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

Standard III: Eligibility, Enrollment, and Disenrollment
CONTRACT
SECTION
Submitting
Enrollment
Requests
Exhibit 3
18. FFS PSNs &
CCC ONLY:
Frequency of
Submitting
Enrollment
Requests
Exhibit 3
19. Submitting
Birth
Information to
DCF and MPI
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
Disenroll–Newborn Enroll.xls providing all
the information required for the newborn’s
enrollment into the health plan. The Excel
workbook format and naming convention is
provided in the Agency’s Report Guide.
The health plan submits the completed
workbook to the local Medicaid area office for
newborn enrollment processing.
Newborn requests are submitted electronically
to the local Medicaid area office each
Wednesday using the Excel workbook
template provided by the Agency. All fields
are to be completed.
a. Before sending the workbook by e-mail,
the health plan password-protects the
Excel File.
b. The password is sent to the area office in a
separate e-mail message.
c. If there are no new cases for a week, the
health plan so indicates in an e-mail to the
Agency area office.
The health plan completes and submits the
Excel spreadsheet for unborn activation to
DCF and to MPI for its information.
The e-mail submission includes the passwordprotected
spreadsheet as an attachment. The
spreadsheet contains all pregnancy
notifications and newborn births for the health
a. Yes
No
N/A
b. Yes
No
N/A
c. Yes
No
N/A
Yes
No
Met
Partially Met
Not Met
DOCUMENTS
REVIEWED
FINDINGS
State of Florida Compliance Monitoring_Standard_III_F2_07_11
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