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Miami Children's Health Plan is led by doctors that live and work in South Florida.


Our provider partners are what make our plan different.  We look forward to working with you to support the communities we serve together.

 

Benefits to Physicians & Providers

 
Clinical Support
  • High- quality patient data and practical, actionable physician reports and analytics
  • Local care managers and clinical performance improvement expert support
Service Focused
  • Timely and accurate claims payment
  • Clear and efficient credentialing
  • Local physician creation of policies and prior authorization lists to reduce abrasion
Local Decision Making
  • Local physician engagement in clinical decisions customized to community and patient needs
Flexible Contracting Models
  • Innovative reimbursement and incentive redesign developed with local physician input
  • Insightful and trustworthy information to manage performance


Continuity of Care (COC)

Miami Children’s Health Plan (MCHP) is required to ensure continuity of care (COC) during the transition period for Medicaid recipients enrolled in the SMMC program. COC requirements ensure that when enrollees transition from one health plan to another, one service provider to another, or one service delivery system to another (i.e., fee-for-service to managed care), their services continue seamlessly throughout their transition. MCHP will comply with the below COC provisions:

 

  • Health care providers should not cancel appointments with current patients. MCHP will honor any ongoing treatment that was authorized prior to the recipient’s enrollment into the plan for up to 60 days after the roll-out date in each region. There must be no disruption of care for enrollees. Care may continue after the transition period with prior authorization.
  • Providers will be paid. Providers should continue providing any services that were previously authorized, regardless of whether the provider is participating in the plan’s network. MCHP will pay for previously authorized services for up to 60 days after the roll-out date in each region and must pay providers at the rate previously received for up to 30 days.
  • Providers will be paid promptly. During the continuity of care period, MCHP will follow all timely claims payment contractual requirements.  The Agency will monitor complaints to ensure that any issues with delays in payment are resolved.
  • Prescriptions will be honored. MCHP will allow recipients to continue to receive their prescriptions through their current provider, for up to 60 days after the roll-out date in each region, until their prescriptions can be transferred to a provider in the plan’s network.
  • As of January 31, 2019, the Agency has decided to extend the COC period for an additional month (through February 28, 2019) for medical foster care services, early intervention services, and child health services targeted case management for enrollees receiving services in Regions 9 and 11.
 
Region Implementation Date Transition Period End Date - all other provider types
 
Transition Period End Date -(For medical foster care services, early
intervention services, and child health services targeted case management only)

9

12/01/2018

01/31/2019

2/28/2019

11

12/01/2018

01/31/2019

2/28/2019