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

Standard VI: Provider Services
CONTRACT
SECTION
4. Updating Provider
Handbook
CC-VII.I.2.a
5. Contract Education
& Training for
Providers
CC-VII.I.3.
6. Toll-free Provider
Help Line
CC-VII.I.4.a
7. Provider Help Line
Staff
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
The health plan keeps all provider
handbooks and bulletins up to date and in
compliance with state and federal laws.
The health plan offers training to all
providers and their staff regarding the
requirements of the Health Plan Contract
and special needs of enrollees.
a. The health plan conducts initial
training within 30 calendar days of
placing a newly contracted provider,
or provider group, on active status.
b. The health plan also conducts
ongoing training, as deemed
necessary by the health plan or the
Agency, in order to ensure
compliance with program standards
and this contract.
The health plan operates a toll-free
telephone help line to respond to provider
questions, comments and inquiries.
The help line is:
• Staffed 24-hours a day, seven days
a week (24/7) to respond to prior
authorization requests.
• Staffed to respond to provider
questions in all other areas,
including the provider complaint
system, provider responsibilities,
etc., between the hours of 8:00 am
Yes
No
a. Yes
No
b. Yes
No
Yes
No
Yes
No
Met
Partially Met
Not Met
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 2
FINDINGS