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

Standard IV: Enrollee Services & Enrollee Rights
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT SECTION CONTRACT REQUIREMENT COMPLIANT SCORING
3. Request for Address
Correction
CC-IV.A.1.c
4. Returned Mailing
Envelopes
CC-IV.A.1.c.1-2
Mailing envelopes for enrollee materials
contain a request for address correction.
When mailing envelopes are returned to
the health plan as undeliverable, the
health plan uses and maintains in a file a
record of all of the following methods to
contact the enrollee:
a. Telephone contact at the telephone
number obtained from the local
telephone directory, directory
assistance, city directory, or other
directory.
b. Routine checks (at least once a
month for the first 3 months of
enrollment) on services or claims
authorized or denied by the health
plan to determine if the enrollee has
received services, and to locate
updated address and telephone
number information.
Yes
No
a. Yes
No
b. Yes
No
Met
Partially Met
Not Met
Met
Partially Met
Not Met
DOCUMENTS
REVIEWED
FINDINGS
State of Florida Compliance Monitoring_Standard_IV_F2_07_11
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