Molina Healthcare of Michigan MI Health Link Presentation June 3, 2015 Nursing Facility FAQs
|
|
- Cora Hudson
- 5 years ago
- Views:
Transcription
1 CONTRACTING What if our facility is auto-assigned a member, but is not contracted with Molina? If you are not contracted with Molina, we will sign a single case agreement, or Letter of Agreement, while we move toward a full agreement and credentialing. Prior Authorization of services is required. What if our facility is not contracted yet? If you are in the process of the contracting/credentialing process, a Letter of Agreement (LOA) is not required for any auto-assigned members. Once a contract/complete credentialing information is received, Molina updates the facility status to provisional for authorization and claims payment purposes. If you have not started this process, please contact Diane Carr at , ext or diane.carr@molinahealthcare.com. Can our pharmacy participate with CVS Caremark? Yes, your pharmacy may contract with MHM s Pharmacy Benefit Manager (PBM), CVS Caremark. Please call HEALTH SERVICES How will Molina Care Coordinators be assigned, by facility or by patient? Molina s goal is to assign by facility. How long will it take for a Molina Care Coordinator to be assigned new members within their aligned facility? The assignment of the Care Coordinator happens upon notification of member enrollment. How big will the caseloads be for the Case Managers? Care Managers have a targeted case load of 300 members and care coordinators have a targeted case load of 50 members. 1
2 If a member comes from the hospital, or from home, how long before the Care Coordinator performs the assessment? Molina s Care Coordinators will do the assessment within 48 hours. When the member is in the hospital, does the hospital obtain the prior authorization for the transfer to the nursing home? Yes, the hospital would obtain the prior authorization for the transfer to the nursing facility. If a member has a stage four wound and needs an air mattress, who will order it? The nursing facility will complete the form as usual and send it in to Molina for authorization. The timeframe for Level of Care Determinations (LOCDs) is 90 days if a member is a current resident in a nursing facility. If the member is a new resident, when will the LOCD be completed? Molina s timeframe to complete a LOCD is no longer than 90 days; however, we will make every effort to complete prior to the 90 th day. Each nursing facility should complete the LOCD per its current process. Beginning in the Fall of 2015, the state will assign a vendor to perform the LOCDs, but that does not change the process the nursing facility currently has in place. How often is a prior authorization required for custodial care? Prior Authorizations are required every six months for custodial care. If you have a member in the MI Health Link plan, you must request a continued stay authorization every six months. 2
3 Will the nursing facilities be notified when the six-month time period for authorization is coming close? No, Molina will not notify the nursing facility of pending continued stay authorizations. Molina is not always informed when members enter custodial care. Please notify Molina directly by calling the Utilization Management Department at or fax a request to when you admit a new MI Health Link member. What is the process when a member is custodial and develops a need for PT/OT/ST? This is covered under Medicare Part B. Providers will submit an authorization request for the necessary services based on the Molina Prior Authorization guide. What are the approval times for the Pre-Paid Inpatient Health Plans (PIHPs) for behavioral health services? Molina does not approve behavioral health services. Please contact the PIHP in the appropriate county. Normal NCQA and state requirements apply for 72 hours for urgent cases and 14 days for non-urgent cases. PIHP contact information is: Detroit Wayne Mental Health Authority Macomb County Community Mental Health Who is responsible for ordering DME? DME is covered under the per diem. The nursing facility is responsible for ordering, paying and obtaining the authorization for their vendors, since they are paid at a per diem. Will Molina notify nursing facilities of new members? We request that you please contact Molina s call center at to let us know if you have a custodial care member. 3
4 How long does the process take if home care is required when leaving the facility to go home? The initial three home care visits do not require preauthorization; then the home care agency will request further visits. What if a durable medical equipment transitions from the hospital to the nursing facility under rehabilitation; how long will it take for the prior authorization? The hospital will notify Molina and Molina strives to complete the authorization within 72 hours. Where will the required 30 day meeting for members take place if they are in the nursing facility? The Molina Care Coordinator will stay in touch and make the visit with the member at the nursing facility. There will be one or two Care Coordinators per facility who will work with the facility to figure out the best process when conducting meetings. There is no hospice care in the MI Health Link program. So, if a member moves from MI Health Link to hospice, how is the transition period handled? When the member elects hospice, Molina is responsible for covering services until the first of the next month. The member will be disenrolled from MI Health Link as of the first day of the month following the month the member elects to receive hospice care. Is authorization for short-term rehab required upon patient discharge from the hospital? Authorization is required. Under regulatory and NCQA guidelines, Molina has up to 72 hours to respond, but our goal is to respond within 24 hours. Molina works with the hospital throughout the inpatient stay to plan for anticipated needs upon discharge. 4
5 Does the care coordinator follow the patient into multiple settings such as rehab? Yes, Care Coordinators are available to assist in multiple settings. Does Molina have a process in place to work with hospitals to ensure all applicable services are coordinated upon transfer to a nursing facility? Molina has a hospital transition team that works with the discharge planners at the hospital during the inpatient stay to ensure that all equipment and other services are coordinated at the point of discharge. Working in conjunction with the hospital, we will make our best effort to ensure sure the nursing facility is notified of the discharge and the member s special needs (order of equipment, infusion, etc.). QUALITY MANAGEMENT Does Molina following the guidelines utilized by the State of Michigan for incident reporting? Yes, Molina utilizes the same algorithm as the state for Critical Incident Reporting. What are the notification requirements for Critical Incident Reporting? Follow the state process and notify Molina as well. Does Molina process incident reports via the state? Molina will report what the state mandates. Our Care Coordinators will work with the nursing facility Director of Nursing on all incidents and will report within 48 hours. The nursing facility must inform Molina of any incidents that require mandatory reporting. 5
6 BLLING/OTHER What is the turnaround time for claims going through two cycles? Molina processes claims for Medicare benefits first, then Medicaid. All claims are processed within 30 days. Both segments of the payment will appear on the same remittance advice. How should the nursing facility bill for therapy services billed on a UB04 for Part B services only, with no room and board? Please bill Molina in the same way you would bill Medicare or Medicaid. What is covered under the per diem? Same as it is for you today, for all services you are billing. What is covered under Medicaid? Services not covered or benefits that have been exceeded under Medicare. How is it different now that Molina is the insurance provider? You only have to bill one entity. When patients come to the nursing facility under Medicare and convert to MI Health Link, when do they begin billing Molina? They begin billing on the first of the month following their effective date. What is the best method to validate eligibility? The state s CHAMPS system and then Molina s WebPortal to verify MI Health Link coverage. What if a member if retroactively enrolled? Please notify Molina as soon as you know the patient is Molina. Authorizations, as appropriate, will be given back to the first of the month of eligibility. 6
7 What are the member s rights to opt in or opt out of MI Health Link? Members can choose to dis-enroll and opt out of the MI Health Link program or choose a different MI Health Link health plan to coordinate their care. Members are sent at least two letters about being enrolled in a new MI Health Link health plan. The letter includes details regarding the plan, effective date of enrollment, and instructions on choice or opt out. Can you hold a follow-up session for nursing facilities? Yes, one will be held in the fall. Molina will notify nursing facilities of the date. 7
MI Health Link Program Nursing Facility Presentation October 27 th, Molina Healthcare of Michigan
Program Nursing Facility Presentation October 27 th, 2015 Molina Healthcare of Michigan Headline Goes Here MI Health Link Molina Healthcare of Michigan Molina Healthcare of Michigan is one of five health
More informationFREQUENTLY ASKED RHO QUESTIONS- November 2013
ELIGIBILITY How will Medicaid Pending applicants be handled? Will they be approved by DHS and then transitioned to Neighborhood? Or will Neighborhood be handling the pending applicants? All eligibility
More informationMolina Healthcare MyCare Ohio Prior Authorizations
Molina Healthcare MyCare Ohio Prior Authorizations Agenda Eligibility Medicare Passive Enrollment Transition of Care Definition Submission Time Frame Standard vs. Urgent How to Submit a Prior Authorization
More informationMolina Healthcare Michigan Health Care Services Department Phone: (855) Fax: (800)
Utilization Management Program Molina Healthcare of Michigan s Utilization Management (UM) program utilizes a care management approach based upon empirically validated best practices, where experience
More informationFallon Total Care Provider Orientation
Fallon Total Care Provider Orientation 2014 AGENDA Introductions Fallon Total Care Member enrollment Model of Care Doing business with FTC Provider Tools Q&A 2 About Fallon Total Care Fallon Total Care
More informationVIRGINIA COALITION OF PRIVATE PROVIDER ASSOCIATIONS. Commonwealth Coordinated Care Plus (Anthem CCC Plus)
VIRGINIA COALITION OF PRIVATE PROVIDER ASSOCIATIONS Commonwealth Coordinated Care Plus (Anthem CCC Plus) Our Team Keven Schock, Manager, Behavioral Health Kimberly White, Manager, Behavioral Health Taylor
More informationProvider Manual Molina Healthcare of Michigan, Inc. (Molina Healthcare) Molina Marketplace Product* Effective 1/1/2015
Provider Manual Molina Healthcare of Michigan, Inc. (Molina Healthcare) Molina Marketplace Product* Effective 1/1/2015 *Molina Healthcare s Health Benefit Exchange product is now known as the Molina Marketplace
More informationProvider Newsletter October-December 2017
Provider Newsletter October-December 2017 Table of Contents Contact Information... 3 HAP Midwest Health Plan Access and Availability Standards... 3 Provider Enrollment in CHAMPS Requirement... 4 Claims...
More informationOptum is providing NOMNC letter to facilities for skilled care for long-term residents
25-Jun-15 United HealthCare Optum has been contracted with UHC to deliver case management and nursing home model of care with a NP and RN. NP/RN is responsible for authorizing Part A and Part B skilled
More informationTherapies (e.g., physical, occupational and speech) Medical social worker (MSW) 3328ALL0118-F 1
1. Q: Why is Humana implementing this utilization management (UM) program? A: Humana is implementing this program to help coordinate home health care for its Medicare Advantage members in Oklahoma and
More informationNursing Facility Provider Liaison Meeting Frequently Asked Questions (FAQ) Document
Nursing Facility Provider Liaison Meeting Frequently Asked Questions (FAQ) Document The questions MDHHS received from providers in response to L-Letter 17-18: Medicaid Nursing Facility Provider Liaison
More informationCredentialing Verification Organization (CVO) Provider FAQ
Credentialing Verification Organization (CVO) Provider FAQ 1. What is a CVO? TexasMedicalAssociation(TMA)andTexasMedicaidMCOsproposedastatewide CVO concept to facilitate provider credentialing, which was
More informationMedicare, Managed Care & Emerging Trends
Medicare, Managed Care & Emerging Trends LeadingAge Michigan 2015 Annual Leadership Institute August 12, 2015 Jon Lanczak, Manager Beth Sullivan, Senior Manager Plante Moran, PLLC Overall Theme Healthcare
More informationHabilitation Supports Waiver(HSW) Focus on Quality and Compliance
Habilitation Supports Waiver(HSW) Focus on Quality and Compliance Home and Community Based Waiver Conference November 2017 Belinda Hawks Yingxu Zhang Agenda Welcome & Introductions Target Audience: HSW
More informationAdministrative Provider Manual for MI Health Link
Administrative Provider Manual for MI Health Link Page 1 of 52 MISSION STATEMENT... 5 GENERAL OVERVIEW... 5 CONTACT INFORMATION... 5 MEMBERS RIGHTS AND RESPONSIBILITIES... 6 TRANSPORTATION... 8 LANGUAGE
More informationProvider Manual. Utilization Management Care Management
Provider Manual Utilization Management Care Management Utilization Management This section of the Manual was created to help guide you and your staff in working with Kaiser Permanente s Resource Stewardship
More informationTRANSITION OF NURSING HOME POPULATIONS AND BENEFITS TO MEDICAID MANAGED CARE Frequently Asked Questions March 2015
ANDREW M. CUOMO Governor HOWARD A. ZUCKER, M.D., J.D. Acting Commissioner SALLY DRESLIN, M.S., R.N. Executive Deputy Commissioner TRANSITION OF NURSING HOME POPULATIONS AND BENEFITS TO MEDICAID MANAGED
More informationAetna. NOMNC Letter -- SNF needs to fax to NOMNC Fax
FINAL APPROVED 3/17/2015 Aetna Optum has contracted with Aetna Better Health to provide NP model of care during a nursing facility event and has assumed responsibility for obtaining service authorizations
More informationFlorida Medicaid. State Mental Health Hospital Services Coverage Policy. Agency for Health Care Administration. January 2018
Florida Medicaid State Mental Health Hospital Services Coverage Policy Agency for Health Care Administration Table of Contents 1.0 Introduction... 1 1.1 Description... 1 1.2 Legal Authority... 1 1.3 Definitions...
More informationEnrollment, Eligibility and Disenrollment
Health Plans Medicaid Medicaid is a federal program created by Title XIX of the Social Security Act in 1965. The primary objective of the program is to provide essential medical and health services to
More informationKaiser Permanente Washington - Pre-Authorization requirements:
Kaiser Permanente Washington - Pre-Authorization requirements: Kaiser Permanente Washington requires pre-authorization for most services to be covered. The information below outlines pre-authorization
More informationReferrals, Prior Authorizations, Medical Management, and Appeals
Referrals, Prior Authorizations, Medical Management, and Appeals 1 An Independent Licensee of the Blue Cross Blue Shield Association 044506 (12-21-2017) 2017 Premera. Proprietary and Confidential. Referrals
More informationHOME HEALTH CARE TABLE OF CONTENTS. OVERVIEW TRANSITIONAL... CARE... SERVICES . MEMBERS... MANAGED... BY... EVICORE
TABLE OF CONTENTS. OVERVIEW............................................................................................. 452..... TRANSITIONAL................. CARE...... SERVICES......................................................................
More informationMolina Healthcare of Illinois Prior Authorization Codification List Q ILUM182.1
Q3-2018 ILUM182.1 MOLINA HEALTHCARE OF ILLINOIS 2018 PRIOR AUTHORIZATION CODIFICATION LIST The Molina Healthcare of Illinois (Molina) is reviewed for updates quarterly, or as deemed necessary to meet the
More informationStandardized Prior Authorization Form Instructions
Standardized Prior Authorization Form Instructions The Standardized one-page Prior Authorization Request Form is to be used by all NH Medicaid Fee for Service (FFS) and Managed Care Organization (MCO)
More informationPrimary Care Provider Orientation. Over 1.4 million people have chosen Molina Healthcare
Primary Care Provider Orientation Over 1.4 million people have chosen Molina Healthcare 2012 Molina Healthcare Mission Statement Our mission is to provide quality health services to financially vulnerable
More informationDelegation Oversight 101: How to Pass Oversight Audits Session Code: TU01 Time: 8:00 a.m. 9:30 a.m. Total CE Credits: 1.5 Presenter: Angela Dorsey,
Delegation Oversight 101: How to Pass Oversight Audits Session Code: TU01 Time: 8:00 a.m. 9:30 a.m. Total CE Credits: 1.5 Presenter: Angela Dorsey, MA and Sallye Marcus Delegation Oversight 101 - How to
More informationAdministrative services which may be delegated to IPAs, Medical Groups, Vendors, or other organizations include:
Delegation Delegation This section contains information specific to medical groups, Independent Practice Associations (IPA), and Vendors contracted with Molina to provide medical care or services to Members,
More informationFACILITY BASED SERVICES
CUSTODIAL NURSING HOME CARE Chiropratic Services Custodial Nursing Home Care DME Equipment and Supplies Incontinence Supplies: Diapers, briefs, wipes, gloves, pads Infusion (IV, Enteral) Services Outpatient
More informationPOLICY AND PROCEDURE DEPARTMENT:
PAGE: 1 SCOPE: Coordinated Care (Plan) Department. PURPOSE: To evaluate members for admission to a Post-Acute Facility (Skilled Nursing, Inpatient Rehabilitation or Long Term Acute Care) including support
More informationConnecticut Medical Assistance Program Refresher for Hospice Providers. Presented by The Department of Social Services & HP for Billing Providers
Connecticut Medical Assistance Program Refresher for Hospice Providers Presented by The Department of Social Services & HP for Billing Providers 1 Training Topics Hospice Agenda HIPAA 5010 Hospice Form
More informationSection 7. Medical Management Program
Section 7. Medical Management Program Introduction Molina Healthcare maintains a medical management program to ensure patient safety as well as detect and prevent fraud, waste and abuse in its programs.
More informationSection 4 - Referrals and Authorizations: UM Department
Section 4 - Referrals and Authorizations: UM Department Primary Care Referral Process 1 Referrals to In-Network Specialists 1 Referrals to Out-Of-Network Specialists 2 Consultation Referral Forms 2 Consultation
More informationTRANSITION OF NURSING HOME POPULATIONS AND BENEFITS TO MEDICAID MANAGED CARE
ANDREW M. CUOMO Governor HOWARD A. ZUCKER, M.D., J.D. Acting Commissioner SALLY DRESLIN, M.S., R.N. Executive Deputy Commissioner TRANSITION OF NURSING HOME POPULATIONS AND BENEFITS TO MEDICAID MANAGED
More informationFlorida Medicaid. Hospice Services Coverage Policy
Florida Medicaid Agency for Health Care Administration June 2016 Table of Contents 1.0 Introduction... 1 1.1 Description... 1 1.2 Legal Authority... 1 1.3 Definitions... 1 2.0 Eligible Recipient... 2 2.1
More informationFlorida Medicaid. Statewide Inpatient Psychiatric Program Coverage Policy
Florida Medicaid Statewide Inpatient Psychiatric Program Coverage Policy Agency for Health Care Administration December 2015 Table of Contents 1.0 Introduction... 1 1.1 Description... 1 1.2 Legal Authority...
More informationADDRESSES AND PHONE NUMBERS
ADDRESSES AND PHONE NUMBERS Please register on the Molina Healthcare WebPortal at https://eportal.molinahealthcare.com/provider/registration. By registering you can access online member eligibility, claims
More informationINPATIENT HOSPITAL REIMBURSEMENT
HCRA CLAIMS PROCESSING Reimbursement: HCRA is not Medicaid; however, HCRA covered services are reimbursed at the hospital s outpatient or inpatient reimbursement rate allowed for Florida Medicaid. The
More informationFacility-Based Behavioral Health Program Professional Fees Reimbursement Policy Annual Approval Date. Approved By
Policy Number 2016RP505A Facility-Based Behavioral Health Program Professional Fees Reimbursement Policy Annual Approval Date 09/30/2016 Approved By Optum Behavioral Reimbursement Committee IMPORTANT NOTE
More informationModel of Care Heritage Provider Network & Arizona Priority Care Model of Care 2018
Model of Care Model of Care 2018 Learning Objectives Program participants will be able to: List two differences between the Complex Care Management (CCM), and Special Needs Program (SNP) programs. Identify
More informationProvider Orientation Molina Healthcare of Ohio, Inc.
Provider Orientation Molina Healthcare of Ohio, Inc. Agenda Molina Healthcare Overview Ohio Managed Care Overview Molina Healthcare Members Eligibility Enrollment Benefits Health Care Services Prior Authorization
More informationInformation for Skilled Nursing Facilities, Hospice R&B Providers & Supportive Living Programs: Authorizations, Billing and Claims
Information for Skilled Nursing Facilities, Hospice R&B Providers & Supportive Living Programs: Authorizations, Billing and Claims Skilled Nursing Facility Services Custodial Care, SLP and Hospice R&B
More informationMHP Service Codes Requiring Preauthorization - Effective July 1, 2018
McLaren Health Plan Medicaid/Healthy Michigan McLaren Health Advantage (PPO) McLaren Health Plan Community MHP Service Codes Requiring Preauthorization - Effective July 1, 2018 Auditory Procedures Oral
More informationMedicaid-Enrolled Hospice and Nursing Facility Providers
M E D I C A I D B U L L E T I N B T 1 9 9 9 2 4 J U L Y 3 0, 1 9 9 9 To: Subject: Medicaid-Enrolled Hospice and Nursing Facility Providers Treatment for Non-Terminal Conditions for Hospice Recipients Admitted
More informationHome Health, Hospice, and Nursing Facility. Indiana Health Coverage Programs DXC Technology October 2017
Home Health, Hospice, and Nursing Facility Indiana Health Coverage Programs DXC Technology October 2017 Agenda Billing Tips Home Health Hospice Nursing Facility Claim Form Update Helpful Tools Questions
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 informationThis document is updated quarterly. Please check this document prior to PA submission as codes may be removed or added. All codes listed require PA.
, PA Code Matrix IMPORTANT NOTICES September 1, 2016 This document is updated quarterly. Please check this document prior to PA submission as codes may be removed or added. All codes listed require PA.
More informationEnrollment, Eligibility and Disenrollment
Section 2. Enrollment, Eligibility and Disenrollment Enrollment: Enrollment in Medicaid Programs: The State of Florida (State) has the sole authority for determining eligibility for Medicaid and whether
More informationCHAPTER 3: EXECUTIVE SUMMARY
INDIANA PROVIDER MANUAL EXECUTIVE SUMMARY Indiana Family and Social Services Administration (FSSA) contracts with Anthem Insurance Companies, Inc. (dba Anthem Blue Cross and Blue Shield) for the provision
More informationNational Imaging Associates, Inc. (NIA) Frequently Asked Questions (FAQ s) For NH Healthy Families Providers Post Service Therapy Review Program
National Imaging Associates, Inc. (NIA) Frequently Asked Questions (FAQ s) For NH Healthy Families Providers Post Service Therapy Review Program Question Answer GENERAL Who is National Imaging Associates,
More informationAmeriHealth Michigan Provider Overview. April, 2014
AmeriHealth Michigan Provider Overview April, 2014 Who We Are Our Mission Dual Demonstration of Michigan AmeriHealth VIP Care Plus Agenda Our Record of Success Integrated Care Management Provider Partnerships
More informationINTRODUCTION TO CARE COORDINATION FOR PPEC PROVIDERS April 2014
INTRODUCTION TO CARE COORDINATION FOR PPEC PROVIDERS April 2014 1 eqhealth Solutions eqhealth Solutions is the Agency for Health Care Administration s (AHCA) contracted quality improvement organization
More informationBCBSNC Provider Application for Participation
BCBSNC Provider Application for Participation This application is to be used if you wish to become a participating provider facility with BCBSNC. This application is not a contract. Please follow the applicable
More informationHAP Midwest MI Health Link Medicare-Medicaid Plan Member Handbook
H9712_2016 MMP Handbook Accepted 12/12/2015 HAP Midwest MI Health Link Medicare-Medicaid Plan 2016 Member Handbook Effective: January 1, 2016 1 If you have questions, please call HAP Midwest MI Health
More informationState Fiscal Year 2017 Validation of Performance Measures for Region 7 Detroit Wayne Mental Health Authority
Michigan Department of Health and Human Services State Fiscal Year 2017 Validation of Performance Measures for egion 7 Detroit Wayne Mental Health Authority Behavioral Health and Developmental Disabilities
More informationMedical Management Program
Medical Management Program Introduction Molina Healthcare maintains a medical management program to ensure patient safety as well as detect and prevent Fraud, Waste and Abuse in its programs. The Molina
More informationGeneral Who is National Imaging Associates, Inc. (NIA)?
National Imaging Associates, Inc. (NIA) Frequently Asked Questions (FAQ s) For Managed Health Services (MHS) Providers Post Service Therapy Review Program Question Answer General Who is National Imaging
More informationTRANSITION OF NURSING HOME POPULATIONS AND BENEFITS TO MEDICAID MANAGED CARE Frequently Asked Questions March 2015 (Updated)
ANDREW M. CUOMO HOWARD A. ZUCKER, M.D., J.D. SALLY DRESLIN, M.S., R.N. Governor Acting Commissioner Executive Deputy Commissioner TRANSITION OF NURSING HOME POPULATIONS AND BENEFITS TO MEDICAID MANAGED
More informationNational Provider Identifier Industry Forum Type 2 NPIs Organizational and Subpart NPI Strategies: The Granularity Issue
National Provider Identifier Industry Forum Type 2 NPIs Organizational and Subpart NPI Strategies: The Granularity Issue Presented by John Bock Gail Kocher Suzanne Stewart Objectives What is a Subpart?
More informationIHCP bulletin INDIANA HEALTH COVERAGE PROGRAMS BT SEPTEMBER 22, 2017
IHCP bulletin INDIANA HEALTH COVERAGE PROGRAMS BT201760 SEPTEMBER 22, 2017 2017 IHCP Annual Provider Seminar scheduled for October 17-19 in Indianapolis The Indiana Family and Social Services Administration
More informationBlue Cross and Blue Shield of Illinois Provider Manual. Extended Care Facility Section
Blue Cross and Blue Shield of Illinois Provider Manual Extended Care Facility Section 2017 Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve
More informationProvider orientation. HealthKeepers, Inc. for Anthem HealthKeepers Plus, Commonwealth Coordinated Care Plus (Anthem CCC Plus)
Provider orientation HealthKeepers, Inc. for Anthem HealthKeepers Plus, Commonwealth Coordinated Care Plus (Anthem CCC Plus) Professional, facility, behavioral health providers Agenda Who we are Provider
More informationSubject: Indiana Health Coverage Programs 2003 Seminar
P R O V I D E R B U L L E T I N B T 2 0 0 3 4 8 J U L Y 1 5, 2 0 0 3 To: All Providers Subject: Overview The Office of Medicaid Policy and Planning (OMPP), the Children s Health Insurance Program (CHIP),
More informationMOLINA HEALTHCARE MEDICAID PRIOR AUTHORIZATION/PRE-SERVICE REVIEW GUIDE EFFECTIVE: 6/1/2018
MOLINA HEALTHCARE MEDICAID PRIOR AUTHORIZATION/PRE-SERVICE REVIEW GUIDE EFFECTIVE: 6/1/2018 THIS PRIOR AUTHORIZATION/PRE-SERVICE GUIDE APPLIES TO ALL MOLINA HEALTHCARE MEDICAID MEMBERS ONLY REFER TO MOLINA
More informationVNSNY CHOICE. VNSNY CHOICE- Ancillary and Other Special Services 7.1- Overview of Services and the Provider Network
7.1- Overview of Services and the Provider Network has arrangements in place to provide a full range of ancillary and other special services to its members, depending on the program in which they are enrolled.
More informationObjectives. Observation: Exploring the MOON and Charge Capture. Aurora Health Care 10/11/2016
Observation: Exploring the MOON and Charge Capture Lynn Sisler, Senior Director Case Management Manpreet Lehn, Manager Revenue Assurance Objectives Understand the CMS requirements for the Medicare Outpatient
More informationMedicare: 2017 Model of Care Training 4/13/2017
Medicare: 2017 Model of Care Training Training Objectives This course will describe how MHS Health Wisconsin Medicare Advantage and its contracted providers work together to successfully deliver the Model
More informationNJ Department of Human Services. FREQUENTLY ASKED QUESTIONS (FAQs) FOR PROVIDERS NJ FamilyCare MANAGED LONG TERM SERVICES AND SUPPORTS (MLTSS)
NJ Department of Human Services FREQUENTLY ASKED QUESTIONS (FAQs) FOR PROVIDERS NJ FamilyCare MANAGED LONG TERM SERVICES AND SUPPORTS (MLTSS) Assisted Living Billing Process when Member is Pending Enrollment
More informationUnderlying principles of the CVS Caremark Formulary Development and Management Process include the following:
Formulary Development and Management at CVS Caremark Development and management of drug formularies is an integral component in the pharmacy benefit management (PBM) services CVS Caremark provides to health
More informationLong Term Care (LTC) Claims Forwarding Webinar for Nursing Facility Users Frequently Asked Questions (FAQ)
Long Term Care (LTC) Claims Forwarding Webinar for Nursing Facility Users Frequently Asked Questions (FAQ) 1. What assistance is available if providers have additional questions regarding claims billing
More informationTCS FAQ s. How will the implementation of national standard code sets reduce burden on the health care industry?
TCS FAQ s What is a code set? Under HIPAA, a code set is any set of codes used for encoding data elements, such as tables of terms, medical concepts, medical diagnosis codes, or medical procedure codes.
More informationMSG0117 Group Health Options, Inc. Medicare Supplement Plans 2017
MSG0117 Group Health Options, Inc. Medicare Supplement Plans 2017 The Group Health difference Why choose Group Health? Here are just a few of the reasons why many Medicare enrollees choose and re-enroll
More informationMolina Healthcare of Ohio Nursing Facility and Assisted Living Provider Guide
Molina Healthcare of Ohio Nursing Facility and Assisted Living Table of Contents General Information... 3 Definitions... 3 Verifying Eligibility... 5 Utilization Management/Authorizations... 5 Claims Management...
More informationMichigan Health Link Integrated Care Dual Eligible Pilot. Nora Barkey MDCH Kyleen Gray SWMBH Roxanne Perry Audrey Smith DWMHA
Michigan Health Link Integrated Care Dual Eligible Pilot Nora Barkey MDCH Kyleen Gray SWMBH Roxanne Perry Audrey Smith DWMHA 1 Today s Agenda Welcome and Introductions Nora Barkey MI Health Link Overview
More informationReadmission Policy REIMBURSEMENT POLICY UB-04. Reimbursement Policy Oversight Committee
Readmission Policy Policy Number 2018F7001A Annual Approval Date 11/11/2017 Approved By Reimbursement Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You are responsible for submission
More informationMolina Healthcare of Washington, Inc. Health Delivery Organization (HDO) Application
INSTRUCTIONS: If your organization has multiple physical locations/businesses, include a separate full application for any facility grouping for which there is an independent facility survey and/or facility
More informationLifeWise Reference Manual LifeWise Health Plan of Oregon
11 UB-04 Billing Description This chapter contains participation, claims and billing information for providers who bill on a UB-04 (CMS 1450) claim form. This chapter supplements information contained
More information10/4/2015. ACA-based integrated care demonstration for beneficiaries with dual (Medicare/Medicaid) eligibility. Phased in start up in 2015
David LaLumia, President/CEO Health Care Association of Michigan October 11, 2015 1 MI Health Link (dual eligibles) FY2017 state budget Corporate practice of medicine legislation Healthy Michigan (Medicaid
More informationBenefits. Section D-1
Benefits Section D-1 Practitioners/providers who participate in Medicaid agree to accept the amount paid as payment in full (see 42 CRF 447.15) with the exception of co-payment amounts required in certain
More informationNeighborhood INTEGRITY MMP RIPIN
Neighborhood INTEGRITY MMP RIPIN 9.16.16 Agenda Overview of INTEGRITY Coverage Documents Carved Out Benefits Continuity of Care Provider Directory and Formulary INTEGRITY Overview NEIGHBORHOOD: History
More informationIMPORTANT NOTICES. Office visits and/or procedures at PAR/Network Providers do not require PA. Referrals to PAR/Network Specialists do not require PA.
, PA Code Matrix IMPORTANT NOTICES This document is updated quarterly. Please check this document prior to PA submission as codes may be removed or added. All codes listed require PA unless there is a
More informationPOLICY SUBJECT: POLICY:
POLICY SUBJECT: Healthcare Provider Documentation and Compliance Standards Business: Madonna Rehabilitation Hospital - Omaha Date of Origin: 7/1/2016 System: Quality & Risk Management Review Date: 07/25/2016
More informationSkilled Nursing Facility Level of Payment Guidelines for Tufts Health Plan Senior Care Options Members
Skilled Nursing Facility Level of Payment Guidelines for Tufts Health Plan Senior Care Options Members For level of payment guidelines for Tufts Medicare Preferred HMO members, click here. LEVEL 1A - SKILLED
More information5010 Changes. CHAMPS Changes 01/01/12 4/4/12. Copyright Kearney & Associates, Inc 1. 01/01/2012 Change From 4010 to 5010
Flowing Change Julie Kearney Kearney & Associates, Inc. 5010 Changes 01/01/2012 Change From 4010 to 5010 Went From Allowing 8 Diagnosis to 12 Diagnosis Postponed fines, and compliance until 04/01/2012
More informationHome Care Accreditation
Home Care Accreditation Q&A Guide Concise answers to frequently asked questions about how to begin the accreditation process, whom to call with questions and much more! Home Health Hospice Personal Care
More informationThe benefits of the Affordable Care Act for persons with Developmental Disabilities
Tuesday, 2:30 2:00, B5 The benefits of the Affordable Care Act for persons with Developmental Disabilities Objectives: Notes: Audrey E. Smith, MPH 33-402-9608 Asmith2@waynecounty.com. Identify effective
More informationMedicaid RAC Audit Results
Medicaid RAC Audit Results Clinical Audits: The RAC Clinical audit goal was to review supporting documentation for necessity of admission and continued stay in long term care for Medicaid residents. There
More informationMedicare Plus Blue SM Group PPO
2018 Medicare Plus Blue SM Group PPO Evidence of Coverage Your Medicare Health Benefits and Services as a Member of Medicare Plus Blue SM Group PPO This booklet gives you the details about your Medicare
More informationIMPORTANT NOTICES. All codes listed in this document require authorization, unless otherwise specified.
IMPORTANT NOTICES This document is updated quarterly. Codes requiring prior authorization may be added or deleted. Please check this document prior to submitting your prior authorization request as changes
More informationPROVIDER INFORMATION UPDATE FORM CURRENT CONTRACT INFORMATION - ALL FIELDS IN THIS SECTION ARE REQUIRED
PROVIDER INFORMATION UPDATE FORM CURRENT CONTRACT INFORMATION - ALL FIELDS IN THIS SECTION ARE REQUIRED 1. Type of Group: Ancillary Specialist PCP Hospital Urgent Care FQHC/RHC QFPP/ X Contracted Entity/Name:
More informationObservation Care Evaluation and Management Codes Policy
Policy Number Observation Care Evaluation and Management Codes Policy 2017R0115A Annual Approval Date 3/8/2017 Approved By Reimbursement Policy Oversight Committee IMPORTANT NOTE ABOUT THIS You are responsible
More informationSkilled Nursing Facility Level of Payment Guidelines for Tufts Medicare Preferred HMO Members
Skilled Nursing Facility Level of Payment Guidelines for Tufts Medicare Preferred HMO Members For level of payment guidelines for Tufts Health Plan Senior Care Options members, click here. LEVEL 1A SKILLED
More informationMichigan Complete Health (Medicare-Medicaid Plan) 2018 Provider Manual. mmp.michigancompletehealth.com
Michigan Complete Health (Medicare-Medicaid Plan) 2018 Provider Manual mmp.michigancompletehealth.com TABLE OF CONTENTS INTRODUCTION...4 Overview...4 Our Purpose...4 Our Mission and Care Beliefs...4 Our
More informationMedicare: 2018 Model of Care Training
Medicare: 2018 Model of Care Training Training Objectives This course will describe how Centene and its contracted providers work together to successfully deliver the duals Model of Care (MOC) program.
More informationCLASSIC BLUE SECURE/BLUE CROSS BLUE SHIELD COMPLEMENTARY Monroe County Benefit Summary/Comparison (Over 65 Retirees)
WHO IS COVERED Enrollment Requirement Members must be enrolled in both Medicare Parts A and B Members must be enrolled in both Medicare Parts A and B Type of Tier Single only Single only Dependent/Student
More informationNaviNet Authorizations transaction: Frequently asked questions
NaviNet Authorizations transaction: Frequently asked questions 1 of 4 10/30/2017 These frequently asked questions (FAQs) were developed to assist you in navigating the new Authorizations transaction on
More informationBenefit Name In Network Out of Network Limits and Additional Information. Benefit Name In Network Out of Network Limits and Additional Information
Excellus BluePPO $5/$35/$70, $0 gen for kids Integrated Rx, No Ded Prev Rx Benefit Time Period: 01/01/2018-12/31/2018 NYSADA General Information Cost Sharing Expenses Deductible - Single $3,500 $3,500
More informationProvider and Billing Manual
Provider and Billing Manual 2015-2016 Ambetter.SuperiorHealthPlan.com PROV15-TX-C-00008 2015 Celtic Insurance Company. All rights reserved. Table of Contents WELCOME----------------------------------------------------------------------------------
More informationODM FACILITY COMMUNICATION FREQUENTLY ASKED QUESTIONS (FAQ) Updated 09/2016
ODM 09401 FACILITY COMMUNICATION FREQUENTLY ASKED QUESTIONS (FAQ) Updated 09/2016 This document was developed as a response to the webinars that the Ohio Department of Medicaid (ODM) held to train nursing
More informationVNAA BLUEPRINT FOR EXCELLENCE BEST PRACTICES TO REDUCE HOSPITAL ADMISSIONS FROM HOME CARE. Training Slides
VNAA BLUEPRINT FOR EXCELLENCE BEST PRACTICES TO REDUCE HOSPITAL ADMISSIONS FROM HOME CARE Training Slides 061015 Why Take Action to Prevent Readmissions? Better patient care and patient experience Home
More information