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

Agency For Health Care Administration
Managed Care Organizations
Online Provider Directory Audit Tool
Online Provider Directory Review Tool
Item Number Standard Found in Directory Reference Comments
5 Information concerning how to determine a provider’s hospital affiliation Y N CC-IV.A.7.b
6
7
8
9
10
Pharmacy network requirements:
a. If a health plan elects to use a more restrictive pharmacy network
than the network available to people enrolled in the Medicaid
fee-for-service program, the provider directory includes the
names of the participating pharmacies.
b. If all pharmacies are part of a chain and all within the health
plan’s service area are under contract with the health plan, the
provider directory need list only the chain name.
The provider directory includes a statement that some providers may
choose not to perform certain services based on religious or moral beliefs.
The health plan provides:
a. The most recently printed provider directory and appends to it a
list of the providers who have left the network and those who
have been added since the directory was printed.
b. In lieu of the appendix, to the provider directory, the health plan
may enclose a letter stating that the most current listing of
providers is available by calling the health plan at its toll-free
telephone number and the Internet address that will take the
enrollee directly to the online provider directory.
Have terminated provider on the health plan’s Provider Termination and
New Provider Notification Report been removed from the on-line
provider directory?
Have new providers on the health plan’s Provider Termination and New
Provider Notification Report been added to the on-line provider directory?
Total # Applicable Elements
Total # Compliant Elements
Total Percent Compliant
a. Y N N/A
b. Y N N/A
CC-IV.A.7.d
Y N CC-IV.A.7.e
a. Y N N/A
a. Y N N/A
Managed Care Organizations Page 2
Online Provider Directory Audit Tool F1_03_10
Florida Medicaid
Y N
Y N