Provider agrees to be the health care case manager and provide comprehensive primary health care services for Medicaid recipient who have been assigned to your practice. Provider agrees to refer recipients for specialty care, hospital care, and other services only when medically necessary and sign and document referrals. Provider agrees to authorize services provided by referred providers if it is determined by the Provider that those services are medically necessary. Provider agrees not to refuse an assignment or disenroll a recipient or otherwise discriminate against a recipient solely on the basis of age, sex, race, color, national origin, marital or economic status, physical or mental handicap, or type of illness or condition, except when that illness or condition can be better treated by another provider type.
Provider agrees to keep the recipient as a patient until another provider is assigned.
Provider agrees to accept the established monthly case management fee for each eligible recipient under their caseload. Provider agrees not to have a managed care caseload which exceeds 500 recipients. Provider agrees to be disenrolled as a Provider for failure to comply with Provider requirements. Provide a current list of managed care recipients assigned to the Provider. Reimburse the Provider a monthly case management fee for each enrolled and eligible managed care recipient on the Provider's caseload .