The EMA Review Agent will be responsible for the following: Overview. The selected Responder shall serve as STATE’s Emergency Medical Assistance (“EMA”) Review Agent by reviewing CPC requests from MHCP enrolled providers and recommending approval or denial of CPC’s to STATE. Staff. The selected Responder shall employ medical professionals to perform all EMA review functions. Staff who review CPC requests must be registered nurses or physicians. Selected Responder must have a pharmacist to review requests for drugs and to coordinate with the pharmacy review agent. Selected Responder must have a medical director who is a licensed medical physician. Selected Responder must have access to appropriate peer review physicians. Selected Responder may employ non-clinical staff to conduct the preliminary review of incoming requests and to enter administrative denials. Acceptance of CPC Requests. Selected Responder will accept CPC requests from MHCP enrolled providers via fax, mail, or the selected Responder’s secure provider portal. Document Management System. Selected Responder shall establish and maintain an Electronic Document Management System (EDMS) for all submitted CPC requests and related documentation and reviewers’ notes. Selected Responder shall allow STATE staff to access the EDMS. Call Center. Selected Responder shall establish and maintain a provider call center, available from 8:00 AM to 5:00 PM, Central Time, Monday through Friday, except State holidays...
