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Continuity of Care (COC)
Vivida Health 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. Vivida will comply with the below COC provisions:
- Providers should continue to render healthcare services during the transition period- 60 days after the implementation date
- Providers should bill claims to the health plan to which the MMA member is assigned
- Vivida will cover the continued course of treatment without authorization and without regard to participation status during the transition period
- For non-participating providers, Vivida will pay claims at the rate previously paid by the member’s prior health plan for the first 30 days
- Care may continue after the transition period with prior authorization.
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