q. Copies of all member mailings/materials (print and multimedia) must be provided. 8 RFP IV.I.9 Add new section g. The DBPM must completely process credentialing applications from the provider within thirty (30) calendar days of receipt of a completed credentialing application. A completed application includes all necessary documentation and attachments. h. “Completely process” means that the DBPM must: i. Review, approve, and load approved providers to its provider files in its system and submit the information in the weekly electronic provider file to MLTC or designee, or MLTC’s ii. Deny the application and ensure that the provider is not used by the DBPM. A provider whose application is denied must receive written notification of the decision, with a description of his/her/its appeal rights. 9 RFP IV.D.2, 1. Planning and 1. Planning and working with Table 1 working with Provider Provider Services staff to expand Services staff to and enhance dental services for expand and enhance American Indian members. physical and behavioral health services for American Indian members. 10 RFP IV.P.5.b b. Pursuant to b. Pursuant to Neb. Rev. Neb. Rev. Stat. Stat. §71-831, the DBPM must the DBPM must hold back 1.5% of the aggregate hold back 2% of the of all income and revenue earned aggregate of all income by the DBPM and related parties and revenue earned by under the contract in a separate the DBPM and related account. The hold-back parties under the constitutes the maximum amount contract in a separate available to the DBPM to earn via account. The hold-back the quality performance program. constitutes the maximum amount available to the DBPM to earn via the quality performance program.
q. Copies of all member mailings/materials (print and multimedia) must be provided. 8 RFP IV.I.9 Add new section g. The DBPM must completely process credentialing applications from the provider within thirty (30) calendar days of receipt of a completed credentialing application. A completed application includes all necessary documentation and attachments. h. “Completely process” means that the DBPM must: i. Review, approve, and load approved providers to its provider files in its system and submit the information in the weekly electronic provider file to MLTC or MLTC’s designee, or ii. Deny the application and ensure that the provider is not used by the DBPM. A provider whose application is denied must receive written notification of the decision, with a description of his/her/its appeal rights. 9 RFP IV.D.2, Table 1 1. Planning and working with Provider Services staff to expand and enhance physical and behavioral health services for American Indian members. 1. Planning and working with Provider Services staff to expand and enhance dental services for American Indian members. 10 RFP IV.P.5.b b. Pursuant to Neb. Rev. Stat. the DBPM must hold back 2% of the aggregate of all income and revenue earned by the DBPM and related parties under the contract in a separate account. The hold-back constitutes the maximum amount available to the DBPM to earn via the quality performance program. b. Pursuant to Neb. Rev. Stat. §71-831, the DBPM must hold back 1.5% of the aggregate of all income and revenue earned by the DBPM and related parties under the contract in a separate account. The hold-back constitutes the maximum amount available to the DBPM to earn via the quality performance program.
Addendum%20Four%20-%20Revisions%20to%20RFP.docx