Member and Provider Services Unit: Provider Member Relations

What We Do

The Provider and Member Relations Unit (PMR) ensures members have access to appropriate healthcare for their medical, dental, and mental health needs. The unit monitors the adequacy of the Green Mountain Care (GMC) network of providers and ensures that members are served in accordance with managed care requirements. The Green Mountain Care Member Support Center contractor is the point of initial contact for members’ questions and concerns.  PMR oversees the Non-Emergency Medical Transportation (NEMT) for covered service for members enrolled in Medicaid and Dr. Dynasaur programs. PMR oversees and monitors NEMT, issuing policies and procedures to coincide with changing circumstances and federal and state directives.  NEMT is a statewide service for providing transportation for eligible members to and from necessary, non-emergency medical services. It is provided through a contract between the State of Vermont, Department of Vermont Health Access (DVHA) and the Vermont Public Transportation Association (VPTA).

Please note that in the Fall of 2020 the Coordination of Benefits (COB) Unit and the Provider Member Relations (PMR) Unit merged and became the Member Provider Services (MPS) Unit.  They are displayed as separate units in this scorecard due to their different lines of work.

Who We Serve

The Provider and Member Relations Unit (PMR) serves members enrolled in Medicaid and Dr. Dynasaur programs as well as all Providers enrolled with Vermont Medicaid.  The PMR Unit also serves internal stakeholders such as DXC, Division of Aging and Independent Living, as well as other departments within the Agency of Human Services.

How We Impact

The Provider and Member Relations Unit (PMR) works with all members of Vermont Medicaid to ensure that they have access to covered services as well as ensuring that the provider community is actively engaged with DVHA.

Action Plan

The top priorities/initiatives for the PMR Unit in SFY20 are:

 

  • Issue an RFP for Non-Emergency Transportation to ensure our members have safe, reliable transportation for medical appointment and PMR has contract oversight to ensure quality results.
  • Engage Member community on a more proactive real time approach to help them understand the program.
  • Engage with Provider Community to increase access by working with provider that currently do not participate or have very low utilization of participation
Scorecard Result Container Indicator Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy