MCO Response Time Frames Clause Samples
The "MCO Response Time Frames" clause defines the specific periods within which a Managed Care Organization (MCO) must respond to requests, inquiries, or submissions from other parties, such as providers or members. Typically, this clause outlines deadlines for acknowledging receipt of information, making determinations, or providing required documentation, and may differentiate between standard and expedited situations. By establishing clear timelines, the clause ensures timely communication and decision-making, thereby reducing delays and promoting accountability in managed care operations.
MCO Response Time Frames. The MCO must submit required reports, requests for information, documentation, ad hoc reports, data certification forms, overpayment remittances, or any other item required within the time frames provided by this Contract or by BMS. If an MCO does not submit a required or ad hoc report, requests for information, documentation, data certification form, overpayment remittance, or item required to meet any State or Federal reporting requirements (e.g., provider-preventable conditions) to BMS within the timeframes outlined in this Contract or in the BMS’ request, BMS may assess liquidated damages on the MCO. The MCO will have a one (1) business day grace period following the due date of the data, report, requests for information, documentation, overpayment remittance, or data certification form. However, for each additional day an item is overdue beyond the grace period, BMS may assess liquidated damages on the MCO as outlined in Article II, Section 6 and Appendix F.
MCO Response Time Frames. The MCO must submit required reports, requests for information, documentation, ad hoc reports, data certification forms, or any other data required within the time frames provided by this Contract or by the Department. If an MCO does not submit a required or ad hoc report, requests for information, documentation, data certification form, or data required to meet any State or Federal reporting requirements (e.g., provider-preventable conditions) to the Department within the timeframes outlined in this Contract or in the Department’s request, the Department may assess damages on the MCO. The MCO may have a one (1) business day grace period following the due date of the data, report, requests for information, documentation, or data certification form. However, for each additional calendar day an item is overdue beyond the grace period, the Department may assess damages on the MCO as outlined in Article II, Section 6 and Appendix G.
MCO Response Time Frames. The MCO must submit required reports, requests for information, documentation, ad hoc reports, data certification forms, overpayment remittances, or any other item required within the time frames provided by this Contract or by the Department. If an MCO does not submit a required or ad hoc report, requests for information, documentation, data certification form, overpayment remittance, or item required to meet any State or Federal reporting requirements (e.g., provider- preventable conditions [PPCs]) to the Department within the timeframes outlined in this Contract or in the Department’s request, the Department may assess liquidated damages on the MCO. The MCO will have a one (1) business day grace period following the due date of the data, report, requests for information, documentation, overpayment remittance, or data certification form. However, for each additional calendar day an item is overdue beyond the grace period, the Department may assess liquidated damages on the MCO as outlined in Article II, Section 6 and Appendix F.
MCO Response Time Frames. The MCO must submit required reports, documentation, ad hoc reports, data certification forms, or any other data required within the time frames provided by this Contract or by the Department. If an MCO does not submit a required or ad hoc report, documentation, data certification form, or data required to meet any State or Federal reporting requirements (e.g., drug utilization data, provider-preventable conditions) to the Department within the timeframes outlined in this contract or in the Department’s request, the Department may assess damages on the MCO. The MCO may have a one business day grace period following the due date of the data, report, documentation, or data certification form. However, for each additional day an item is overdue beyond the grace period, the Department may assess damages on the MCO as outlined in Article II, Section 6 and Exhibit H.