Get Management Contract Statement And Certification: Doh-5038 - Planaheadnewyork

Completing the Management Contract Statement And Certification: DOH-5038 form is a crucial step for managed care organizations seeking approval for their contracts. This guide provides clear and supportive instructions to help you navigate each section of the form effectively.

Follow the steps to fill out the form accurately.

1. Click ‘Get Form’ button to access the form and open it in the designated editing space.
2. In Section A, decide on the type of submission by checking the appropriate box for either a new management contract, an amendment, an extension, a renewal, or any combination thereof. Make sure to fill in the original contract ID, approval date, and effective date if applicable.
3. Provide the anticipated effective date and the contract term in the designated fields. Additionally, enter the MCO unique contract or amendment ID number, ensuring that it is also included in the main contract.
4. Indicate whether the contract includes express incorporation of the standard clauses and provide the page number if it does. Check all lines of business covered by the contract.
5. Complete the character and competence review section. Include necessary forms and list the date of the last review along with the current board members and officers.
6. In Section B, input the MCO name and contact person details. Fill in the management contractor's name, address, and phone numbers. Indicate the corporate relationship to the MCO.
7. For delegation information in Section C, answer if the goals of the existing contract have been met, the quality of care has been maintained, and if reporting requirements have been adhered to.
8. In Section D, identify relevant provisions within the management contract, including staffing and resources. Record any performance criteria or reporting obligations specified.
9. In Section E, state the payment methodology and any financial incentives. Fill out the table for administrative costs and complete any relevant reimbursement terms.
10. Finally, review the certification section, fill in the details of the certifying officer, and sign the form. Ensure all additional documentation is attached, and check for completeness before submission.

Complete the Management Contract Statement And Certification: DOH-5038 online to ensure a smooth approval process.