Pending Member. If a pending member (i.e., an eligible individual subsequent to MCP selection or assignment to an MCP, but prior to their membership effective date) contacts the selected MCP, the MCP shall provide any membership information requested, including but not limited to explaining how to access services as an MCP member and assistance in determining whether current services require prior authorization. The MCP shall also ensure any care coordination (e.g., PCP selection, prescheduled services, and transition of services) information provided by the pending member is logged in the MCP’s system and forwarded to the appropriate MCP staff for processing as required. The MCP may confirm any information provided on the CCR at this time. Such communication does not constitute confirmation of membership. Upon receipt of the CCR or the HIPAA 834, the MCP may contact a pending member to confirm information provided on the CCR or the HIPAA 834, assist with care coordination and transition of care, and inquire if the pending member has any membership questions.
Pending Member. If a pending member (i.e., an eligible individual subsequent to MCP selection or assignment to an MCP, but prior to their membership effective date) contacts the selected MCP, the MCP shall provide any membership information requested, including but not limited to explaining how to access services as an MCP member and assistance in determining whether current services require prior authorization. The MCP shall also ensure any care coordination (e.g., PCP selection, prescheduled services and transition of services) information provided by the pending member is logged in the MCP’s system and forwarded to the appropriate MCP staff for processing as required. When a member does not select a PCP, the MCP’s second rank for assignment shall be based on the member’s prior PCP claims utilization. The PCP assignment algorithm shall integrate FFS and MCP historical files. The MCP may confirm any information provided on the CCR at this time. Such communication does not constitute confirmation of membership. Upon receipt of the CCR or the HIPAA 834, the MCP may contact a pending member to confirm information provided on the CCR or the HIPAA 834, assist with care coordination and transition of care, and inquire if the pending member has any membership questions.
Pending Member. If a pending member (i.e., an eligible individual subsequent to plan selection but prior to their membership effective date) contacts the selected MCP, the MCP must provide any membership information requested, including but not limited to. assistance in determining whether the current medications require prior authorization. The MCP must also ensure that any care coordination (e.g., PCP selection, transition of services) information provided by the pending member is logged in the MCP's system and forwarded to the appropriate MCP staff for processing as required. MCPs may confirm any information provided on the CCR at this time. Such communication does not constitute confirmation of membership. MCPs are prohibited from initiating contact with a pending member. Appendix C
Pending Member. If a pending member (i.e., an eligible individual subsequent to MCO selection or assignment to an MCO, but prior to their membership effective date) contacts the selected MCO, the MCO must provide any membership information requested, including how to access services as an MCO member and assistance in determining whether the eligible individual’s current services require prior authorization. The MCO must ensure any care coordination (e.g., primary care provider [PCP] selection, prescheduled services, and transition of care) information provided by the pending member is logged in the MCO’s system and forwarded to the appropriate MCO staff for processing as required. The MCO may confirm any information provided on the Client Contact Record, or data provided by ODM, at the time the pending member contacts the MCO. Such communication does not constitute confirmation of membership. Upon receipt of the Client Contact Record or the HIPAA 834, the MCO may contact a pending member to confirm information provided on the Client Contact Record, data provided by ODM, or the HIPAA 834, assist with care coordination and transition of care, and inquire if the pending member has any membership questions.
Pending Member. (i) If a pending member (i.e., an eligible individual subsequent to plan selection but prior to their membership effective date) contacts the selected MCP, the MCP must provide any membership information requested and ensure that any care coordination (e.g., PCP selection, continuity of care) information provided by the member is forwarded to the appropriate MCP staff for processing. Such communication does not constitute confirmation of membership.
Pending Member. 1. If a pending member (i.e., a member who meets criteria for OhioRISE enrollment prior to their membership effective date or a member idenfied as meeting first day eligibility per OAC rule 5160-59-02.1) contacts the OhioRISE Plan, the OhioRISE Plan must provide any membership information requested, including how to access services as an OhioRISE Plan's member and assistance in determining whether the eligible individual's current services require prior authorization.
Pending Member. 1. If a pending member (i.e., an eligible individual subsequent to MCO selection or assignment to an MCO, but prior to their membership effective date) contacts the selected MCO, the MCO must provide any membership information requested, including how to access services as an MCO member and assistance in determining whether the eligible individual's current services require prior authorization.
