Common use of Provider Enrollment and Disenrollment Clause in Contracts

Provider Enrollment and Disenrollment. The Contractor shall be responsible for meeting all provider screening and enrollment requirements described in 42 CFR 455 Subpart E. The Contractor is prohibited from contracting with providers who have been excluded from the Federal Government or by the State's Medicaid program for fraud or abuse. The Contractor shall be responsible for checking the lists of providers currently excluded by the State and the Federal Government every thirty (30) calendar days. The federal list is available at: xxxx://xxxxxxxxxx.xxx.xxx.xxx. FSSA reserves the right to immediately disenroll any provider if the provider becomes ineligible to participate in the IHCP. When a provider serving as the primary source of care for a member voluntarily or involuntarily disenrolls from the Contractor’s network, the Contractor is responsible for assisting members in selecting a new provider within the Contractor’s network. In accordance with 42 CFR 438.10(f), the Contractor must make a good faith effort to provide written notice of a provider’s disenrollment to any member that has received primary care services from that provider or otherwise sees the provider on a regular basis. Such notice must be provided by the later of thirty (30) days prior to the effective date of the termination or within fifteen (15) calendar days of the Contractor’s receipt or issuance of the provider termination notice. If a provider disenrolls from the Contractor but remains an ICHP provider, the Contractor must assure that the provider provides continuation of care for his or her Hoosier Care Connect members for a minimum of thirty (30) calendar days or until the member is linked to another provider. The Contractor shall submit provider enrollment and disenrollment data to the State or its designee in the manner and format prescribed by FSSA. When advanced notice of provider disenrollment is available, disenrollment data shall be submitted within five (5) business days prior to the effective disenrollment date. When advanced notice is not feasible, including, but not limited to, in the event of provider death or exclusion due to fraud or abuse, the Contractor shall submit the disenrollment within five (5) business days of the provider’s termination effective date.

Provider Enrollment and Disenrollment. The Contractor shall be responsible for meeting all provider screening and enrollment requirements described in 42 CFR 455 Subpart E. The Contractor is prohibited from contracting with providers who have been excluded from the Federal Government or by the State's Medicaid program for fraud or abuse. The Contractor shall be responsible for checking the lists of providers currently excluded by the State and the Federal Government every thirty (30) calendar days. The federal list is available at: xxxx://xxxxxxxxxx.xxx.xxx.xxx. FSSA reserves the right to immediately disenroll any provider if the provider becomes ineligible to participate in the IHCP. When a provider serving as the primary source of care for a member voluntarily or involuntarily disenrolls from the Contractor’s network, the Contractor is responsible for assisting members in selecting a new provider within the Contractor’s network. In accordance with 42 CFR 438.10(f), the Contractor must make a good faith effort to provide written notice of a provider’s disenrollment to any member that has received primary care services from that provider or otherwise sees the provider on a regular basis. Such notice must be provided by the later of thirty (30) days prior to the effective date of the termination or within fifteen (15) calendar days of the Contractor’s receipt or issuance of the provider termination notice. If a provider disenrolls from the Contractor but remains an ICHP provider, the Contractor must assure that the provider provides continuation of care for his or her Hoosier Care Connect members for a minimum of thirty (30) calendar days or until the member is linked to another provider. The Contractor shall submit provider enrollment and disenrollment data to the State or its designee in the manner and format prescribed by FSSA. When advanced notice of provider disenrollment is available, disenrollment data shall be submitted within five (5) business days prior to the effective disenrollment date. When advanced notice is not feasible, including, but not limited to, in the event of provider death or exclusion due to fraud or abuse, the Contractor shall submit the disenrollment within five (5) business days of the provider’s termination effective date.