WAG 20-24-01: Enrolling in an MCO

PM 20-24-01.

1. (MCO) Provides Springfield with information needed to enroll clients.
2. (CO) Creates transactions to enroll clients. A 6-digit code is reflected in CIS and MMIS. The 6-digit code shows:
   • 1st and 2nd digits - MCO that the person is enrolled in;
   • 3rd, 4th, and 5th digits - assigned clinic site; and
   • 6th digit - 4 indicates an HMO, 5 indicates an MCCN.
3. (MCO) Sends client an MCO ID card.
4. (CO) Sends client a restricted MediPlan or All Kids card.
5. (CO) The following message appears on front of the MediPlan or All Kids card:

   MANAGED CARE ENROLLEE(S): Services may require payment authorization.

   The back of the MediPlan or All Kids card reflects "managed care" under each recipient enrolled and gives the name of the MCO and the customer service phone number under the DOB. 

6. (FCRC) Issue a Temporary MediPlan Card (Form 1411) for clients enrolled in an MCO who lose their MediPlan or All Kids card.
7. (FCRC) Add a newborn to the appropriate case as soon as the Family Community Resource Center or All Kids Unit becomes aware of the birth, so that MCO newborn eligibility can be determined.