Provider Effective Date Policy

Effective Date Policy: (Effective 1/1/2022)

A brand-new provider that is not part of an existing contract with MHS will be effective the first of the month following the contract execution. Contract execution is the date that MHS countersigns the first signature agreement received from the Provider. In order for the contract to be executed. the provider's complete network participation request must also be submitted electronically via an online portal, email, postal mail, or fax. All required fields must be completed, required supporting documentation provided, etc. for the network participation request to be considered complete.
- If a provider and MHS cannot come to terms with a contract, the provider will not be effective with MHS.
A provider that is being added to an existing contract will be effective the first of the month following receipt of the network participation request from the provider. The network participation receipt date is the date MHS receives the provider’s complete network participation request electronically via an online portal, email, postal mail, or fax. All required fields must be completed, required supporting documentation provided, etc. for the network participation request to be considered complete.
- If a provider requires credentialing and is not able to be credentialed, the provider will not be effective with MHS.
MCEs are encouraged to use the standard out of network process for services rendered by providers prior to the effective date if needed for member access to care.
The MCE network effective date must also be after the IHCP effective date. Providers must be enrolled and effective with IHCP prior to being effective with MHS.
Notification from MHS will be sent to the original submitter of an incomplete network participation request within five (5) business days after receipt of initial request. An incomplete network participation request is a request that MHS cannot fully process because there is missing documentation, information needed to write a contract, etc.
Providers should hold all claims until the final welcome letter from MHS is received confirming that they are effective with the MHS network. Claims submitted prior to receipt of a welcome letter will not automatically be reprocessed and providers will need to submit a Medical Claim Dispute/Appeal Form to request reconsideration of the claim. MHS and providers are expected to complete all pieces of the network participation process timely. However, in instances where the network participation process extends for a time period longer than the standard timeframe, MHS will not hold providers to the timely filing limit for claims rendered before the provider was confirmed effective.
OMPP is allowing the MCEs flexibility to deny the provider participation request if the contracting phase cannot be completed in an acceptable timeframe that is no more than 60 days. This will allow the effective date policy to remain consistent but also hold all parties accountable for the turnaround of necessary items for the network participation process. It is important that the MCEs educate providers on the significant impact any delay in signing a contract will have and that if they do not meet the timeframe their request will be denied.
Exceptions to the effective date policy outlined may be granted by MHS in the following circumstances:
- When the retroactive date is in the best interest of member care.
- In situations involving changes of ownership, including provider mergers, acquisitions, or tax identification changes.
- In situations where a provider has a preexisting contractual relationship with an MCE and has sought a change in their provider enrollment type or classification with IHCP (i.e., when a provider was enrolled as a billing provider but has decided to enroll as a group provider).
- Upon request from providers in FQHCs or RHCs. The effective date cannot be prior to the date established by IHCP.
- The effective date policy does NOT affect delegated provider arrangements.