having developed or accumulated a substantial number of patients in the PA Health & Wellness with high cost medical conditions Coordinate and cooperate with other service providers who serve Medicaid Participants, such as Head Start Programs, Healthy Start Programs, Nurse Family Partnerships, and school based programs as appropriate Object to providing relevant or medically necessary services on the basis of the provider’s moral or religious beliefs or other similar grounds Disclose to PA Health & Wellness, on an annual basis, any physician incentive plan (PIP) or risk arrangements the provider or provider group may have with physicians either within its group practice or other physicians not associated with the group practice even if there is no substantial financial risk between PA Health & Wellness and the physician or physician group Provide services in accordance with applicable state and federal laws and regulations and adhere to the requirements set forth in the Participating Provider Agreement Allow PA Health & Wellness direct access (not via vendor) to medical records for the purpose of data collection initiatives, such as HEDIS and other contractual, regulatory or other programs Review and follow clinical practice guidelines distributed by PA Health & Wellness Document Medical chart with up to three reach out attempts via phone to Participants who have not completed an office visit in the past 12 month or more Have been discharged from an inpatient-stay within the last 24 hours since notification Have a gap-in-care overdue by 30 or more days Develop report based on PA Health & Wellness specification to submit monthly clinical data feed from the Electronic Medical Record (EMR) system within one year of enrolling in the PA Health & Wellness Provider Network Comply with Pennsylvania Risk Adjustment programs rely on complete and accurate diagnosis coding and reporting according to the ICD-10-CM coding guidelines Providers must allow for and process voluntary payroll deductions of fringe benefits or wage supplements for any employee who requests it, in accordance with the Wage Payments and Collection Law (43 P.S. §§ 260.2a and 260.3).
94 • • o Report all suspected physical and/or sexual abuse and neglect Report Communicable Disease to PA Health & Wellness: PA Health & Wellness must work with DOH State and District Office epidemiologists in partnership with the designated county or municipal health department staffs to appropriately report reportable conditions in accordance with 28 Pa. Code §§ 27.1 et seq. It is your responsibility as a provider to participate in education on proper reporting of communicable disease and reportable conditions. PA Health & Wellness has designated a single point of contact for reportable conditions, who can be reached by calling 1-717-809-7035 or 1-866-535-2545 or by faxing to 1-844-873-7451. A copy of this policy can be found on our website, PAHealthWellness.com.
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