Provider Services Function Sample Clauses
Provider Services Function. The Contractor will operate a Provider Services function during regular business hours. At a minimum, the Contractor's Provider Services staff must be responsible for the following:
a) Assisting providers with prior authorization and referral protocols.
b) Assisting providers with claims payment procedures.
c) Fielding and responding to provider questions and complaints.
Provider Services Function. (A) The Contractor shall operate Provider Services function during regular business hours.
(B) At a minimum, Provider Services staff shall be responsible for the following:
(1) training, including ongoing training, of the Contractor’s Providers on Medicaid rules and regulations that shall enable Providers to appropriately render services to Enrollees;
(2) assisting Providers to verify whether an individual is enrolled with the Health Plan;
(3) assisting Providers with prior authorizations and referral protocols;
(4) assisting Providers with claims payment procedures, including training Providers on how to bill using the National Provider Identification Number or the Department- assigned atypical provider identification number that is known to Medicaid to avoid rejection of Encounters; and
(5) ▇▇▇▇▇▇▇▇ and responding to Provider questions and the Grievance and Appeals System.
Provider Services Function. (A) The Contractor shall operate Provider Services function during regular business hours.
(B) At a minimum, Provider Services staff shall be responsible for the following:
(1) training, including ongoing training, of the Contractor’s Providers on CHIP rules and regulations that shall enable Providers to appropriately render services to Enrollees;
(2) assisting Providers to verify whether an individual is enrolled with the Dental Plan;
(3) assisting Providers with prior authorizations and referral protocols;
(4) assisting Providers with claims payment procedures; and
(5) ▇▇▇▇▇▇▇▇ and responding to Provider questions and the Grievance and Appeals System.
Provider Services Function. The Contractor shall operate Provider Services function during regular business hours.
Provider Services Function. (A) The Contractor shall operate a Provider services function during regular business hours.
(B) At a minimum, Provider services staff shall be responsible for:
(1) training, including ongoing training, of the Contractor’s Providers on Medicaid rules and regulations that shall enable Providers to appropriately render services to Enrollees;
(2) assisting Providers to verify whether an individual is enrolled with the Contractor;
(3) assisting Providers with Service Authorization Requests and referral protocols;
(4) assisting Providers with Claims payment procedures, including training Providers on how to bill using the National Provider Identifier (NPI) number or the Department-assigned atypical provider identification number that is known to Medicaid to avoid rejection of Encounter Data; and