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Community Supports (CS) Provider Reassignment Request Member and Provider Information MediCal Number:Authorization Number:Member Name:Date of Birth:Member Phone Number: Provider Reassignment Requested

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What is mcp-ecm-and-ilos-contract-template-provisionspdf?

The mcp-ecm-and-ilos-contract-template-provisionspdf is a document template that outlines the specific provisions and requirements for contracts related to MCP (Medicaid managed care programs), ECM (Enhanced Care Management), and ILOS (In Lieu of Services).

Who is required to file mcp-ecm-and-ilos-contract-template-provisionspdf?

Entities participating in Medicaid managed care programs, including providers, managed care organizations, and contractors involved in ECM and ILOS services are required to file the mcp-ecm-and-ilos-contract-template-provisionspdf.

How to fill out mcp-ecm-and-ilos-contract-template-provisionspdf?

To fill out the mcp-ecm-and-ilos-contract-template-provisionspdf, follow the instructions provided within the template, ensuring that all relevant sections are completed accurately, including details about the services offered, compliance requirements, and any financial agreements.

What is the purpose of mcp-ecm-and-ilos-contract-template-provisionspdf?

The purpose of the mcp-ecm-and-ilos-contract-template-provisionspdf is to standardize the contractual agreements between providers and managed care organizations regarding the delivery of Enhanced Care Management and In Lieu of Services, ensuring compliance and clarity in the delivery of these services.

What information must be reported on mcp-ecm-and-ilos-contract-template-provisionspdf?

The information that must be reported on the mcp-ecm-and-ilos-contract-template-provisionspdf includes provider details, service descriptions, compliance measures, payment structures, and any relevant performance metrics related to ECM and ILOS.

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