Enrollment Specialist definition

Enrollment Specialist. An entity contracted by the Department to perform HMO choice counseling and HMO enrollment activities. Choice counseling refers to activities such as answering questions and providing unbiased information on available managed care organization delivery system options, and advising on what factors to consider when choosing among HMOs and in selecting a primary care provider. Enrollment activities refers to distributing, collecting, and processing enrollment materials and taking enrollments by phone, by mail, or in person. Estimated Data Completeness: A measure used by the Department to evaluate HMO compliance with encounter submission requirements. Excluded Services: Services that Medicaid does not pay for. Expedited Grievance or Appeal: An emergency or urgent situation in which a member or their authorized representative requests a review of a situation where further delay could be a health risk to the member, as verified by a medical professional. Experimental Surgery and Procedures: Experimental services that meet the definition of Wis. Adm. Code DHS 107.035(1) and (2) as determined by the Department. External Quality Review (EQR): Per 42 CFR §438.320, the analysis and evaluation by an External Quality Review Organization of aggregated information on quality, timeliness, and access to the health care services that an HMO or their contractors furnish to Medicaid beneficiaries. External Quality Review Organization (EQRO): Per 42 CFR §438.320, an organization that meets the competence and independence requirements set forth in 42 CFR §438.354, and performs external quality review, other EQR-related activities as set forth in 42 CFR §438.358, or both. Fiscal Agent (as cited in 42 CFR §455.101): A contractor that processes or pays vendor claims on behalf of the Medicaid agency. Formally Enrolled with a Continuing Care Provider (as cited in 42 CFR §441.60(d)): A member, member’s guardian, or authorized representative agrees to use one continuing care provider as the regular source of a described set of services for a stated period of time. ForwardHealth interChange: ForwardHealth interChange handles claims, prior authorizations, and other services for many of the state health care programs within a single system. Throughout this contract, the system is referred to as “interChange.” Fraud: An intentional deception or misrepresentation made by a person or entity with the knowledge that the deception could result in some unauthorized benefit to him/herself, itsel...
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Enrollment Specialist. An entity contracted by the Department to perform HMO choice counseling and HMO enrollment activities. Choice counseling refers to activities such as answering questions and providing unbiased information on available managed care organization delivery system options, and advising on what factors to consider when choosing among HMOs and in selecting a primary care provider. Enrollment activities refers to distributing, collecting, and processing enrollment materials and taking enrollments by phone, by mail, or in person. Enrollment Year: An enrollment year is defined as the continuous 12-month period beginning the first day of the calendar month in which a member is enrolled in the Benchmark or Core Plans and ending on the last day of the 12th calendar month. Further information is available in the BadgerCare Plus All-Provider Updates.
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Enrollment Specialist means the Tribal official whose duty it is to verify enrollment in the Tribe.
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Examples of Enrollment Specialist in a sentence

  • Enrollment Specialist — The individual responsible to assist Recipients with selecting a PH-MCO and PCP as well as providing information regarding Physical and Behavioral Health Services and service Providers under the HealthChoices Program.

  • The HMO may request assistance from the Department’s contracted Enrollment Specialist in situations where the member has commercial insurance that limits the members to providers outside the HMO’s network.

  • The Enrollment Specialist will assist with determining the shortest pedestrian route to the bus stop and to School whether or not it is accessible to motor vehicle traffic.

  • The applicant must notify the Enrollment Specialist or his or her designee no later than the third Friday in May as to whether the applicant will be attending the non-attendance area school.

  • Upon enrollment the Enrollment Specialist will visit with all students and families to identify potential students that have limited resources in the home, express the need, and would benefit from receiving a healthy snack upon need.

  • I can report any suspected fraud to the PPL Enrollment Specialist and/or the Florida Medicaid Fraud Unit at 1-888-419-3456.

  • Initial enrollment with be handled by the Ukids – Child Care Programs Enrollment Specialist.

  • Applications for transfer from nonattendance area students may be submitted by a student's parent(s)/guardian(s) to the Enrollment Specialist or designee from the day following the last weekday in January and not later than 4:00 p.m. on the last weekday of April of the school year immediately preceding the school year in which the student wishes to attend.

  • The parent/guardian may appeal this decision to the Enrollment Specialist or designee within three days of being notified of the revocation of transfer.

  • Applications for transfer from nonattendance area students are to be submitted by a student's parent(s)/guardian(s) to the Enrollment Specialist or designee by the first student day in January and not later than 4:00 p.m. on the last weekday of January of the school year immediately preceding the school year in which the student wishes to attend.


More Definitions of Enrollment Specialist

Enrollment Specialist. An entity contracted by the Department to perform HMO choice counseling and HMO enrollment activities. Choice counseling refers to activities such as answering questions and providing unbiased information on available managed care organization delivery system options, and advising on what factors to consider when choosing among HMOs and in selecting a primary care provider. Enrollment activities refers to distributing, collecting, and processing enrollment materials and taking enrollments by phone, by mail, or in person. Estimated Data Completeness: A measure used by the Department to evaluate HMO compliance with encounter submission requirements. It is calculated by multiplying the pricing submitted by the pricing percentage for a defined time period such as a Calendar or Fiscal Year.
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Related to Enrollment Specialist

  • Enrollment means the number of students who are enrolled in a school operated by the district on October 1. A student shall be counted as one whether the student is enrolled as a full-time or part-time student. Students enrolled in prekindergarten programs shall not be counted.

  • Benefits Specialist means a specialized position that would primarily be responsible for coordinating Client applications and appeals for State and Federal benefits.

  • Declining enrollment means a decrease in the School District’s total enrollment or enrollment in a particular program or curriculum offering which in the sole judgement of the board of education may adversely affect the School District’s current or future allocation of funds and/or the necessity of maintaining certain current class sections or curriculum offerings.

  • Peer support specialist means an individual who has experienced a severe and persistent mental illness and who has successfully completed standardized training to provide peer support services through the medical assistance program or the Iowa Behavioral Health Care Plan.

  • Disenrollment means either voluntary or involuntary termination of a participant from the Independent Choices Program.

  • Open enrollment means a period of time as defined in rule

  • Eligibility and selection criteria means criteria for determining:

  • Clinical nurse specialist means a registered nurse with relevant post-basic qualifications and 12 months’ experience working in the clinical area of his/her specified post-basic qualification, or a minimum of four years’ post-basic registration experience, including three years’ experience in the relevant specialist field and who satisfies the local criteria.

  • Participating Certified Clinical Nurse Specialist means a Certified Clinical Nurse Specialist who has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • Enrollment Form means an agreement pursuant to which an Eligible Employee may elect to enroll in the Plan, to authorize a new level of payroll deductions, or to stop payroll deductions and withdraw from an Offering Period.

  • Enrollment Agreement means an agreement between the Company and an employee, in such form as may be established by the Company from time to time, pursuant to which the employee elects to participate in this Plan, or elects changes with respect to such participation as permitted under the Plan.

  • Non-Participating Certified Clinical Nurse Specialist means a Certified Clinical Nurse Specialist who does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • Basic health plan model plan means a health plan as required in RCW 70.47.060(2)(e).

  • Random selection process means a process by which currently income-eligible households are selected for placement in affordable housing units such that no preference is given to one applicant over another except for purposes of matching household income and size with an appropriately priced and sized affordable unit (e.g., by lottery).

  • Open Enrollment Period means an enrollment period during which time any Eligible Employee and/or Dependent may apply to become a Subscriber and/or Covered Dependent, and existing Subscribers may apply to change to another provider network or coverage option, if available, or elect to terminate coverage.

  • Expedited review means an examination, in accordance with

  • Participating Retail Health Clinic means a Retail Health Clinic which has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • Random selection basis means a mechanism for selection of employees that:

  • Over-Riding Nomination Criteria means the criteria set out in clause 4.2.

  • Design Criteria Professional means a firm who holds a current certificate of registration under Chapter 481 of the Florida Statutes, to practice architecture or landscape architecture, or a firm who holds a current certificate as a registered engineer under Chapter 471 of the Florida Statutes, to practice engineering, and who is employed by or under contract to the District to provide professional architect services, landscape architect services, or engineering services in connection with the preparation of the Design Criteria Package.

  • Participating Prescription Drug Provider means an independent retail Pharmacy, chain of retail Pharmacies, mail-order Pharmacy or specialty drug Pharmacy which has entered into an agreement to provide pharmaceutical services to participants in the benefit program. A retail Participating Pharmacy may or may not be a select Participating Pharmacy as that term is used in the Vaccinations Obtained Through Participating Pharmacies section.

  • Selection Criteria means and includes all of the requirements, considerations,

  • Nomination Criteria means the criteria made up of the Over-Riding Nomination Criteria andthe Specific Nomination Factors, and is also referred to as “this Criteria”.

  • Statewide special election means a special election called by the governor or the

  • Examination Criteria means the loan classification criteria employed by, or any applicable regulations of, the Assuming Institution’s Chartering Authority at the time such action is taken, as such criteria may be amended from time to time.

  • Product Specification means a product specification for a Medical Device set out in Schedule 2;