Provider Effective Date Policy

Effective Date Policy: (Effective 1/1/2024)

• 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.
  • 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.
  • An incomplete network participation request also includes an unclean credentialing application. MHS notify the provider within fifteen (15) days of the full credentialing decision in writing.
  • If a provider and MHS cannot come to terms with a contract, the provider will not be effective with MHS.
  • If a provider requires credentialing and is not able to be credentialed, 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.
  • An incomplete network participation request also includes an unclean credentialing application. MHS notify the provider within fifteen (15) days of the full credentialing decision in writing.
  • If a provider requires credentialing and is not able to be credentialed, the provider will not be effective with MHS.
• Provider has five (5) business days to respond to an incomplete credentialing or network participation request. If no response after five (5) business days, MHS may deny the request.
• For reimbursement of medically necessary services rendered between the credentialing decision date and the network participation date, the MHS will utilize the out-of-network reimbursement rate for all services. 
• The 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.
• In order to be able to receive reimbursement for medically necessary covered services, the contract or contract amendment must still be executed by both parties.
• 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 provides MHS flexibility to deny the network participation request if the contracting phase cannot be completed in an acceptable timeframe that is no more than 60 (sixty) 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. MHS will 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.
• MHS will reimburse for medically necessary services provided between the date in which the provider was credentialed and the network participation date according to the following rules:
  • If the provider was fully credentialed without the need for provisional credentialing, MHS will reimburse to the date in which the provider was fully credentialed.  
  • If the provider was provisionally credentialed and then fully credentialed, MHS will reimburse back to the date in which the provider was provisionally credentialed.
  • If the provider was provisionally credentialed but not fully credentialed, MHS is not required to reimburse for any services during the provisionally credentialed timeframe.
• For reimbursement of medically necessary services rendered between the credentialing decision date and the network participation date, the provider will be reimbursed at the out-of-network reimbursement rate for all services, until their contract effective date.  
• Services provided before a provider has successfully completed the network participation process are subject to the prior authorization process.
• 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.