Enrollment activities definition

Enrollment activities means activities that OHCA performs or conducts related to distributing, collecting, or processing enrollment materials, taking enrollments by technological device or in person, or enrolling or disenrolling eligibles into any MCO or DBM.

Split View

AI-Powered Contracts

Draft, Review & Redline at the Speed of AI

Get StartedSchedule a Demo

Enrollment activities means activities performed or conducted by OHCA related to distributing, collecting, or processing enrollment materials, taking enrollments by technological device or in person, or enrolling or disenrolling, including by algorithm, Medicaid beneficiaries with respect to any health plan or managed care services contract.

Enrollment activities means activities such as distributing, collecting, and processing enrollment materials and taking enrollments by phone or in person.

Examples of Enrollment activities in a sentence

• Agent: An entity that contracts with the State of Georgia to perform administrative functions, including but not limited to: fiscal agent activities; outreach, eligibility, and Enrollment activities; Systems and technical support; etc.

• The entity engaged by DCH to assist in outreach, education and Enrollment activities associated with the GF program.

• If the PIPs, CAHPS, the PMs, the annual Medical Record audit or the EQRO indicate that the Health Plan's performance is not acceptable, then the Agency may restrict the Health Plan’s Enrollment activities including, but not limited to, termination of Mandatory Assignments.

• An entity that contracts with ASES to perform administrative services, including but not limited to: fiscal agent activities; outreach, eligibility, and Enrollment activities; and Information Systems and technical support.

• When considering whether to impose a limitation on Enrollment activities or Mandatory Assignments, the Agency may take into account the Health Plan’s cumulative performance on all QI activities.

• Agent: An entity that contracts with ASES to perform Administrative Functions, including but not limited to: fiscal Agent activities; Outreach, eligibility, and Enrollment activities; and systems and technical support.

• If the Health Plan fails to provide a CAP within the time specified by the Agency, the Agency shall sanction the Health Plan, in accordance with the provisions of Section XIV, Sanctions, and may immediately terminate all Enrollment activities and Mandatory Assignments.

• The Agency may restrict the Health Plan’s Enrollment activities if the Health Plan does not meet acceptable Quality Improvement and performance indicators, based on HEDIS reports and other outcome measures to be determined by the Agency.

• This administrative office must be open at least between the hours of 9:00 a.m. and 5:00 p.m. Puerto Rico Time, Monday through Friday; in addition, pursuant to the Contractor’s Enrollment Outreach Plan (see Section 6.12.2 of this Contract), the Contractor’s administrative office must have extended opening hours (until 7:00 p.m.) one Business Day per week; and must be open (to the extent necessary to permit Enrollment activities) one Saturday per month, from 9:00 a.m. to 5:00 p.m.

• When considering whether to impose a limitation on Enrollment activities or Mandatory Assignment, the Agency may take into account the Health Plan’s cumulative performance on all QI activities.

More Definitions of Enrollment activities

Enrollment activities means activities performed or conducted by OHCA related to distributing, collecting, or processing enrollment materials, taking enrollments by technological

Enrollment activities means activities performed or conducted by the Company and/or Employer relating to enrolling and disenrolling Participants and Dependents with respect to the Plan, including, but not limited to the following::

Enrollment activities means activities performed or conducted by the Company and/or Employer relating to enrolling and disenrolling Participants and Dependents with respect to the Plan, including, but not limited to the following:: (a) Determining a Participant’s and Dependent’s eligibility to participate in the Plan (and determining when such participation terminates); (b) Any system, procedure or practice to capture Enrollment Information relating to the enrollment and disenrollment of Participants and Dependents with respect to the Plan, including updating and revising their enrollment and disenrollment status with respect to the Plan during the Plan Year; and (c) Any system, procedure or practice for communicating, transferring, sending and receiving the Enrollment Information of Participants and Dependents with respect to the Plan to and from the Employer, Participants, Dependants, Business and other designated agents.

Enrollment activities means activities such as distributing, collecting, and processing enrollment materials and taking enrollments by phone or in person. Enrollee means a Medicaid recipient who is currently enrolled in an MCO, PIHP, PAHP, or PCCM in a given managed care program. Potential enrollee means a Medicaid recipient who is subject to mandatory enrollment or may voluntarily elect to enroll in a given managed care program, but is not yet an enrollee of a specific MCO, PIHP, PAHP, and PCCM Basic Rules. The Contractor, acting as the enrollment broker for the State of Iowa, and enrolling eligible recipients into managed care plans must provide all enrollment notices, informational materials, and instructional materials relating to enrollees and potential enrollees in a manner and format that is easily understood by enrollees and potential enrollees. All written materials must be approved by the State prior to use.