Uniform managed care pharmacy claims manual version 2. Hfs began mandatory enrollment in the summer of 2014. Effective january 1, 2014, medicare health plans are not required to automatically. Chapter 9 of the medicare managed care manual, and chapter 12 of medicare managed care manual chapter 5 cms. Chapter medicare managed care beneficiary grievances, organization. November 16, 2011, august 7, 2012, august 30, 20, august 14, 2014, july 6, 2015, september 1, 2015, september 14, 2015, december 30, 2015, may 27. Guidance on standalone pdp quality requirements can be found in chapter. Texas medicaid and chip uniform managed care manual. Provider general compliance training health partners plans. Illinois department of healthcare and family services managed care manual for medicaid providers.
Maximus federal medicare health plan reconsideration process. Initial version uniform managed care manual chapter 2. Chapter 21, cms medicare managed care manual type sources contract 42c. Chapter 9 previously addressed the prevention of fraud, waste and abuse fwa by only part d. Transmittals for prescription drug benefit manual medicare managed care manual. Employer group health plans should refer to section of this chapter. Default enrollment option for medicaid managed care plan enrollees. Record retention schedule cvs health code of conduct. Chapter 9 employerunion sponsored group health plans pdf chapter 10.
Medicare managed care eligibility and enrollment home a federal government website managed and paid for by the u. This chapter applies to contracts issued as a result of hhsc rfp numbers 529060293, 529080001, 52920, and 529120002. R117mcm 08082014 chapter 5, quality improvement program. Transmittal 116, dated february 28, 2014, is being rescinded and replaced by.
Medicare managed care manual chapter 9 employerunion sponsored group health plans. Programguidelines found in chapter 9 of the pdbm and chapter 21 of the. Chapter 9 employerunion sponsored group health plans. Background on medicare advantage, qualified health plans and medicaid.
Drug benefit manual and chapter 21 of the medicare managed care. Sections iii and iv are modified to add clarifying language to the t. Chapter medicare managed care beneficiary grievances, organization determinations, and appeals applicable to medicare advantage plans, cost plans, and health care prepayment plans hcpps, collectively referred to as medicare health plans pdf chapter 14 contract determinations and appeals pdf chapter 15 intermediate sanctions pdf. In addition references to medicare carriers and intermediaries in the three chapters that.
Prescription drug benefit manual, chapter 9 medicare managed care manual, chapter 21. November 16, 2011, august 7, 2012, august 30, 20, august 14, 2014, july 6, 2015. Prescription drug benefit manual medicare managed care. Develop, compile, evaluate, and report certain measures and other. Texas medicaid and chip uniform managed care manual the manual below defines procedures that managed care organizations mcos must follow in order to meet certain requirements in the hhsc managed care contracts, and to provide interpretation on contractual provisions that need clarification.