PROVIDER NEWSLETTER WINTER
|
|
- Cornelius Dickerson
- 6 years ago
- Views:
Transcription
1 in FOCUS PROVIDER NEWSLETTER WINTER 2018 Formulary Changes Provider Directory ACCURACY Care1st Blue Shield Health LITERACY INITIATIVE Provider OVERPAYMENTS Long Term Services and Supports ELECTRONIC FUNDS TRANSFER & Secure Remittance Advices
2 in FOCUS TABLE OF CONTENTS 3 Care1st/Blue Shield Health Literacy Initiative Long Term Services and Supports 4 (LTSS) information for providers 5 Provider Directory Accuracy 7 Provider Overpayments Pharmacy 3 rd Qtr Pharmacy & Therapeutic Formulary 8 Changes- Physician Notice Pharmacy 4 th Qtr Pharmacy & Therapeutic Formulary 10 Changes- Physician Notice Electronic Fund Transfer and 6 Secure Remittance Advices 2
3 Health literacy is a very important component of provider/patient interaction. The US Department of Health and Human Services defines health literacy as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. CARE1ST/BLUE SHIELD HEALTH LITERACY INITIATIVE Health literacy is a very important component of provider/patient interaction. The US Department of Health and Human Services defines health literacy as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Care1st and Blue Shield of California recognize the importance of addressing health literacy and are working together to improve health literacy levels in our member populations by launching a company wide Health Literacy Initiative. The initiative aims to engage our staff, members, and participating providers in the health literacy conversation through trainings, outreach, and education on communicating simply and effectively with members and patients. The next phase of the initiative aims to reach Care1st/Blue Shield providers through webinars, outreach, and a training that will be available on our website in the near future. The trainings will cover recommendations for improving communication with patients, such as: Not making assumptions about language preferences or literacy level 3 Using visual aids Providing patients with a note pad so they can write down questions and information Creating a comfortable, helpful, shame-free environment Using plain and simple, nonmedical language Confirming patient understanding of key instructions and knowledge Involving patients in decision making around their own care Speaking slowly Breaking down information into small manageable steps For more information, please contact the Care1st/Blue Shield Health Education department at HealthEducation@care1st.com or visit the provider health education section of our website at The Centers for Disease Control and Prevention also offer a Health Literacy course for Public Health Professionals, which can be accessed online at
4 COULD ONE OF YOUR PATIENTS BENEFIT FROM LONG-TERMS SERVICES AND SUPPORTS? Here is how Long Term Services and Supports (LTSS) provides services intended to help seniors and persons with disabilities: Services intended to help seniors and persons with disabilities Helps people remain living in the community in the setting of their choice Rebalances service delivery away from institutional care (LTC) and into the home and community This Medi-Cal benefit includes Cal MediConnect (CMC) Long Term Services and Supports include: Home and Community Based Services (HCBS) In-Home Supportive Services (IHSS) Community Based Adult Service (CBAS) Multipurpose Senior Services Program (MSSP) Institutionalized Long Term Care (LTC) To refer a patient to Long Term Services and Supports please call our Care1st Social Services department at (323) x LTSS SERVICES: In-Home Supportive Services (IHSS) Allows individuals to receive support services which enable them to remain living in their home: Assistance with shopping Preparing food House keeping Bathing Community Based Adult Services (CBAS) Day program includes a variety of services designed to be an alternative to long term nursing home care: help people stay mentally and physically active reduce social isolation improve their health prevent decline of their abilities and promote selfmanagement as a safe, positive, caring Multipurpose Senior Services Program (MSSP) Provides on-going medical and social case management oversight to allow those who are eligible for LTC to remain living in the community. Long Term Care (LTC) Provides care in a skilled nursing facility for people unable to remain living in the community independently. Provides 24/7 medical care. 4
5 PROVIDER DIRECTORY ACCURACY Provider Directory Updates Keeping and maintaining an accurate provider network supports our goal to provide exceptional care for our members. Care1st would like to thank participating providers for being responsive to our attempts in soliciting and validating information. following occurs: 1. The provider had previously accepted new patients and the provider is not currently accepting new patients. 2. The provider had previously not accepted new patients and the provider is currently accepting new patients. What s next? Our Care1st Provider Network Operations department will continue to reach out to participating providers to collect information and update provider records on a semi-annual basis for our direct network. Network providers can review their information on our Care1st website and submit changes by contacting Care1st: Telephone: (323) Fax: (323) Demographicupdates@care1st.com You may also complete an online interface for providers to submit verification For San Diego Providers: By telephone: (888) Fax: (619) at: DemographicupdatesSD@care1st.com You may also complete an online interface for providers to submit verification Providers are required to notify Care1st or the participating provider group within five (5) business days when either of the 5 Online Profile Form The Online Profile Form is an electronic web form that contains provider directory information which Care1st has on file for the provider. Providers can notify Care1st of changes to their demographic data by completing the Online Profile Form and/or providing an affirmative response to Care1st s Outreach Program through the online interface. 1. Practitioners (i.e., physicians and other health professionals such as physical therapists, occupational therapists or podiatrists) 2. Participating provider groups 3. Hospital and ancillary providers A system generated acknowledgment is automatically sent upon your submission of the completed form Please note that these channels of communication are designed to report provider directory inaccuracies. For any additional provider related questions or concerns, please refer to our provider manual which can be found on our website:
6 ELECTRONIC FUND TRANSFER AND SECURE REMITTANCE ADVICES For several years, Care1st Health Plan has encouraged providers to receive claim payments and secure remittance advices (SRA) through electronic fund transfer (EFT). The remittance advices associated with payments for patient care contain patient health information (PHI) / personal identifiable information (PII) and that information is at risk when delivered in paper form. Care1st Health Plan takes the protection of our members PHI/ PII seriously and has teamed up with J.P. Morgan and Office Ally clearing houses to provide secure electronic download services. Both Office Ally and JP Morgan clearing houses permit providers to securely download remittance advices. Providers who enroll in EFT have the additional benefits of claim payments made directly into their bank account, minimize exposure to check fraud and lost checks, and have secure access to download SRA s for up to 10 years. Care1st Health Plan is committed to providing secure and efficient payments and remittance advices. For more information about EFT and SRA, including how to sign up for both, please call (855) or visit the following website: care1st.com/ca/providers/news-and-resources.asp Effective January 1, 2018 Care1st will no longer provide Remittance Advices on paper. They will be available only through SECURE electronic download. Providers who have not enrolled will continue to receive checks by regular mail, however, will not have the ability to access their SRAs without enrolling. 6
7 PROVIDER REPORTING REQUIREMENTS TO CARE1ST HEALTH PLAN ON OVERPAYMENTS Effective July 1, 2017, Title 42 of the Code of Federal Regulations (CFR), section (d), Care1st Health Plan ( Care1st ) is required to report overpayments and/ or recoveries made to providers to the Department of Health Care Services (DHCS). Care1st is obligated to require its network providers to report overpayments/ recoveries to the Care1st Health Plan. Effective July 1, 2017, when providers received an overpayment from Care1st Health Plan, including overpayments due to fraud, waste, and abuse, providers must take the following actions: Return the overpayment to Care1st within 60 calendar days after the date on which the overpayment was identified. Notify Care1st Health Plan in writing of the reason for overpayment by sending an to ComplianceDepartment@care1st.com DEFINITIONS: Overpayment is any payment made to a network provider made by Care1st Health Plan to which the network provider is not entitled under Title XIX of the Social Security Act. 1 Network Provider is any provider, group of providers, or entity that has a network provider agreement with Care1st Health Plan, or is a subcontractor and receives Medi-Cal funding directly or indirectly to order, refer or render covered services as a result of the state s contract with Care1st Health Plan. 2 Fraud is defined as intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to himself or some other person. It includes any act that constitutes fraud under applicable federal or state law. 3 Waste is generally understood to mean the overutilization or inappropriate utilization of services and misuse of resources, and typically is not a criminal or intentional act. 4 Abuse is defined as provider practices that are inconsistent with sound fiscal business, or medical practices that result in an unnecessary cost to the Medicaid program, or reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards for health care. It also includes beneficiary practices that result in unnecessary cost to the Medicaid program Ibid CFR and Welfare and Institutions (W&I) Code Fraud, Waste, and Abuse Toolkit. Healthcare Fraud and Program Integrity: An Overview for Providers (2014). Centers for Medicare and Medicaid Services. Retrieved at CFR 455.2
8 PHYSICIAN NOTICE 3RD QTR 2017 DRUG NAME LABEL NAME DRUG STRENGTH FORMULATION ANTICANCER AGENTS Brigatinib Alunbrig 30mg Tablet Durvalumab Imfinzi 20mg/2.4ml, 500mg/10ml IV vial Methotrexate Xatmep 2.5mg/ml Oral Solution Midostaurin Rydapt 25mg Capsule Neratinib Nerlynx 40mg Tablet ANTIVIRALS HIV Maraviroc Selzentry 20mg/ml Oral solution IMMUNOSUPPRESSIVES Sarilumab Kevzara 150mg/1.14, 200mg/1.14 Syringe OSTEOPOROSIS AGENTS Abaloparatide Tymlos 80mcg/dose Pen Injector SMOKING CESSATION Nicotine Nicotine Patch (various) 21mg, 14mg, 7mg/patch Transdermal Patch TOPICAL ANTIBIOTICS Erythromycinbenzoyl peroxide Benzamycin 3%-5% Gel VITAMIN A DERIVATIVES Adapalene Differin OTC 0.1% Gel Tretinoin Tretinoin All strengths Cream, Gel ANTIVIRALS - HEPATITIS C Ledispavir - sofosbuvir Harvoni 90mg-400mg Tablet ANTIVIRALS - HEPATITIS C VIRUS Glecaprevir - pibrentasvir Mavyret 100mg-400mg Tablet INSULINS - LONG ACTING Insulin Glargine, Hum, Rec. Analog Lantus 100u/ml Vial 8
9 This report provides formulary changes approved by the Care1st Pharmacy and Therapeutics Committee. For a complete listing, please refer to the Care1st website at You may also call the Care 1st Pharmacy Department at (877) RX-CARE1 or (877) FORMULARY COMMENTS MEDICARE FORMULARY MEDI-CAL FORMULARY Add to Medicare formulary tier 5 (Specialty) with a prior authorization requirement Yes No Add to Medicare formulary tier 5 (Specialty) with a prior authorization requirement Yes No Add to Medicare formulary tier 4 with a prior authorization requirement Yes N/A Add to Medicare formulary tier 5 (Specialty) with a prior authorization requirement Yes No Add to Medicare formulary tier 5 (Specialty) with a prior authorization requirement Yes No Add to Medicare Formulary at preferred brand tier (tier 3) Yes N/A Add to Medicare formulary tier 5 (Specialty) with a prior authorization requirement Yes N/A Remove prior authorization restriction, available on formulary with a quantity limit of 84 patches per year for each strength. N/A Yes Add a step therapy to erythromycin- benzoyl peroxide gel, requiring a prior trial in the last 120 days of either: adapalene, erythromycin topical, clindamycin topical, or benzoyl peroxide gel/cream/lotion. N/A Yes Add to Medi-Cal formulary, OTC version only, restricted to ages up to 25 years old N/A Yes Remove from formulary, alternative is adapalene gel OTC N/A Yes Remove from Medi-Cal formulary. Mavyret preferred Hep C treatment. N/A Yes Add to Medi-Cal formulary with a PA restriction. Preferred Hep C treatment. N/A Yes Remove from Medi-Cal formulary effective 11/01/2017 Basaglar KwikPen preferred insulin glargine product No Yes 9
10 PHYSICIAN NOTICE 4TH QTR 2017 DRUG NAME LABEL NAME DRUG STRENGTH FORMULATION ANTINEOPLASTICS Abemaciclib Verzenio 50mg, 100mg, 150mg, 200mg Tablet Copanlisib Aliqopa 60mg Vial Daunorubicin cytarabine liposome Vyxeos Liposome 44mg/100mg Vial Enasidenib Idhifa 50mg, 100mg Tablet Gemtuzumab ozogamicin Mylotarg 4.5mg Vial Inotuzumab ozogamicin Besponsa 0.9mg Vial Olaparib Lynparza 100mg, 150mg Tablet ANTIVIRALS - HEPATITIS C VIRUS Glecaprevir/pibrentasvir Mavyret 100mg/40mg Tablet C1 ESTERASE INHIBITORS C1 Esterase Inhibitor, human Haegarda 2000 units, 3000 units Vial GASTROINTESTINAL Infliximab-abda Renflexis 100mg Vial RESPIRATORY DRUGS Glycopyrrolate/formoterol Bevespi mcg Inhaler Umeclidinium bromide Incruse Ellipta 62.5 mcg Inhalation powder VACCINES Varicella-Zoster GE Shingrix GE Antigen Component 50mcg/0.5 Kit 10
11 This report provides formulary changes approved by the Care1st Pharmacy and Therapeutics Committee. For a complete listing, please refer to the Care1st website at You may also call the Care 1st Pharmacy Department at (877) RX-CARE1 or (877) FORMULARY COMMENTS MEDICARE FORMULARY MEDI-CAL FORMULARY Add to Medicare formulary at tier 5 (Specialty) with a prior authorization requirement Yes N/A Add to Medi-Cal formulary only with a step care, requiring the use of a Long Acting Beta Agonist (LABA) or Long Acting AntiMuscarinic Agent (LAMA) for at least 15 days in the last 45 days Add to Medi-Cal formulary only with a code 1 restriction: restricted for the diagnosis of COPD N/A N/A Yes Yes Add to Medicare formulary at tier 3 (Brand) with for ages 50 and older and a QL of 2 per lifetime Yes No 11
12 601 Portrero Grande Dr Monterey Park, CA in FOCUS PROVIDER NEWSLETTER WINTER 2018
Provider Relations Training
Cal MediConnect Provider Relations Training Presented by Victor Gonzalez and George Scolari Provider Relations Training Agenda Overview of Cal MediConnect Eligibility & Exclusions Enrollment & Disenrollment
More informationCalifornia s Coordinated Care Initiative
California s Coordinated Care Initiative Sarah Arnquist Harbage Consulting Presentation on 4/22/13 2 Overview Federal and State Movement toward Coordinated Care Update on California s Coordinated Care
More informationMedicare Advantage and Part D Fraud, Waste and Abuse Compliance Training 2015
Medicare Advantage and Part D Fraud, Waste and Abuse Compliance Training 2015 Overview This Medicare Advantage and Part D Fraud, Waste and Abuse Compliance Training for first-tier, downstream and related
More informationUnderstanding and Leveraging Continuity of Care
Understanding and Leveraging Continuity of Care Cal MediConnect Providers Summit January 21, 2015 Moderator: Jane Ogle, Consultant, Harbage Consulting www.chcs.org An Overview of Continuity of Care in
More informationCAL MEDICONNECT: Understanding the Health Risk Assessment. Physician Webinar Series
CAL MEDICONNECT: Understanding the Health Risk Assessment Physician Webinar Series Today s Webinar This webinar is part of a series designed specifically for CAPG members. For a general overview of the
More informationMEDICARE CARE1ST DUAL PLUS PLAN SUMMARY OF BENEFITS.
ine 1-800-544-0088 www.care1st.com CARE1ST DUAL PLUS PLAN SUMMARY OF BENEFITS MEDICARE 2009 COUNTIES: LOS ANGELES - ORANGE - SAN BERNARDINO - SAN DIEGO H5928_09_004_SNP_SB 10/2008 Section I Introduction
More informationComing Changes for Adults Who Have Medicare and Medi-Cal
Coming Changes for Adults Who Have Medicare and Medi-Cal California Coordinated Care Initiative and the Cal MediConnect Program 1 Coming Changes for People with Medicare and Medi-Cal California Coordinated
More informationCAL MEDICONNECT: Understanding the Individualized Care Plan & Interdisciplinary Care Team. Physician Group Webinar Series
CAL MEDICONNECT: Understanding the Individualized Care Plan & Interdisciplinary Care Team Physician Group Webinar Series Today s Webinar This webinar is part of a series designed specifically for physicians.
More informationCoordinated Care Initiative DRAFT Assessment and Care Coordination Standards November 20, 2012
Coordinated Care Initiative DRAFT Assessment and Care Coordination Standards November 20, 2012 Table of Contents CARE COORDINATION GENERAL REQUIREMENTS...4 RISK STRATIFICATION AND HEALTH ASSESSMENT PROCESS...6
More informationFACT SHEET Low Income Assistance: Cal MediConnect(E-004) p. 1 of 6
FACT SHEET Low Income Assistance: Cal MediConnect(E-004) p. 1 of 6 Low Income Assistance: Cal MediConnect What is Cal MediConnect? California is 1 of 15 states that has signed a Memorandum of Understanding
More informationCare1st Provider Model of Care Training
Care1st Provider Model of Care Training Special Needs Plan (SNP) 2017-2018 SNP Model of Care (MOC) The Medicare Act of 2003 established a Medicare Advantage coordinated care plan that is designed to provide
More information2015 CMS National Training Program Workshop Monika Vega, MSW Harbage Consulting, LLC Representing California s Department of Health Care Services
California s Coordinated Care Initiative 2015 CMS National Training Program Workshop Monika Vega, MSW Harbage Consulting, LLC Representing California s Department of Health Care Services Roadmap Nationally
More informationUnderstanding Balance Billing. A Primer for L.A. Care Contracted Providers
Understanding Balance Billing A Primer for L.A. Care Contracted Providers Purpose for this Training 1. With new managed care programs (i.e. Cal MediConnect, Covered California, PASC- SEIU), members and
More information2015 Summary of Benefits
2015 Summary of Benefits Health Net Cal MediConnect Plan (Medicare-Medicaid Plan) Los Angeles County, CA H3237_2015_0291 CMS Accepted 09082014 Health Net Cal MediConnect Summary of Benefits! This is a
More informationFACT SHEET Low Income Assistance: Cal MediConnect (E-004) p. 1 of 6
FACT SHEET Low Income Assistance: Cal MediConnect (E-004) p. 1 of 6 Low Income Assistance: Cal MediConnect What is Cal MediConnect? California is one of 12 states that has signed a Memorandum of Understanding
More informationModel Of Care: Care Coordination Interdisciplinary Care Team (ICT)
Cal MediConnect 2017 Model Of Care: Care Coordination Interdisciplinary Care Team (ICT) 2017 CMC Annual Training Learning Objectives Define the L.A. Care Cal MediConnect (CMC) Model of Care Describe the
More informationDisability Rights California
Disability Rights California California s protection and advocacy system BAY AREA REGIONAL OFFICE 1330 Broadway, Suite 500 Oakland, CA 94612 Tel: (510) 267-1200 TTY: (800) 719-5798 Toll Free: (800) 776-5746
More informationSanta Clara Family Health Plan New Provider Orientation
Santa Clara Family Health Plan New Provider Orientation 2017 SCFHP Overview Santa Clara Family Health Plan (SCFHP) was established in 1996 by the Santa Clara County Board of Supervisors in response to
More informationBest Practices for Integrated Care Teams
Best Practices for Integrated Care Teams Cal MediConnect Providers Summit January 21, 2015 Moderator: Alexandra Kruse, Senior Program Officer, CHCS www.chcs.org Interdisciplinary Care Teams Providers have
More informationMedicare Advantage and Part D Compliance Training. 42 CFR Parts and
Medicare Advantage and Part D Compliance Training 42 CFR Parts 422.503 and 423.504 Background > As a Medicare Advantage (MA) and Part D (PDP) Plan Sponsor ( Sponsor ), Blue Cross and Blue Shield Northern
More informationCoordinated Care Initiative (CCI) ADVANCED I: Benefit Package and Consumer Protections
July 29, 2014 Coordinated Care Initiative (CCI) ADVANCED I: Benefit Package and Consumer Protections Amber Cutler, Staff Attorney National Senior Citizens Law Center www.nsclc.org 1 The National Senior
More informationUPDATE ON THE IMPLEMENTATION OF CALIFORNIA S COORDINATED CARE INITIATIVE
UPDATE ON THE IMPLEMENTATION OF CALIFORNIA S COORDINATED CARE INITIATIVE Eileen Kunz Chief of Government Affairs & Compliance On Lok Carol Hubbard Executive Director of Home & Community Services St. Paul
More informationSpecial Needs Plan Model of Care Chinese Community Health Plan
Special Needs Plan Model of Care 2017 2017 Chinese Community Health Plan Elements of CCHP SNP Model of Care Special Needs Plan (SNP) Goals CCHP Dual Eligible SNP Enrollment & Eligibility Vulnerable Beneficiaries
More informationJune 2004 PROVIDER NOTICE NUMBER 421 PHARMACY PROVIDERS
June 2004 PROVIDER NOTICE NUMBER 421 Kansas Medical Assistance Program Vertical Perspective PHARMACY PROVIDERS Information about the Kansas Medical Assistance Program as well as provider manuals and other
More informationCoordinated Care Initiative Frequently Asked Questions for Physicians
What is the Coordinated Care Initiative? California's Coordinated Care Initiative (CCI) changes the focus and delivery of health care for seniors and people with disabilities. Coordinated care offers participants
More informationCAL MEDICONNECT: Working with In-Home Supportive Services (IHSS) Physician Webinar Series
CAL MEDICONNECT: Working with In-Home Supportive Services (IHSS) Physician Webinar Series Today s Webinar This webinar is part of a series designed specifically for physicians. For a general overview of
More informationManaged Long Term Services and Supports (MLTSS)
Cal MediConnect 2017 Managed Long Term Services and Supports (MLTSS) 2017 CMC Annual Training Topics of Discussion What are MLTSS services? Overview of MLTSS programs MLTSS Referrals Services covered Eligibility
More informationOneCare Connect Cal MediConnect Plan (Medicare-Medicaid Plan) OneCare Connect Program Overview
OneCare Connect Cal MediConnect Plan (Medicare-Medicaid Plan) OneCare Connect Program Overview 2018 1 Learning Objectives After completing this module you will: Have gained an awareness and knowledge about
More informationCRCE Exam Study Manual Update for 2017
CRCE Exam Study Manual Update for 2017 This document reflects updates made to the instructional content from the Certified Revenue Cycle Executive (CRCE-I, CRCE-P) Exam Study Manual - 2016 to the 2017
More informationCoordinated Care Initiative Monthly Update: March 2018
Keeping You Informed About Medicare / Medi-Cal Integration Coordinated Care Initiative Monthly Update: March 2018 Click here for an accessible version of this newsletter. Important Announcements New Performance
More informationDHCS Update: Major Initiatives and Strategies Towards Standardization
DHCS Update: Major Initiatives and Strategies Towards Standardization Javier Portela, Division Chief Managed Care Operations Department of Health Care Services ICE 2016 Annual Conference December 2016
More informationComment Template for Care Coordination Standards
GENERAL COMMENTS Thank you for the opportunity to provide input into these very important standards. We offer the following comments in the spirit of improving clarity, consistency, and ease of reading
More informationMEDICARE-MEDICAID CAPITATED FINANCIAL ALIGNMENT MODEL REPORTING REQUIREMENTS: CALIFORNIA-SPECIFIC REPORTING REQUIREMENTS
MEDICARE-MEDICAID CAPITATED FINANCIAL ALIGNMENT MODEL REPORTING REQUIREMENTS: CALIFORNIA-SPECIFIC REPORTING REQUIREMENTS Effective as of January 1, 2015, Issued August 24, 2015 CA-1 Table of Contents California-Specific
More informationMedi-cal Manual Update Section 12 Provider Network Operations (pg ) SECTION 12: PROVIDER NETWORK OPERATIONS
SECTION 12: PROVIDER NETWORK OPERATIONS The Provider Network Operations Department is dedicated to educating, training, and ensuring all participating providers have a resource to voice any concern they
More informationMichigan Newsletter Summer 2010
What s New Michigan Newsletter Summer 2010 Provider Demographic Changes Effective September 1, 2010 Molina Healthcare will allow Providers to submit their demographic changes either via e-mail, regular
More informationFOCUSFALL Be ready to answer questions. Quality. Satisfaction Survey. Standards: 2013 CAHPS PROVIDER NEWSLETTER
PROVIDER NEWSLETTER in FOCUSFALL 2013 Quality Improvement Annual Summary Please take a moment to review the summary of our findings for 2013 The Ethics of Medicare: Fraud, Waste & Abuse Member Satisfaction
More informationDuals Demonstration. An Overview for Home Medical Equipment Providers
Duals Demonstration An Overview for Home Medical Equipment Providers Overview Background Medi-Cal Delivery Models State Budget Coordinated Care Initiative Duals Demonstration Overview Goals Population
More informationAnthem Blue Cross Cal MediConnect Plan (Medicare- Medicaid Plan) Santa Clara County Behavioral Health provider training
Anthem Blue Cross Cal MediConnect Plan (Medicare- Medicaid Plan) Santa Clara County Behavioral Health provider training Anthem Blue Cross Cal MediConnect Plan Effective January 1, 2015, Anthem Blue Cross
More information2018 Evidence of Coverage
Los Angeles, Riverside and San Bernardino Counties 2018 Evidence of Coverage SCAN Connections (HMO SNP) Y0057_SCAN_10165_2017F File & Use Accepted DHCS Approved 08232017 08/17 18C-EOC006 January 1 December
More informationCoordinating Care for Dual Eligibles: California s Demonstration Project
Coordinating Care for Dual Eligibles: California s Demonstration Project Sarah Arnquist, Harbage Consulting Alameda County Board of Supervisors Health Committee January 30, 2012 Presentation Outline Misaligned
More informationLONG TERM CARE INTEGRATION
LONG TERM CARE INTEGRATION Kristen D Smith, MPH Aging Program Administrator Aging & Independence Services County of San Diego Health and Human Services 1/11/2017 1 COUNTY OF SAN DIEGO Building Better Health
More informationCalifornia s Coordinated Care Initiative: An Update
California s Coordinated Care Initiative: An Update Background On April 1, 2014, health plans in selected counties began enrolling beneficiaries as part of the Coordinated Care Initiative. This fact sheet
More information2016 Quality Improvement Program Description
2016 Quality Improvement Program Description Board Approval 8/23/2016 Revision Date: 6/10/2016, 8/23/2016 Approved by the Board of Directors: March 19, 2002; April 22, 2003; April 20, 2004; April 26, 2005,
More information2018 Minnesota Vaccines for Children (MnVFC) Program Provider Agreement
2018 Minnesota Vaccines for Children (MnVFC) Program Provider Agreement All sites enrolled in the MnVFC program must submit a signed MnVFC Program Provider Agreement by Nov. 30 each year. We prefer you
More informationTable of contents Quarter 1
2016 Quarter 1 Welcome to Amerigroup Iowa, Inc. Welcome to the Amerigroup Iowa, Inc. network provider family! We are pleased you have joined our Iowa network, which consists of some of the finest health
More informationCoordinated Care Initiative Information for Advocates
Coordinated Care Initiative Information for Advocates 1 Medicare and Medi-Cal Today What You Will Learn Your Health Care Coverage Options Cal MediConnect Medi-Cal Managed Care Plan Who Can Join Benefits
More informationLessons Learned from the Dual Eligibles Demonstrations. Real-Life Takeaways from California and Other States
Lessons Learned from the Dual Eligibles Demonstrations 1 May 28, 2015 Real-Life Takeaways from California and Other States Introductions Toby Douglas Consultant, MAXIMUS Former Director of California Department
More informationFreedom Blue PPO SM Summary of Benefits
Freedom Blue PPO SM Summary of Benefits R9943-206-CO-308 10/05 Introduction to the Summary of Benefits for Freedom Blue PPO Plan January 1, 2006 - December 31, 2006 California YOU HAVE CHOICES IN YOUR
More informationCal MediConnect Plan Choice Book. Medicare and Medi-Cal. To the addressee or guardian of: John B. Sample 1234 Any Street ANY CITY, CA 90000
CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES Health Care Options, P.O. Box 989009 West Sacramento, CA 95798-9860 To the addressee or guardian of: John B. Sample 1234 Any Street ANY CITY, CA 90000 Cal
More informationKeenan Pharmacy Care Management (KPCM)
Keenan Pharmacy Care Management (KPCM) This program is an exclusive to KPS clients as an additional layer of pharmacy benefit management by engaging physicians and members directly to ensure that the best
More informationA Newsletter for Participating Physicians and Other Health Care Professionals, Acute Care Facilities and Ancillary Staff
March 2018 BLUE Review A Newsletter for Participating Physicians and Other Health Care Professionals, Acute Care Facilities and Ancillary Staff In This Issue: Shatterproof: Changing Substance Use Disorder
More informationThe broker proposal subjects consumers to overzealous broker misconduct, resulting in increased confusion and disruption.
May 25, 2018 Sarah Brooks, Deputy Director, Health Care Delivery Systems California Department of Health Care Services Sacramento, California 95812 Via email: Sarah.Brooks@dhcs.ca.gov; info@calduals.org
More informationSummary of California s Dual Eligible Demonstration Memorandum of Understanding
April 2013 Summary of California s Dual Eligible Demonstration Memorandum of Understanding The Nation s Largest, Most Aggressive Plan for Integration On March 27, 2013, the Centers for Medicare and Medicaid
More informationDocumentation Standards for Home and Community Based Services (HCBS) Presented by: LeAnn Moskowitz
Documentation Standards for Home and Community Based Services (HCBS) Presented by: LeAnn Moskowitz Agenda Introduction Medicaid Documentation Standards Medical and Financial Records Service Plan Documentation
More informationSANTA BARBARA COUNTY DEPARTMENT OF Behavioral Wellness A System of Care and Recovery
SANTA BARBARA COUNTY DEPARTMENT OF Behavioral Wellness A System of Care and Recovery P age 11 of 5 Department Policy and Procedure Section Sub-section Policy Policy# Quality Care Management General Contracted
More informationThe Impact of Cal MediConnect on Transitions from Institutional to Community-Based Settings
Research Brief The Impact of Cal MediConnect on Transitions from Institutional to Community-Based Settings Carrie Graham, PhD, MGS Mel Neri Edward Bozwell Bueno This evaluation was funded by The SCAN Foundation
More informationParticipation in the Vaccines for Children Program ALL providers servicing our members between the ages of 0-20 are to register with the Vaccine
Participation in the Vaccines for Children Program ALL providers servicing our members between the ages of 0-20 are to register with the Vaccine for Children Program (VFC) and understand that they are
More informationAnthem Blue Cross Cal MediConnect Plan. Santa Clara County. Provider Manual
Cal MediConnect Plan Santa Clara County Provider Manual Effective January 1, 2015 This page left intentionally blank. Page 2 Table of Contents Cal MediConnect Plan Table of Contents CHAPTER 1: INTRODUCTION...
More information1500 Capitol Ave. Sacramento, CA 95814
Health Net Community Solutions, Inc. Health Net of California, Inc. 1201 K Street, Ste. 1815 Sacramento, CA 95814 April 22, 2016 Ms. Sarah Brooks, Deputy Director Health Care Delivery Systems Department
More informationMedical Care Meets Long-Term Services and Supports (LTSS)
Medical Care Meets Long-Term Services and Supports (LTSS) Cal MediConnect Providers Summit January 21, 2015 Moderator: Rebecca Malberg von Lowenfeldt, Director LTSS Practice, Harbage Consulting www.chcs.org
More informationMESSAGE FROM Care 1st Health Plan. Notice of Privacy Practices Effective: April 14, 2003
MESSAGE FROM Care 1st Health Plan Notice of Privacy Practices Effective: April 14, 2003 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO
More informationCoordinated Care Initiative (CCI): Basics for Consumers
California s Protection & Advocacy System Toll-Free (800) 776-5746 Coordinated Care Initiative (CCI): Basics for Consumers September 2016, Pub #5535.01 January 28, 2014 Revised April 1, 2014 Updated September
More informationCoordinated Care Initiative (CCI): An Update
Coordinated Care Initiative (CCI): An Update Amber Christ, Senior Staff Attorney Tuesday, December 19, 2017 All on mute. Use Questions function for substantive questions and for technical concerns. Problems
More informationDepartment of Health Care Services
State of California Department of Health Care Services Streamlining the Cal MediConnect Voluntary Enrollment Experience April 2016 This is one of three documents released by the Department of Health Care
More informationL.A. Care Cal MediConnect Plan (Medicare-Medicaid Plan) Provider Manual
L.A. Care Cal MediConnect Plan (Medicare-Medicaid Plan) Provider Manual L.A. Care Cal Mediconnect Plan Provider Manual Table of Contents 1.0 L.A. CARE HEALTH PLAN 1 2.0 MEMBERSHIP AND MEMBERSHIP SERVICES..
More informationMember Handbook. IEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid Plan) IEHP (4347) TTY. For The Benefit Year
Member Handbook IEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid Plan) For The Benefit Year 1-877-273-IEHP (4347) 1-800-718-4347 TTY 2016 IEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid
More informationMEMBER HANDBOOK. California. Molina Dual Options Cal Medi-Connect Plan Medicare-Medicaid Plan
MEMBER HANDBOOK California 2014 Molina Dual Options Cal Medi-Connect Plan Medicare-Medicaid Plan Member Services (855) 665-4627, TTY/TDD 711 Monday - Friday, 8 a.m. - 8 p.m. local time H8677_14_15108_0003_MMPCAMbrHbk
More informationAnthem Blue Cross Cal MediConnect Plan (Medicare-Medicaid Plan) Santa Clara County Provider Manual
Anthem Blue Cross Cal MediConnect Plan (Medicare-Medicaid Plan) Santa Clara County Provider Manual This page is intentionally left blank. Table of Contents CHAPTER 1: INTRODUCTION... 9 Welcome to the Anthem
More informationCCI Stakeholder Operational Workgroup Wednesday, July 30, :00 pm 3:00 pm
CCI Stakeholder Operational Workgroup Wednesday, July 30, 2014 1:00 pm 3:00 pm The California Endowment 1000 N Alameda St, Los Angeles, CA 90012 Yosemite B Conference Line: 213-438-5445 Access Code: 999
More informationSacramento Medi-Cal Managed Care Advisory Committee
Meeting Minutes April 22, 2013, 3:00 PM 5:00 PM DHHS Administration 7001A East Parkway Sacramento, CA 95823 Conference Room 1 COMMITTEE MEMBERS X Chair Sandy Damiano, PhD Hospital Robert Waste, PhD X Advocate
More informationMEDI-CAL (MC051) EDI ENROLLMENT INSTRUCTIONS
MEDI-CAL (MC051) EDI ENROLLMENT INSTRUCTIONS HOW LONG DOES PRE-ENROLLMENT TAKE? Standard processing time is approximately 4 to 6 weeks. WHERE SHOULD I SEND THE FORMS? Mail the original forms to: Office
More informationMEDICAID DENTAL PROGRAM Policy Review
MEDICAID DENTAL PROGRAM Policy Review What is Medicaid? Wyoming Medicaid is a joint federal and state government program that pays for medical and dental care for eligible low income and medically needy
More informationCal MediConnect (CMC) Model of Care
Cal MediConnect (CMC) Model of Care CMC MOC Annual Training Presentation for Providers and Health Net Associates Presentation by Health Net Medical Management Training Department Herminia Escobedo Health
More information2009 Evidence of Coverage BlueMedicare SM Polk County HMO. A Medicare Advantage HMO Plan
2009 Evidence of Coverage BlueMedicare SM Polk County HMO A Medicare Advantage HMO Plan Member Services phone number: 1-800-926-6565 TTY/TDD users call: 711 8:00 a.m. - 9:00 p.m. ET, seven days a week
More informationNewfoundland and Labrador Pharmacy Board
Newfoundland and Labrador Pharmacy Board Standards of Practice Prescribing by Pharmacists August 2015 Table of Contents 1) Introduction... 1 2) Requirements... 1 3) Limitations... 1 4) Operational Standards...
More informationSummary of Benefits. for Blue Medicare Access Value SM (Regional PPO) Available in Ohio
Summary of Benefits for SM Available in Ohio Anthem Blue Cross and Blue Shield is a Health plan with a Medicare contract.anthem Insurance Companies, Inc. (AICI) is the legal entity that has contracted
More informationSUMMARY OF BENEFITS. H5649_090412_1065_SB CMS Accepted
2013 SUMMARY OF BENEFITS H5649_090412_1065_SB CMS Accepted Introduction Section I Introduction to the for MEDICARE PLAN (HMO), MEDI-MEDI PLAN (HMO SNP), and PREMIER PLAN (HMO) January 1 - December 31
More informationPreparing California s Community-Based Organizations to Partner with the Health Care Sector by Building Business Acumen:
Preparing California s Community-Based Organizations to Partner with the Health Care Sector by Building Business Acumen: Case Studies from the First Cohort of Linkage Lab Grantees August 2015 Authors:
More informationCalifornia s Duals Demonstration: A Transparent and Inclusive Stakeholder Process. Peter Harbage President Harbage Consulting
California s Duals Demonstration: A Transparent and Inclusive Stakeholder Process Peter Harbage President Harbage Consulting 1 Today s Agenda 1. California Context 1. California s Stakeholder Engagement
More informationEvidence of Coverage SANTA CLARA FAMILY HEALTH PLAN MEDI-CAL. Toll Free: TTY:
SANTA CLARA FAMILY HEALTH PLAN MEDI-CAL Evidence of Coverage 2016-2017 Toll Free: 1-800-260-2055 TTY: 1-800-735-2929 Hours: 8:30 a.m. to 5:00 p.m., Monday - Friday (except holidays). If you have questions,
More informationSummary of Benefits. New York: Bronx, Kings, New York, Queens and Richmond Counties
Summary of Benefits New York: Bronx, Kings, New York, Queens and Richmond Counties January 1, 2006 - December 31, 2006 You ve earned the right to live life on your own terms. And that includes the right
More informationSection I Introduction to Summary of Benefits
Section I Introduction to Summary of Benefits Thank you for your interest in + Rx Classic (PPO) and. Our plans are offered by Regence BlueShield, a Medicare Advantage Preferred Provider Organization (PPO)
More informationDepartment of Health and Human Services. Centers for Medicare & Medicaid Services. Medicaid Integrity Program
Department of Health and Human Services Centers for Medicare & Medicaid Services Medicaid Integrity Program California Comprehensive Program Integrity Review Final Report Reviewers: Jeff Coady, Review
More informationSummary Of Benefits. CALIFORNIA Imperial, Los Angeles, Riverside (partial), San Bernardino (partial), and San Diego
Summary Of Benefits CALIFORNIA Imperial, Los Angeles, Riverside (partial), San Bernardino (partial), and San Diego 2018 Molina Medicare Options Plus (HMO SNP) (800) 665-0898, TTY/TDD 711 7 days a week,
More informationSmartSaver. A Medicare Advantage Medical Savings Account Plan. Summary of Benefits and Other-Value Added Services. From Blue Cross of California
SmartSaver From Blue Cross of California A Medicare Advantage Medical Savings Account Plan Service Area C Summary of Benefits and Other-Value Added Services H5769 2007 CO 415 09/22/06 Introduction to the
More informationCA Duals Demonstration: Bringing Coordination to a Fragmented System
CA Duals Demonstration: Bringing Coordination to a Fragmented System Martha Smith Health Net s Chief Dual Eligible Program Officer Integrated Healthcare Association & California Association of Physician
More informationRhode Island Department of Health Office of Immunization
Rhode Island Department of Health Office of Immunization Fraud and Abuse Policy and Procedures The Rhode Island Department of Health (RIDOH) Office of Immunization is required by federal grant to investigate
More informationLong Term Care Nursing Facility Resource Guide
Long Term Care Nursing Facility Resource Guide September 2014 Table of Contents Section 1: Introduction and Overview Introduction... 4 Purpose and Organization of Long Term Care Nursing Facility Resource
More informationMedi-Pak Advantage: Reimbursement Methodology
Medi-Pak Advantage: Reimbursement Methodology The information located on the following pages is intended to summarize the reimbursement methodologies for Medi-Pak Advantage: Medi-Pak Advantage reimburses
More informationAssessing the Quality of California Dual Eligible Demonstration Health Plans
M A Y 2 0 1 2 Assessing the Quality of California Dual Eligible Demonstration Health Plans T A B L E O F C O N T E N T S Overview... 1 Introduction... 2 Table 1: Plan Rating Overview... Summary of Quality
More informationLong-Term Services and Support (LTSS) Handbook. Blue Cross Community ICPSM
Blue Cross Community ICPSM Long-Term Services and Support (LTSS) Handbook Effective March 2014 www.bcbsilcommunityicp.com Call Toll Free: 1-888-657-1211 TTY/TDD 711. We are open between 8 a.m. to 8 p.m.
More informationCal MediConnect (CMC) Model of Care 2018
Cal MediConnect (CMC) Model of Care 2018 A Comprehensive Annual Training for Health Net Providers and Associates Geoffrey Gomez Health Net Learning Objectives By the end of this training, participants
More informationAssessment. SMP Foundations Training Kit. Table of Contents
SMP Foundations Training Kit Assessment Table of Contents Participant Assessment Questions and Answer Form Assessment Questions... 10 Pages Answer Form... 2 Pages Trainer s Resources Answer Key... 2 Pages
More informationNetwork Health Insurance Corporation Upcoming Negative Changes to the Medicare Part D Formulary Requesting an Exception to the Formulary
Requesting an Exception to the Formulary You can ask Network Health Insurance Corporation to make an exception to our coverage rules. Generally, we will only approve your request for an exception if alternative
More informationPatient Section All fields are required. Please print clearly and complete all information.
Lilly Cares Foundation Patient Assistance Program PO Box 13185 La Jolla, CA 92039 Phone: 1-800-545-6962 Fax: 1-844-431-6650 www.lillycares.com Patient Section All fields are required. Please print clearly
More informationMild-to-Moderate Mental Health Coverage in Medi-Cal: The Challenge and Promise of Coordination between Counties and Health Plans
Advancing innovations in health care delivery for low-income Americans Mild-to-Moderate Mental Health Coverage in Medi-Cal: The Challenge and Promise of Coordination between Counties and Health Plans December
More informationOFFICE OF DEVELOPMENTAL PROGRAMS BULLETIN
ISSUE DATE XX-XX-XXXX SUBJECT EFFECTIVE DATE XX-XX-XXXX OFFICE OF DEVELOPMENTAL PROGRAMS BULLETIN NUMBER 00-XX-17 BY Office of Developmental Programs Claim and Service Documentation Requirements for Providers
More informationHealthPartners Freedom Plan (Cost) 2011 Medical Summary of Benefits Wisconsin
HealthPartners Freedom Plan 2011 Medical Summary of Benefits Wisconsin HealthPartners Wisconsin Freedom Plan I HealthPartners Wisconsin Freedom Plan II 420421 (10/10) H2462_SB WI_151 CMS Approved 10/5/10
More informationBeau Hennemann IHSS Program Manager
Beau Hennemann IHSS Program Manager Consumer, Family and Caregiver Forum February 1, 2013 L.A. Care is the nation s largest public health plan, with more than 1 million members. L.A. Care is governed by
More informationThank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need.
Thank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need. Did you know that NeedyMeds has thousands of other free resources?
More information