Common use of Re-Enrollment and Retroactive Eligibility Clause in Contracts

Re-Enrollment and Retroactive Eligibility. ‌ The Division or its Agent will automatically re-assign a Member into the Contractor in which he or she was most recently assigned if the Member has a temporary loss of eligibility, defined as less than sixty (60) Calendar Days. The Division will only retroactively enroll newborns in the categories of eligibility containing children under one (1). When Retroactive Eligibility and Retrospective Reviews requests are necessitated, the Contractor shall not deny payment for medically necessary covered services for lack of prior authorization or lack of referral. The Contractor shall not deny a claim on the basis of the provider’s failure to file the claim within a specified time period after the date of service when the provider could not have reasonably known which Contractor the Member was in during the timely filing period.

Re-Enrollment and Retroactive Eligibility. ‌ The Division or its Agent will automatically re-assign a Member into the Contractor in which he or she was most recently assigned if the Member has a temporary loss of eligibility, defined as less than sixty (60) Calendar Days. The Division will only retroactively enroll newborns in the categories of eligibility containing children under one (1). When Retroactive Eligibility and Retrospective Reviews requests are necessitated, the Contractor shall not deny payment for medically necessary covered services for lack of prior authorization or lack of referral. The Contractor shall not deny a claim on the basis of the provider’s failure to file the claim within a specified time period after the date of service when the provider could not have reasonably known which Contractor the Member was in during the timely filing period.

Re-Enrollment and Retroactive Eligibility. ‌ The Division or its Agent will automatically re-assign a Member into the Contractor in which he or she was most recently assigned if the Member has a temporary loss of eligibility, defined as less than sixty (60) Calendar Days. The Division will only retroactively enroll newborns in the categories of eligibility containing children under one (1). When Retroactive Eligibility and Retrospective Reviews requests are necessitated, the Contractor shall not deny payment for medically necessary covered services for lack of prior authorization or lack of referral. The Contractor shall not deny a claim on the basis of the providerProvider’s failure to file the claim within a specified time period after the date of service when the provider Provider could not have reasonably known which Contractor the Member was in during the timely filing period.

Re-Enrollment and Retroactive Eligibility. ‌ The Division or its Agent will automatically re-assign a Member into the Contractor in which he or she was most recently assigned if the Member has a temporary loss of eligibility, defined as less than sixty (60) Calendar Days. The Division will only retroactively enroll newborns in the categories of eligibility containing children under one (1). When Retroactive Eligibility and Retrospective Reviews requests are necessitated, the Contractor shall not deny payment for medically necessary covered services for lack of prior authorization or lack of referral. The Contractor shall not deny a claim on the basis of the providerProvider’s failure to file the claim within a specified time period after the date of service when the provider Provider could not have reasonably known which Contractor the Member was in during the timely filing period.

Re-Enrollment and Retroactive Eligibility. ‌ The Division or its Agent will automatically re-assign a Member into the Contractor in which he or she was most recently assigned if the Member has a temporary loss of eligibility, defined as less than sixty (60) Calendar Dayscalendar days. The Division will only retroactively enroll newborns in the categories of eligibility containing children under one (1). When Retroactive Eligibility and Retrospective Reviews requests are necessitated, the Contractor shall must not deny payment for medically necessary covered services for lack of prior authorization or lack of referral. The Contractor shall must not deny a claim on the basis of the provider’s failure to file the claim within a specified time period after the date of service when the provider could not have reasonably known which Contractor the Member was in during the timely filing period.