Letter to CMS - Medicaid Managed Care Policies - Agency for ...

AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
MCO Health Plan: Contract Number:
Contract Manager: Date(s) of Monitoring:
Standard VI: Provider Services
CONTRACT
SECTION
1. Provider
Handbook
CC-VII.I.2.a
2. FFS PSNs:
Provider
Handbook
CC-VII.I.2.a
3. Distribution of
Provider
Handbooks
CC-VII.I.2.a
CONTRACT REQUIREMENT COMPLIANT SCORING
The health plan issues a provider
handbook to all providers at the time the
provider’s credentialing is complete.
In addition to other requirements
specified in Attachment II, Section VI,
Provider Network, Item I. Provider
Services, regarding the provider
handbook, the health plan includes in its
provider handbook a notice that the
amount paid to providers by the Agency
is the Medicaid fee schedule amount less
any applicable co-payments.
The health plan may choose not to
distribute the provider handbook via
surface mail, provided it submits a
written notification to all providers that
explains:
How to obtain the handbook from the
health plan’s website, and how to request
a hard copy from the health plan at no
charge.
Yes
No
Yes
No
N/A
Yes
No
N/A
Met
Partially Met
Not Met
Met
Partially Met
Not Met
Met
Partially Met
Not Met
DOCUMENTS
REVIEWED
State of Florida Compliance Monitoring_Standard_VI_F2_07_11
Page 1
FINDINGS