On-line Provider Website. The MCP must have a secure internet-based website for contracting providers through which providers can confirm a consumer’s enrollment and through which providers can submit and receive responses to prior authorization requests (an e-mail process is an acceptable substitute if the website includes the MCP’s e-mail address for such submissions). The MCP provider website must also include, at a minimum, the following information which must be accessible to providers and the general public without any log-in restrictions: (1) MCP contact information, including the MCP’s designated contact for provider issues; (2) a listing of the counties the MCP serves unless the MCP serves the entire state in which case the MCP may indicate it services the entire states; (3) the MCP’s provider manual including the MCP’s claims submission process, as well as a list of services requiring PA, recent newsletters and announcements; (4) the MCP’s policies and procedures for out-of- network providers to seek payment of claims for emergency, post-stabilization and any other services authorized by the MCP; (5) the MCP’s on-line provider directory as referenced in section 41.a. of this appendix; and (6) the MCP’s PDL, including an explanation of the list and identification of any preferred drugs that require PA, the MCP’s list of drugs that require PA, including an explanation of the list, identification of first line drugs for drugs that require PA for step therapy, how to initiate a PA, and the MCP’s policy for coverage of generic versus brand name drugs. ODM may require the MCP to include additional information on the provider website as needed. The MCP must provide prescribers with in-office access to their preferred drug and PA lists via the availability of at least one hand-held software application. Provide all Healthchek information as specified in 25.b.i. of this Appendix.
On-line Provider Website. MCPs must have a secure internet-based website for contracting providers where they will be able to confirm a consumer’s MCP enrollment and through this website (or through e-mail process) allow providers to electronically submit and receive responses to prior authorization requests. This website must also include: (1) a list of the counties that are covered in their service area; (2) the MCP’s provider manual;(3) MCP contact information; (4) a link to the MCP’s on-line provider directory as referenced in section 37(a) of this appendix; (5) the MCP’s current PDL list, including an explanation of the list, which drugs require PA, and the PA process; (6) the MCP’s current list of drugs covered only with PA, the PA process, and the MCP’s policy for covering generic for brand-name drugs. MCPs must ensure that all provider materials designated specifically for CFC and/or ABD consumers (i.e. the MCP’s provider manual) are clearly labeled as such; and (7) information regarding the availability of expedited prior authorization requests, as well as the information that is required from that provider in order to substantiate an expedited prior authorization request. ODJFS may require MCPs to include additional information on the provider website, as needed.
