Common use of Payment Requirements/Procedures Clause in Contracts

Payment Requirements/Procedures. The HMO is responsible for the payment of all contract services provided to all BadgerCare Plus and/or Medicaid SSI members listed as ADDs or CONTINUEs on either the Initial or Final Enrollment Reports generated for the coverage period for BadgerCare Plus – Standard, Benchmark, Core Plans and for Medicaid SSI. The HMO is also responsible for the provision, or authorizing the provision of, services to all members with valid ForwardHealth ID cards indicating HMO enrollment, without regard to disputes about enrollment status and without regard to any other identification requirements. Any discrepancies between the cards and the enrollment reports must be reported to the Department for resolution. The HMO must continue to provide and authorize provision of all contract services until the discrepancy is resolved, including members who were PENDING on the Initial Report and held a valid ForwardHealth ID card indicating HMO enrollment, but did not appear as a CONTINUE on the Final Report. If a member shows on the Initial enrollment report as pending and later shows on the Final report as a disenroll, the HMO will not be liable for services after the date the disenrollment is effective. The payment for services to all newborns meeting the criteria described in the section “Capitation Payment for Newborns.”

Payment Requirements/Procedures. The HMO is responsible for the payment of all contract services provided to all BadgerCare Plus and/or Medicaid SSI members listed as ADDs or CONTINUEs on either the Initial or Final Enrollment Reports Rosters generated for the coverage period for BadgerCare Plus – Standard, Benchmark, Core Plans and for Medicaid SSI. The HMO is also responsible for the provision, or authorizing the provision of, services to all members with valid ForwardHealth ID cards indicating HMO enrollment, without regard to disputes about enrollment status and without regard to any other identification requirements. Any discrepancies between the cards and the enrollment reports rosters must be reported to the Department for resolution. The HMO must continue to provide and authorize provision of all contract services until the discrepancy is resolved, including members who were PENDING on the Initial Report Roster and held a valid ForwardHealth ID card indicating HMO enrollment, but did not appear as a CONTINUE on the Final ReportRoster. If a member shows on the Initial enrollment report roster as pending and later shows on the Final report roster as a disenroll, the HMO will not be liable for services after the date the disenrollment is effective. The payment for services to all newborns meeting the criteria described in the section “Capitation Payment for Newborns.”