Medical claims for restricted Medicaid Managed Care recipients should follow guidelines established by the members Managed Care plan. Proper billing procedures for Fee-For …

Sep 15, 2025 · Find medical, behavioral health, dental, pharmacy, and administrative forms for faster, more efficient care coordination.

Feb 24, 2025 · Coordination of care reduces the potential over-utilization of health care services, prevents abusive or fraudulent behavior, and protects Medicaid recipients’ health and safety. …

The RRP may restrict the recipient to care provided by, or referred by, a Primary Care Provider (i.e., physician, physician group, clinic, or nurse practitioner), Inpatient Hospital, and/or …

Your PCP will get back to you as soon as possible. You may be restricted to certain plan providers if you have been identified as a restricted recipient. Below are examples of why you …

It is your responsibility, as the restricted recipient, to initiate a relationship with your primary health care provider and/or pharmacy. A change of medical provider or pharmacy can be requested …

It is not necessary to submit referral forms to MetroPlusHealth, and MetroPlusHealth does not accept any type of referral form for referrals to Non-Participating Providers.

When you are restricted, a letter will be sent to you. The letter will include the names of the providers you are restricted to.

To request authorization for Personal Care Services for a MetroPlus member, complete the M-11Q Medical Request for Home Care form. Medicaid consumers in the Restricted Recipients …

Aug 13, 2025 · An RRP aims to provide restricted enrollees with tightly managed medical services. It is an aid for the member to meet with their assigned specified Provider to ensure …