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Managed Care Oversight - Contract Management Branch

Welcome to the Managed Care Oversight - Contract Management page

The Contact Compliance Branch provides contract oversight to assure that the Managed Care Organizations (MCOs) contracted with the Department for Medicaid Services (DMS) are compliant in all aspects to consistently provide reliable health care to Kentucky's Medicaid managed care members.

Contract Compliance Branch staff is a liaison between the MCOs and DMS and a point of contact coordinating communications and connecting subject matter experts. Staff also partners with sister agencies such as DBHDID, DCBS and DPH on related Medicaid managed care issues providing oversight consistency in contractual activities.

Responsibilities of branch staff include:

  • Specialization in all areas of contract compliance oversight
  • Reviewing and assessing encounter reports for accuracy and imposing late fees and capitation withholdings when the records are noncompliant
  • Issuing letters of concern and corrective action plans (CAP) when MCO activities are found contractually deficient
  • Reviewing and approving CAPs when MCO activities are found to be substantially noncompliant with any material provision of a contract, such as breaches of member personal health information
  • Approving MCO marketing and outreach documents for the Medicaid managed care members
  • Attending community events to assure MCOs are adhering to marketing materials distribution in compliance with their contract
  • Facilitating MCO encounter file submission and resubmission in conjunction with the Office of Administration and Technology Services and Hewlett Packard
  • Conducting MCO provider network adequacy reviews
  • Maintaining MCO contacts directories
  • Conducting onsite and offsite contract compliance audits
  • Facilitating monthly MCO operations meetings
  • Assisting colleagues in MCO contractual obligations specifically required for program and project activities

 

Contact Information
 

Division of Program Quality and Outcomes
275 East Main Street, 6C-C
Frankfort, KY 40601
Phone: (502) 564-9444

 

Last Updated 4/6/2017