Transfers from Other MCOs. 4.2.10.1 The CONTRACTOR shall accept all Members transferring from any MCO as authorized by HSD. The transfer of membership may occur at any time during the year. The receiving CONTRACTOR shall not be responsible for payment of any Covered Services incurred by Members transferred to the CONTRACTOR prior to the effective date of transfer to the CONTRACTOR.
Transfers from Other MCOs. 2.4.8.1 The CONTRACTOR shall accept enrollees (enrolled or pending enrollment) from any MCO in the CONTRACTOR’s service area as authorized by TENNCARE. The transfer of membership may occur at any time during the year. No enrollee from another MCO shall be transferred retroactively to the CONTRACTOR except as specified in Section 2.4.9. Except as provided in Section 2.4.9, the CONTRACTOR shall not be responsible for payment of any covered services incurred by enrollees transferred to the CONTRACTOR prior to the effective date of transfer to the CONTRACTOR.
Transfers from Other MCOs. The CONTRACTOR shall accept all Members transferring from any MCO as authorized by HCA. The transfer of membership may occur at any time during the year. The receiving CONTRACTOR shall not be responsible for payment of any Covered Services incurred by Members transferred to the CONTRACTOR prior to the effective date of transfer to the CONTRACTOR. The CONTRACTOR shall transfer all Member information electronically to the receiving MCO as referenced in the Managed Care Policy Manual. The CONTRACTOR shall develop policies and procedures for a mass transfer of Members, either into the CONTRACTOR’s MCO or to another MCO, to be reviewed and approved by HCA. The mass transfer process shall be initiated by HCA sixty (60) Calendar Days written notice by HCA when HCA determines, for reasonable cause, that the transfer of Members to or from the CONTRACTOR’s MCO is required. Enrollment Data The CONTRACTOR shall receive, process, and update enrollment files from HCA. Enrollment data shall be updated or uploaded to the CONTRACTOR’s eligibility/enrollment database(s) within twenty-four (24) hours of receipt from HCA ensure that the CONTRACTOR complies with Section 4.20.2.6 of this Agreement. Member Disenrollment Initiated by Member In accordance with Section 4.2.10 of this Agreement, a Member, other than a CISC Member, has the opportunity to change MCOs during the first ninety (90) Calendar Days following the effective date of enrollment with the CONTRACTOR. After exercising change rights, the Member shall remain enrolled with the CONTRACTOR until the annual choice period described in Section 4.2.10.2 of this Agreement. In accordance with Section 4.2.10.2 of this Agreement, a Member, other than a CISC Member, may select another MCO during the Member’s annual choice period. A Member, including a CISC Member, may request to be disenrolled from the CONTRACTOR for cause at any time. The Member must submit a written request to HCA for approval. HCA must respond no later than the first Calendar Day of the second month following the month in which the Member files the request. If HCA does not respond, the request will be deemed approved. The Member will have access to HCA’s Fair Hearing process if he/she is dissatisfied with the determination denying the request to disenroll. The following are causes for Member initiated disenrollment: The Member moves out of the State of New Mexico; The CONTRACTOR does not, because of moral or religious objections, cover the service the Member...
Transfers from Other MCOs. 2.4.8.1 The CONTRACTOR shall accept enrollees (enrolled or pending enrollment) who have been selected by the State for enrollment, from any MCO in the CONTRACTOR’s service area as authorized by TENNCARE, or from any failed MCO in the CONTRACTOR’s service area including any MCO which is terminated in whole or in part, may become insolvent or discontinues service, or who reside in an area in which there is insufficient capacity in risk MCOs to enroll the population. The transfer of membership may occur at any time during the year. No enrollee from another MCO shall be transferred retroactively to the CONTRACTOR except as specified in Section 2.4.9. Except as provided in Section 2.4.9, the CONTRACTOR shall not be responsible for payment of any covered services incurred by enrollees transferred to the CONTRACTOR prior to the effective date of transfer to the CONTRACTOR.
