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COMMUNITY HEALTH PLAN

database. If denied or additional clarification is required, notifies the DHS Facility/Contract Liaison.

3.

Forwards the monthly Change of Information file to Information Systems to update the provider database. (SEE “UPDATING THE PROVIDER DATABASE,” page 11).

3.

Faxes copy of the Change of Information Form to Information Systems.

4.

Upon sending the Change of Information Form to Information Systems, forwards approved copies of the Change of Information Forms to Member Services when member notification is required.

5.

Retains completed and file for the record.

1.

Requests mailing labels from Information Systems, if appropriate.

2.

Prepares and mails Member Notification Letter to affected members informing them of new provider information.

MEMBER SERVICES

1.

Sends a copy of the Excel file and the Change of Information file via electronic mail (e-mail) to Information Systems to add new PCS and provider information to the upload file by 9:00 a.m. no less than three (3) business days prior to the fifteenth (15) of the month.

1.

Assigns a PCS code to the new PCS.

2.

Assigns Primary Care Provider Identification (PCP ID) code and PCS code to new provider, if appropriate.

PROVIDER RELATIONS

INFORMATION SYSTEMS

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