Provider Town Hall Presentation

Transcription

1 Provider Town Hall Presentation

2 Topics HAP & Health Care Reform Overview Healthy Engagement Reminder Healthy Michigan Plan HAP Midwest Health Plan Overview ICD-10 & HAP Provider Newsroom Updates 2

3 HAP & Health Care Reform

4 Qualified Health Plans A Qualified Health Plan (QHP) is an insurance plan that is certified by the Health Insurance Marketplace. It provides the required Essential Health Benefits, follows established limits on cost sharing and meets other state and/or federal requirements. Essential Health Benefits include: Emergencies Hospitalizations Laboratory services Maternity care Mental health and substance abuse treatment Pediatric care Prescription drugs Preventive care Rehabilitative and habilitative care Vision and dental care for children Open Enrollment: November 15, 2014 February 15,

5 HAP Qualified Health Plans 2015 QHPs purchased from the Health Insurance Marketplace are considered on-marketplace (also known as on-exchange). All other options are considered off-marketplace. HAP has a variety of cost-sharing and coverage options available for individuals and small groups (see handout in your packet). These QHPs are offered both on and off the Marketplace. These plans can be purchased through the Health Insurance Marketplace, an agent/broker or directly through HAP In addition to the HMO and PPO networks, HAP is now offering High Performing HMO Network options: Henry Ford Choice Genesys Choice 5

6 Henry Ford Choice Network Available to businesses and residents in Macomb, Oakland* and Wayne counties Members select a PCP in the Henry Ford Choice network Receive specialty care and other services from providers in the Henry Ford Choice network *Excludes the following zip codes in Oakland County: 48356, 48357, 48346, 48348, 48359, 48360, 48362, 48442, 48370, 48371, 48462, 48367,

7 Henry Ford Choice Network The following facilities are associated with this network: Henry Ford Hospital Henry Ford Kingswood Hospital Henry Ford Macomb Hospital Clinton Township Henry Ford Macomb Hospital Mount Clemens Henry Ford Macomb Physical Rehabilitation Center Henry Ford West Bloomfield Hospital Henry Ford Wyandotte Hospital And affiliated urgent care centers In special cases, patients can be referred to a specialist at one of the following: C.S. Mott Children s Hospital University of Michigan Hospital 7

8 Henry Ford Choice Network ID Cards 8

9 Genesys Choice Network Available to residents and businesses in Genesee County Members select a PCP in the Genesys Choice network Receive specialty care and other services from providers in the Genesys Choice Network 9

10 Genesys Choice Network The following facilities are associated with this network: Genesys Regional Medical Center Affiliated urgent care centers In special cases, patients may be referred to a specialist at one of the following: Hurley Medical Center Henry Ford Hospital (main campus only) C.S. Mott Children s Hospital University of Michigan Hospital 10

11 Genesys Choice Network ID Cards 11

12 Identifying Members in a QHP Plan According to your HAP Contract, you must verify eligibility of your HAP patients at each visit prior to rendering services. Failure to obtain verification may result in denial of claims payment. You cannot balance-bill the member. It s also important to always make a copy of the front and back of the patient s ID card. The back contains important contact and claims submission information. You can easily verify member eligibility via the methods below. Online at hap.org. When you log in, select Member Eligibility Application (MEA). If you cannot find the member using his/her ID number, try searching by last name using the magnifying glass icon. Call the Provider Automated Service (PAS) line at (800) (24/7.) Call the Provider Verification line at (313) , Monday through Friday, 8 a.m. to 4 p.m. 12

13 Identifying Members in a QHP Plan While it is not a verification of eligibility, you can quickly identify HAP patients in QHP plans when you look at the RxPCN field on the patient s ID card and note: HAPQHP1ON: Refers to Both Individual and Group HMO on-marketplace HAPQHP4ON: Refers to Both Individual and Group AHL on-marketplace HAPQCOFF: Refers to Both Individual and Group HMO off-marketplace HAPQAOFF: Refers to Both Individual and Group AHL off-marketplace 13

14 Three Month Grace Period The ACA provides for a three month grace period for members receiving advance premium tax credits (APTC) through the Health Insurance Marketplace. This grace period begins immediately upon a current member s first missed or partial premium payment, with the following reimbursement implications: IF: Medical and pharmacy claims incurred during 1 st month Medical claims incurred during 2 nd and 3 rd months* Pharmacy claims incurred during 2 nd and 3 rd months Member makes a full payment of their outstanding premium prior to termination of contract Member does not make full payment of their outstanding premium THEN: HAP pays all appropriate claims HAP pends all medical claims and determines whether member paid outstanding premium HAP denies all pharmacy claims HAP pays outstanding claims Member is terminated back to day 31. Claims for the second and third months would be denied and the provider can seek reimbursement from the member *The Michigan Department of Insurance and Financial Services has indicated that claims submitted for services rendered to these members are not considered clean claims for which HAP would be responsible for payment. Therefore providers may directly bill these members (per the HAP fee schedule), who are in the second and third month of the grace period, for services rendered. 14

15 How do you know if a member is in a delinquent status? Check the Member Eligibility Application 15

16 Member Receiving APTC First Month of Delinquency- MEA Summary Screen Mouse over the? to view information on delinquency including termination date Note: the same screens will appear for a member in their second month of delinquency. Warning message will read: Member is in second month of delinquency. 16

17 Member Receiving APTC First Month of Delinquency- MEA Detail Screen Mouse over the? to view information on delinquency including termination date Note: the same screens will appear for a member in their second month of delinquency. Warning message will read: Member is in second month of delinquency. 17

18 Member Receiving APTC Third and Final Month of Delinquency- MEA Summary Screen 18

19 Member Receiving APTC Third and Final Month of Delinquency- MEA Detail Screen 19

20

21 Health Engagement Update 21

22 Health Engagement Program HAP s Health Engagement Program offers two options: Aspire: participation-based and rewards employees who attempt to improve their health Achieve: outcomes-based and rewards employees for achieving their health goals Members in either option must see a HAP-affiliated primary care physician or approved specialist (Cardiologist, Endocrinologist, Ob/Gyn, Geriatric Specialist) to complete and submit a Member Qualification Form (MQF) that attests to their healthy lifestyle or efforts to achieve this status. 22

23 Health Engagement Reminders We cannot fail participants for not meeting a wellness target identified on their MQF. For example: If a member s blood pressure was above the lifestyle target and they are taking medicine to help control it, they should receive points. We must offer reasonable alternatives to participants if they are unable to meet a wellness target identified on their MQF which includes: Allowing the participants to work with their physicians to develop their own alternatives Contacting HAP s Client Services to discuss all programs that are available There are no time restrictions for completing the treatment plan 23

24 Member Qualification Form Information about reasonable alternatives is on the form Instructions for completing the form are on the back Online form submissions will receive $30 reimbursement Faxes still accepted but will not receive reimbursement 24

25

26 Healthy Michigan Plan & HAP Midwest Health Plan 26

27 Healthy Michigan Plan The Healthy Michigan Plan was created as part of the state s Medicaid eligibility expansion under the Affordable Care Act, with strong support from state business organizations, nurses, doctors and hospitals. The Michigan Primary Care Association and many hospitals support the Healthy Michigan Plan to increase access to medical services for Michigan s low-income working families and reduce uncompensated care costs. 27

28 Healthy Michigan Plan About 470,000 lower-income Michigan working men and women will qualify for the Healthy Michigan Plan. Enrollment began in April, and in the first four months, more than 355,000 eligible Michigan workers had already enrolled. 28

29 Healthy Michigan Plan The Healthy Michigan Plan is different from traditional Medicaid. It provides access to affordable health, dental and vision coverage while encouraging healthy behaviors and personal responsibility. It covers Michigan residents who are: Ages Not eligible for or enrolled in other Medicaid programs Not eligible for or enrolled in Medicare Not pregnant when applying for the Healthy Michigan Plan Make up to 133% FPL (about $16,000 a year for individuals or $33,000 for a family of four) 29

30 HAP Midwest Health Plan Healthy Michigan Plan members living in Wayne, Washtenaw, Macomb, Livingston, Oakland and St. Clair counties can choose HAP Midwest Health Plan as one of the available options. 30

31 HAP Midwest Health Plan HAP Midwest Health Plan is a for-profit, licensed HMO based in southeastern Michigan and a wholly owned subsidiary of HAP that serves more than 90,000 members. HAP Midwest Health Plan contracts with the Michigan Department of Community Health to provide services to Medicaid members including: Children s Special Health Care Services Dual Eligible enrollees Healthy Michigan Plan MIChild beneficiaries 31

32 HAP Midwest Health Plan Provider Network The HAP and HAP Midwest Health Plan provider networks are separate networks. HAP Midwest Health Plan has its own network of the leading PCPs, specialists, hospitals, federally-qualified health centers, local health departments, Children s Multi-Specialty Clinics and non-emergent transportation vendors. If you have a contract with HAP Midwest Health Plan then you are considered a participating provider. 32

33 HAP Midwest Health Plan Contact Information If you have any questions about HAP Midwest Health Plan, please call: (888) , prompt 2, and then 3 for Provider Relations Your patients can visit hap.org/midwest for more information. 33

34 How Your Patients Can Enroll in the Healthy Michigan Plan There are three ways to enroll: Online: Michigan.gov/mibridges By phone: (855) Visit their local Department of Human Services Office 34

35 Healthy Michigan Plan Resources There are many opportunities to assist your patients with applications, plan selection, enrollment and understanding the coverage program they ve enrolled in. You will find helpful provider outreach and enrollment toolkits on the Michigan Primary Care Association website: mpca.net. 35

36 Healthy Michigan Plan Resources When you tell your patients about the Healthy Michigan Plan, please mention that HAP Midwest Health Plan is one of the options available to them. If you would like to display HAP Midwest Health Plan s Healthy Michigan Plan brochures in your office, please contact: Joe Rochester at (313) or jrochester@midwesthealthplan.com 36

37

38 ICD-10 38

39 ICD-10: What is HAP Doing ICD-10 implementation: OCTOBER 1, 2015 We are on course for ensuring our systems and processes are updated to be 1CD-10 compliant Testing partners will be confirmed in early 2015 Testing will take place in mid

40 ICD-10: What Providers Need to Do Continue becoming familiar with the new ICD-10 codes for accurate clinical documentation and claims processing Check out the ICD-10 section when you log in at hap.org. We have some great resources. 40

41

42 Provider Newsroom 42

43 Provider Newsroom The Provider Newsroom provides: Advance notification of changes or additions to HAP s policies and procedures The most efficient, timely means of communication between HAP and you! 43

44 Where can you find the Provider Newsroom 44

45 On the Provider Portal- Link on Provider Home Page 45

46 On Provider Portal- On Related Links in MEA Application 46

47 Provider Newsroom Content 47

48