Contact names and numbers usually provided by the MCO should be highlighted, kept as part of the reference manual and in a place that is readily accessible by staff. In particular, front-line staff should know whom and when to call so that their decisions are appropriate and in keeping with contract specifications. The MCO reference manuals will stipulate the process that should be followed to deal with admissions, pre-certifications, and referrals. Of importance to the contract liaison are the following points. You must have a process for verifying a member's eligibility for health services, either by requesting an identification card or by contacting the MCO's offices.
Any services provided without member verification are vulnerable to non-reimbursement.
During the staff orientation sessions, it is usually helpful to bring in member cards and teach staff how to read them appropriately. You must have a system in place to notify the MCO of any admission to your facility. Elective admissions usually require a notification of 3-5 days before admission. In the event of urgent or emergency admission, notification within 24 hours of the admission is usually acceptable. When an admission falls on a holiday or the weekend, notification usually falls to the next business day.