough review of issues leading to the request and evidence that supports the request. For disenrollment requests based on a member no longer accepting services authorized by the MCO, this documentation must include the last date on which services were provided to the member, a copy of the certified letter sent to the member and relevant case notes.

MCO-Requested Disenrollment Procedure. a) The MCO shall complete and submit to the Department contract coordinator form F-02403 requesting a written request to process the member’s disenrollment along with disenrollment, which includes documentation of the basis for the request, a thorough review of issues leading to the request and evidence that supports the request. For disenrollment requests based on a member no longer accepting services authorized by the MCO, this documentation must include the last date on which services were provided to the member, a copy of the certified letter sent to the member and relevant case notes.