Regional Generic Provider Agreement - Ohio Department of Job and ...

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Appendix I Covered Families and Children (CFC) population Page 3 d. Reporting fraud and abuse: MCPs are required to promptly report all instances of provider fraud and abuse to ODJFS and member fraud to the CDJFS. The MCP, at a minimum, must report the following information on cases where the MCP’s investigation has revealed that an incident of fraud and/or abuse has occurred: i. provider’s name and Medicaid provider number or provider reporting number (PRN); ii. source of complaint; iii. type of provider; iv. nature of complaint; v. approximate range of dollars involved, if applicable; vi. results of MCP’s investigation and actions taken; vii. name(s) of other agencies/entities (e.g., medical board, law enforcement) notified by MCP; and viii. legal and administrative disposition of case, including actions taken by law enforcement officials to whom the case has been referred. e. Monitoring for prohibited affiliations: The MCP’s policies and procedures for ensuring that, pursuant to 42 CFR 438.610, the MCP will not knowingly have a relationship with individuals debarred by Federal Agencies, as specified in Article XII of the Agreement. 2. Data Certification: Pursuant to 42 CFR 438.604 and 42 CFR 438.606, MCPs are required to provide certification as to the accuracy, completeness, and truthfulness of data and documents submitted to ODJFS which may affect MCP payment. a. MCP Submissions: MCPs must submit the appropriate ODJFS-developed certification concurrently with the submission of the following data or documents: i. Encounter Data [as specified in the Data Quality Appendix (Appendix L)] ii. Prompt Pay Reports [as specified in the Fiscal Performance Appendix (Appendix J)] iii. Cost Reports [as specified in the Fiscal Performance Appendix (Appendix J)]
Appendix I Covered Families and Children (CFC) population Page 4 b. Source of Certification: The above MCP data submissions must be certified by one of the following: i. The MCP’s Chief Executive Officer; ii. The MCP’s Chief Financial Officer, or iii. An individual who has delegated authority to sign for, or who reports directly to, the MCP’s Chief Executive Officer or Chief Financial Officer. ODJFS may also require MCPs to certify as to the accuracy, completeness, and truthfulness of additional submissions.
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Baseline Covered Families and Child
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APPENDIX A OAC RULES 5101:3-26 The
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Appendix C Covered Families and Chi
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Appendix D Covered Families and Chi
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Appendix D Covered Families and Chi
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APPENDIX E RATE METHODOLOGY CFC ELI
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APPENDIX F REGIONAL RATES 2. AT-RIS
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Page 135 and 136: Appendix J Page 6 Penalty for nonco
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Appendix O Covered Families and Chi
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Appendix P Covered Families and Chi
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Appendix P Covered Families and Chi
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Regional Generic Provider Agreement - Ohio Department of Job and ...

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