Subject: Eliminating Certain Medicaid Benefits for Medicaid Beneficiaries age 21 and older, and Medicaid Provider Fee Reductions
|
|
|
- Scot Pearson
- 5 years ago
- Views:
Transcription
1 Bulletin Michigan Department of Community Health Bulletin: MSA Distribution: All Providers Issued: June 1, 2009 Subject: Eliminating Certain Medicaid Benefits for Medicaid Beneficiaries age 21 and older, and Medicaid Provider Fee Reductions Effective: July 1, 2009 Programs Affected: Medicaid, Children's Special Health Care Services (CSHCS), Maternity Outpatient Medical Services (MOMS), Plan First!, and Adult Benefits Waiver (ABW) In an effort to address budget shortfalls identified in Fiscal Year 2009, the Michigan Department of Community Health (MDCH) is eliminating certain covered service benefits to Medicaid beneficiaries age 21 and older, and is implementing program/fee reductions effective for dates of service on and after July 1, These changes are in response to Executive Order The specific covered service benefit eliminations and provider fee reductions are described below. Only those providers affected by the reductions are identified in this bulletin. A. Elimination of Certain Medicaid Covered Service Benefits for Adults Effective for dates of service on and after July 1, 2009, the following services will be eliminated for beneficiaries age 21 and older: 1. Chiropractic Services No services provided by a Chiropractor will be covered. 2. Podiatrist Services No services provided by a Podiatrist will be covered. 3. Hearing Aid Dealers No hearing aids will be covered. 4. Eye Glasses and Associated Vision Services Routine eye exams, eye glasses, contact lens, and other vision supplies and services will not be covered. Services relating to eye trauma and eye disease will continue to be covered. 5. Dental Services The adult dental benefit is limited to the following emergent/urgent services for the relief of pain and/or infection only. These emergent/urgent services will continue to be covered for beneficiaries age 21 and older (including nursing facility residents). Routine examinations, prophylaxis, restorations, and dentures will not be covered. Adult Dental Emergent and Urgent Covered Codes Procedure Code Short Description D0140 Limited oral evaluation-problem focused D0220 Intraoral, periapical, first film D0230 Intraoral, periapical, each additional film D7140 Extraction, erupted tooth or exposed root D7210 Extraction of tooth, erupted D7220 Extraction of tooth, soft tissue impaction D7230 Extraction of tooth, partial bony impaction
2 Page 2 of 5 Procedure Code Adult Dental Emergent and Urgent Covered Codes Short Description D7240 Extraction of tooth, complete bony impaction D7260 Oroantral fistula closure D7261 Primary closure of a sinus perforation D7510 Incision and Drainage (intraoral softtissue) Description If a beneficiary has a current prior authorization (PA) on file related to the five types of services being eliminated, providers have 180 days from the date the PA was approved to complete the services, according to existing Medicaid guidelines. No updates or extensions will be granted if the services are not completed within the initial PA service dates. Only PA requests received on and before June 30, 2009, will be processed. PA requests for the five eliminated services that are received on or after July 1, 2009, will be returned. Medically-necessary services for Medicaid beneficiaries under age 21 continue to be covered by Medicaid even though the services may not be covered for beneficiaries age 21 and older. B. Fee Reductions Ambulance Rescind 1/1/2006 increase given to PC A0425 Land mileage. Apply the 4% fee reduction to rate in effect prior to 1/1/06 for PC A0425. Apply 4% fee reduction to all current fee screens for all other ambulance codes. Anesthesia (includes anesthesiologist CRNA and AA) Chiropractic Clinical Laboratory Cochlear Implant Manufacturers Reduce anesthesia conversion factor by 4% 4% fee reduction for equipment and services Family Planning Clinics A4266-A4269, J0696, J1055, J7300, J7302-J7304, Q1044, S4989, and S4993 are Hearing and Speech Centers Hearing Aid Dealers 4% fee reduction for equipment and services Hearing Aids covered under the volume purchase contract are Home Health Providers Hospital (Inpatient) 4% fee reduction to medical supplies 4% reduction for DRG payments (medical/surgical hospitals) and per diem payments (distinct part rehabilitation hospitals). Capital payments are
3 Page 3 of 5 Hospital (Outpatient) and other providers reimbursed under MDCH s OPPS Comprehensive Outpatient Rehabilitation Facilities, Rehab Agencies, Freestanding Dialysis Centers and Hospital Owned Ambulance Providers (Provider Type 40) Maternal Infant Health Program Reduce MDCH s OPPS APC reduction factor by 4%, fees for wrap around codes will be reduced by 4%. Reduce Children's Hospital Special Outpatient Hospital Adjuster Pool from $695,000 to $521,300. The mileage reimbursement rate (S0215 code) will be reduced to align with other provider mileage rate reductions. Immunization Codes; 90284,90649, 90655, 90656, 90657, 90658, 90660, 90669, 90681, 90696, 90698, 90707, 90713, 90714, 90715, 90716, 90718, 90723, 90732, 90734, 90740, 90744, 90746, 90747, and are Administration of immunizations , G0008 G0010, Injectable Drugs and Biologicals J0882, J0886, J1055, J1825, J7300, J7302, J7306, J7307, Q4081, S0077, S4989 are Transportation services (A0100, A0110, A0140, A0170) are Medical Suppliers, Orthotists, and Prosthetists Includes Durable Medical Equipment, Medical Supplies, Orthotics and Prosthetics, and Parenteral and Enteral Nutrition Payment for labor and repairs reduced by 4% Items provided under the Incontinent Supply Volume Purchase Contract are Nursing Facilities Optician/Dispensing Ophthalmologist Optometrists Oxygen 4% reduction to the variable cost portion of the rate for Class I and Class III facilities. Pharmacy The standard dispensing fee reimbursement for long-term care pharmacies will decrease from $3.00 to $2.75. The standard dispensing fee reimbursement for all other pharmacies will decrease from $2.75 to $2.50. Physicians, Medical Clinics, Non-physician practitioners, and Podiatry (includes MD, DO, DPM, PA, CRNA, NP, CNM, Oralmaxillofacial surgeon) Reduce fee screens by 4% Immunization codes ( , ) are Administration of immunizations ( , G0008-G0010) are D1206, D7220, D7230, D7240, D7250 are
4 Page 4 of 5 Radioisotopes (A4641-A4642, A9500- A9700, Q4100-Q4114, Q9951-Q9967) are Injectable Drugs/biologicals (J0128-J9999, Q0515, Q2023, Q3025-Q3026, Q4081, S0030-S0080, S4989) are Splint/casting supplies (L0210, L4350- L4380, L8603-L8604, Q4001-Q4051) are FQHCs, RHCs, and Tribal Health Clinics (THC) will initially be impacted by the reductions; however, payments will be reimbursed as governed through the RHCs prospective payment rate or by the FQHCs and THCs respective Memorandum of Agreements. Medical Clinic SED and Children s Waiver services are Shoe Store Medicaid Health Plans Rates will be reduced effective July 1, 2009, to accommodate the impact on health plan payment obligations that will result from reductions in fee for service rates and fee screens. C. Public Comment Due to the need to achieve significant savings during the current fiscal year, the public comment portion of the policy promulgation process is being conducted concurrently with the implementation of the reductions. Any interested party wishing to comment on the changes may do so by submitting them in writing to: MDCH/Medical Services Administration Program Policy Division PO Box Lansing, MI or MSADraftPolicy@michigan.gov If responding by , please include "Fee Reduction Policy" in the subject line. Comments received will be considered for revisions to eliminated services and the fee reductions implemented by this bulletin.
5 Page 5 of 5 Manual Maintenance Retain this bulletin until the information has been incorporated into the Michigan Medicaid Provider Manual. Questions Any questions regarding this bulletin should be directed to Provider Inquiry, Department of Community Health, P.O. Box 30731, Lansing, Michigan , or at ProviderSupport@michigan.gov. When you submit an , be sure to include your name, affiliation, and phone number so you may be contacted if necessary. Providers may phone toll-free Approved Stephen Fitton, Acting Director Medical Services Administration
Medi-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
KY Medicaid Co-pays Except for the Pharmacy Non-Preferred co-pay, co-pays do not apply to the following:
This is a list of current covered services and co-pays. Except for the Pharmacy Non-Preferred co-pay, co-pays do not apply to the following: Non-KCHIP children Children under 19 in foster care Pregnant
KY Medicaid Co-pays. Acute admissions medical Per admission diagnoses $0 Acute health care related to. Per admission substance abuse and/or for
This is a list of current covered services and co-pays. Except for the Pharmacy Non-Preferred co-pay, co-pays do not apply to the following: Non-KCHIP children Children under 19 in foster care Pregnant
Covered (blood, blood components, human blood products, and their administration) Covered (Some restrictions)
Washington Apple Health Medical Benefits Allergy Services (Antigen/Allergy Serum/Allergy Shots) Ambulance Services (Air Transportation) by FFS* Ambulance Services (Emergency Transportation) Ambulatory
Payment Methodology. Acute Care Hospital - Inpatient Services
Grid Medi-Pak Advantage generally reimburses deemed providers the amount they would have received under Original Medicare for Medicare covered services, minus any amounts paid directly by Original Medicare
Department of Healthcare and Family Services (HFS) Medical and Dental Services
Department of Healthcare and Family Services (HFS) Medical and Dental Services Accessing Medical Services This presentation is designed to provide a general overview of Medical Assistance Program services
Place of Service Code Description Conversion
Place of Conversion CMS Place of Code Place of Name The place of service field indicates where the services were performed Possible values include: Code Description Inpatient Outpatient Office Home 5 Independent
Services Covered by Molina Healthcare
Services Covered by Molina Healthcare Because you are covered by Medicaid, you pay nothing for covered services. As a Molina Healthcare member, you will continue to receive all medically necessary Medicaid-covered
RFS-7-62 ATTACHMENT E INDIANA CARE SELECT PROGRAM DESCRIPTION AND COVERED BENEFITS
The following services are covered by the Indiana Care Select Program. Dual-eligible members, those members eligible for both IHCP and Medicare, will not receive any benefits under Indiana Care Select,
The Healthy Michigan Plan Handbook
The Healthy Michigan Plan Handbook Introduction The Healthy Michigan Plan is a health care program through the Michigan Department of Community Health (MDCH). The Healthy Michigan Plan provides health
MyHPN Solutions HMO Gold 7
MyHPN Solutions HMO Gold 7 HIOS ID: 95865NV0030074 Attachment A Benefit Schedule Calendar Year Deductible (CYD): $3,000 of EME per Member and $6,000 of EME per family. The Calendar Year Out of Pocket Maximum
Services Covered by Molina Healthcare
Services Covered by Molina Healthcare As a Molina Healthcare member, you will continue to receive all medically-necessary Medicaid-covered services at no cost to you. The following list of covered services
Medi-Cal Program. Benefit. Benefits Chart
Chart Please note that the table below is only a summary. More details about benefits can be found in the section of the Medi-Cal Evidence of Coverage booklet. All health care is arranged through your
New to Medicaid? 22 Medicaid Services You Should Know About
New to Medicaid? 22 Medicaid Services You Should Know About Here Are 22 Medicaid Services You Should Know About This year Connecticut expanded Medicaid healthcare coverage (HUSKY) by raising the maximum
Healthy Indiana Plan Reimbursement Manual
H P M a n a g e d C a r e U n i t I N D I A N A H E A L T H C O V E R A G E P R O G R A M S Attention: This manual has not been archived, because the associated provider reference module is not yet complete.
5010 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
SECTION 2: TEXAS MEDICAID REIMBURSEMENT
SECTION 2: TEXAS MEDICAID REIMBURSEMENT 2.1 Payment Information............................................................. 2-2 2.2 Reimbursement Methodology....................................................
All Indiana Health Coverage Programs Providers. Package C Claim Submission and Coverage Information
P R O V I D E R B U L L E T I N B T 2 0 0 0 0 6 J A N U A R Y 2 0, 2 0 0 0 To: Subject: All Indiana Health Coverage Programs Providers Package C Claim Submission and Coverage Information Overview The purpose
ATTACHMENT B-1 Supplies and Services Included In the Basic Daily Rate for Private Pay and Privately Insured Residents
ATTACHMENT B-1 Supplies and Services Included In the Basic Daily Rate for Private Pay and Privately Insured Residents ATTACHMENT B-2 Optional Supplies and Services Not Included in Basic Daily Rate for
Amherst Central School District First Choice Health Plan. Non-First Choice Providers and Out-of-Network Providers
Health: Hospital Services provided by First Choice Preferred Provider Network Medical Services Radiology, Ultrasounds 20% after $500 individual or Laboratory Testing 20% after $500 individual or MRI and
Optional Benefits Excluded from Medi-Cal Coverage
Optional Benefits Excluded from Medi-Cal Coverage May 29, 2009 Assembly Bill X3 5 (Evans, Chapter 20, Statutes of 2009), the budget trailer bill for the recently signed budget bill, added Section 14131.10
CMS-1500 Billing and Reimbursement. HP Provider Relations/October 2013
CMS-1500 Billing and Reimbursement HP Provider Relations/October 2013 Agenda Common Denials for CMS-1500 CMS-1500 Claims Billing Types of CMS-1500 Claims Paper Claim Billing Fee Schedule Crossover Claims
MMA Benefits at a Glance
MMA Benefits at a Glance You must get covered services by providers that are part of the Molina plan. You must also make sure that approval is obtained if needed. Ambulance Art Therapy Assistive Care Services
Benefit Explanation And Limitations
Benefit Explanation And Limitations SFHP providers supply many medical benefits and services, some of which are itemized on the following pages. For specific information not covered in this table, please
FACILITY BASED SERVICES
FACILITY BASED SERVICES Inpatient Hospital Care Elective Inpatient Admission or Elective Inpatient Surgery Inpatient Rehabilitation Care Skilled Nursing Facility Admission Non-Custodial Nursing Home Care
CO-PAYMENT BOOK Las Vegas Blvd. South Suite 107 Las Vegas, NV
CO-PAYMENT BOOK 1901 Las Vegas Blvd. South Suite 107 Las Vegas, NV 89104 702-733-9938 www.culinaryhealthfund.org Revised January 2018 (Replaces Co-Payment Book dated June 2017) TABLE OF CONTENTS 4 5 6
Schedule of Benefits
Schedule of Benefits ANTHEM Small Business Health Options Program (SHOP) This is a brief schedule of benefits. Refer to your Anthem Certificate of Coverage (Booklet) for complete details on benefits, conditions,
For full details of services and costs for each plan, please consult the Evidence of Coverage at GeisingerGold.com or call us for more information.
This Summary of Benefits contains 2018 plan information for: Geisinger Gold Secure Rx (HMO SNP) For full details of services and costs for each plan, please consult the Evidence of Coverage at GeisingerGold.com
Covered Benefits Matrix for Children
Medicaid Managed Care The matrix below lists the available for children (under age 21) enrolled in the West Virginia Mountain Health Trust and s. Ambulance Ambulatory surgical center services Some services
HealthPartners 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
Covered Services List and Referrals and Prior Authorizations for MassHealth Members enrolled in Partners HealthCare Choice
Covered Services Covered Services List and s and Prior Authorizations for MassHealth Members enrolled in Partners HealthCare Choice This chart tells you two things: 1. the covered services and benefits
Summary 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
CLASSIC 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
Summary of Benefits Platinum Full PPO 0/10 OffEx
Blue Shield of California is an independent member of the Blue Shield Association Summary of Benefits Platinum Full PPO 0/10 OffEx Group Plan PPO Benefit Plan This Summary of Benefits shows the amount
CUSTODIAL NURSING HOME CARE
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
Correction Notice. Health Partners Medicare Special Plan
Correction Notice Special Plan Following are corrections that apply to both the English and Spanish versions of the 2015 for Special (HMO SNP): Original Information Page 1, under the heading SECTIONS IN
Provider Enrollment and Change Process Required Document Checklist
Provider Enrollment and Change Process Required Document Checklist Provider Classification To avoid processing delays gather these items before you get started. If applying to network, complete the application
Summary of Benefits [Silver Access+ HMO 1750/55 OffEx] [Silver Local Access+ HMO 1750/55 OffEx]
![Summary of Benefits [Silver Access+ HMO 1750/55 OffEx] [Silver Local Access+ HMO 1750/55 OffEx]](/thumbs/86/94175655.jpg "Summary of Benefits [Silver Access+ HMO 1750/55 OffEx] [Silver Local Access+ HMO 1750/55 OffEx]")
Blue Shield of California is an independent member of the Blue Shield Association Summary of Benefits [Silver Access+ HMO 1750/55 OffEx] [Silver Local Access+ HMO 1750/55 OffEx] Group Plan HMO Benefit
FACILITY 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
Provider Enrollment and Change Process Required Document Checklist
Provider Enrollment and Change Process Required Document Checklist Provider Classification To avoid processing delays gather these items before you get started. If applying to network, complete the application
COVERED SERVICES LIST FOR HNE BE HEALTHY MEMBERS WITH MASSHEALTH STANDARD OR COMMONHEALTH COVERAGE
COVERED SERVICES LIST FOR HNE BE HEALTHY MEMBERS WITH MASSHEALTH STANDARD OR COMMONHEALTH COVERAGE This is a list of all covered services and benefits for MassHealth Standard and CommonHealth members enrolled
Summary of Benefits Platinum Trio HMO 0/25 OffEx
Blue Shield of California is an independent member of the Blue Shield Association Summary of Benefits Platinum Trio HMO 0/25 OffEx Group Plan HMO Benefit Plan This Summary of Benefits shows the amount
IV. Benefits and Services
IV. Benefits and A. HealthChoice Benefits This table lists the basic benefits that all MCOs must offer to HealthChoice members. Review the table carefully as some benefits have limits, you may have to
MEDICARE 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
MEDICARE By Peter G. Pan
Wendell K. Kimura Acting Director Research (808) 587-0666 Revisor (808) 587-0670 Fax (808) 587-0681 LEGISLATIVE REFERENCE BUREAU State of Hawaii State Capitol Honolulu, Hawaii 96813 No. 02-13 October 7,
Benefits Why AmeriHealth Caritas VIP Care Plus Was Created
Benefits Benefits Why AmeriHealth Caritas VIP Care Plus Was Created The Medicare Medicaid Plan, AmeriHealth Caritas VIP Care Plus, was created to coordinate Medicare and Medicaid services, simplify the
Covered Services and Any Limits
WellCare of South Carolina Covered Services and Any Limits Abortions and related Covered only in the case of rape or incest or if the member s life is in danger Allergy testing and treatment Ambulance
GIC Employees/Retirees without Medicare
GIC Active Employees & Retirees without Medicare 7/1/18 GIC Employees/Retirees without Medicare HMO Summary of Benefits Chart This chart provides a summary of key services offered by your Health New England
SmartSaver. 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
SERVICES REQUIRING PRIOR AUTHORIZATION
S REQUIRING PRIOR AUTHORIZATION All Hospital Admissions (All Place of service 21 services require authorization.) ELECTIVE ADMISSIONS All hospital admissions require review by Gold Coast Health Plan Health
Benefit Explanation And Limitations
Benefit Explanation And Limitations SFHP providers supply many medical benefits and services, some of which are itemized on the following pages. For specific information not covered in this table, please
Covered Services and Any Limits
WellCare of South Carolina Covered Services and Any Limits Abortions and related Covered only in the case of rape or incest or if the member s life is in danger Allergy testing and treatment Ambulance
High Deductible Health Plan (HDHP)
High Deductible Health Plan (HDHP) BeneFIts Summary Effective July 1, 2012 or October 1, 2012 Benefit Highlights How The Plan Works...1 Summary Of Benefits...4 Special Programs...7 Approval Of Care At
Place of Service Codes (POS) and Definitions
2950 Robertson Ave, Suite 200 Cincinnati, OH 45209 (P): 513-281-4400 www.medicalreimbursementinc.com www.linkedin.com/company/medical-reimbursement-inc www.twitter.com/medreimburse www.facebook.com/medicalreimbursementinc
Benefits are effective January 01, 2018 through December 31, 2018 PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY
PLAN FEATURES Annual Deductible The maximum out-of-pocket limit applies to all covered Medicare Part A and B benefits including deductible. Hearing aid reimbursement does not apply to the out-of-pocket
Kaiser Permanente (No. and So. California) 2018 Union
Kaiser Permanente (No. and So. California) General Information Lifetime Maximum Benefit Annual Maximum Benefit Coinsurance Percentage Precertification Requirements Precertification Penalty Health Savings
California Children s Services (CCS) Program Medi-Cal Managed Care CCS Whole-Child Model Comparison Chart January 6, 2016
California Children s Services (CCS) Program Medi-Cal Managed Care CCS Whole-Child Model Comparison Chart January 6, 2016 Authorization for Services Plan to adjudicate authorization request. Authorization
Blue Shield $0 Cost-Share HMO AI-AN
Blue Shield $0 Cost-Share HMO AI-AN This plan is only available to eligible Native Americans 1 Uniform Health Plan Benefits and Coverage Matrix Blue Shield of California Effective January 1, 2017 THIS
Covered Benefits Matrix for Adults
Medicaid Managed Care The matrix below lists the available for adults (age 21 and older) enrolled in the West Virginia Mountain Health Trust and s. Ambulance Ambulatory surgical center services Some services
2017 Comparison of the State of Iowa Medicaid Enterprise Basic Benefits Based on Eligibility Determination
General Plan Provisions Benefits Available from Out-of-Network Providers 2017 Comparison of the State of Iowa Enterprise Cost Sharing: A variety of methods are used to share expenses between the state
Benefits and Premiums are effective January 01, 2018 through December 31, 2018 PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY
Benefits and Premiums are effective January 01, 2018 through December 31, 2018 PLAN FEATURES Network & Out-of- Annual Deductible This is the amount you have to pay out of pocket before the plan will pay
Freedom 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
Gold Access+ HMO 500/35 OffEx
An Independent Member of the Blue Shield Association Gold Access+ HMO 500/35 OffEx Benefit Summary (For groups 1 to 100) (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California Effective
Provider Manual Section 7.0 Benefit Summary and
Provider Manual Section 7.0 Benefit Summary and Exclusions Table of Contents 7.1 Benefit Summary 7.2 Services Covered Outside Passport Health Plan 7.3 Non-Covered Services Page 1 of 7 7.0 Benefit Summary
EMERGENCY RULES SFY 2013 REIMBURSEMENT RATE REDUCTIONS
EMERGENCY RULES SFY 2013 REIMBURSEMENT RATE REDUCTIONS In order to avoid a budget deficit in the Medicaid Program, the Department of Health and Hospitals has published Emergency Rules which will: 1) reduce
Platinum Trio ACO HMO 0/20 OffEx
Platinum Trio ACO HMO 0/20 OffEx Benefit Summary (For groups 1 to 100) (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California Effective January 1, 2017 THIS MATRIX IS INTENDED TO
OF BENEFITS. Cigna-HealthSpring TotalCare (HMO SNP) H Cigna H3949_15_19921 Accepted
agesummary OF BENEFITS Cover erage Cigna-HealthSpring TotalCare (HMO SNP) H3949-009 2014 Cigna H3949_15_19921 Accepted SECTION I - INTRODUCTION TO SUMMARY OF BENEFITS You have choices about how to get
Covered Services List
CAREPLUS Covered Services List For CeltiCare Health with MassHealth CarePlus Coverage This is a list of all covered services and benefits for MassHealth CarePlus enrolled in CeltiCare Health. The list
T M A V e r s i o n TABLE OF CONTENTS PART DEFINITIONS
(a) General. 1 (b) Specific definitions. 1 Abortion. 1 Absent treatment. 1 Abuse. 1 Abused dependent. 1 Accidental injury. 2 Active duty. 2 Active duty member. 2 Activities of daily living. 2 Acupuncture.
Benefits and Premiums are effective January 01, 2018 through December 31, 2018 PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY
The maximum out-of-pocket limit applies to all covered Medicare Part A and B benefits including deductible. Primary Care Physician Selection Optional There is no requirement for member pre-certification.
Appeal Process Information
First-Level Appeals Appeal Process Information Regulation 7 AAC 105.270 stipulates the length of time a provider has to submit a first-level appeal. Most firstlevel appeals must be filed within 180 days
Y0114_17_27850_U_085 CMS Accepted 10/01/ MUSENMUB_085 H3240_ _NJ HMO SNP Amerivantage Dual Coordination (HMO SNP) 1
Summary of Benefits for Amerivantage Dual Available in: Select Counties* in New Jersey *See Page 2 for a list of counties. Plan year: January 1, 2017 December 31, 2017 In this section, you ll learn about
Blue Shield Gold 80 HMO
Blue Shield Gold 80 HMO Uniform Health Plan Benefits and Coverage Matrix Blue Shield of California Effective January 1, 2017 THIS MATRIX IS INTENDED TO BE USED TO HELP YOU COMPARE COVERAGE BENEFITS AND
SECTION E COVERED SERVICES
As an AHCCCS contracted health plan, the covered services provided by Phoenix Health Plan (PHP) are mandated by federal and state law. The following list is a summary of covered and non-covered services.
2016 Medical Plan Comparison Chart
2016 Medical Plan Comparison Chart WellStar Health System is committed to helping you control healthcare costs while providing more choices and personal control over your healthcare coverage through the
Summary of Benefits. January 1, 2018 December 31, Providence Medicare Dual Plus (HMO SNP)
Summary of Benefits January 1, 2018 December 31, 2018 Providence Medicare Dual Plus (HMO SNP) This plan is available in Clackamas, Multnomah and Washington counties in Oregon for members who are eligible
ST. MARY S HEALTHCARE SYSTEM, INC. Case # GA6476 BlueChoice HMO Benefit Summary Effective: January 1, 2018
ST. MARY S HEALTHCARE SYSTEM, INC. Case # GA6476 BlueChoice HMO Benefit Summary Effective: January 1, 2018 All benefits are subject to the calendar year deductible, except those with in-network copayments,
Benefits. Benefits Covered by UnitedHealthcare Community Plan
Benefits Covered by UnitedHealthcare Community Plan As a member of UnitedHealthcare Community Plan, you are covered for the following MO HealthNet Managed Care services. (Remember to always show your current
Summary of benefits Health Net. seniority plus green. Benefits effective January 1, 2009 H0562 Medicare Advantage HMO
2009 Health Net Summary of benefits Los Angeles, Orange, Riverside and San Bernardino counties s effective January 1, 2009 H0562 Medicare Advantage HMO Material ID H0562-09-0041 CMS Approval 9/08 Section
Covered Benefits Rhody Health Partners ACA Adult Expansion
Covered s Rhody Health Partners ACA Adult Expansion Abortion Services Adult Day Services AIDS Medical and Non-Medical Case Management Alcohol and Substance Abuse Treatment Cosmetic Surgery Dental Care
NY EPO OA 1-09 v Page 1
PLAN FEATURES Deductible (per calendar year) Member Coinsurance (applies to all expenses unless otherwise stated) Maximum Out-of-Pocket Limit (per calendar year) Lifetime Maximum (per member lifetime)
PROVIDED AND COORDINATED SERVICES
PROVIDED AND COORDINATED SERVICES ArchCare Community Life covers services which are paid for and supplied directly through contracts with providers such as you. ArchCare Community Life also provides Care
HUSKY Health Program Member Benefits Grid. Covered Services for HUSKY A, C, and D
HUSKY Health Program Member Benefits Grid Covered Services for HUSKY A, C, and D All services must be medically necessary. For information on wellness exams, screenings and vaccines, click here. Acupuncture
Medicaid Benefits at a Glance
Medicaid Benefits at a Glance Mountain Health Trust Benefits Children (0 up to 21 years) Ambulatory Surgical Center Services Any distinct entity that operates exclusively for the purpose of providing surgical
Blue Shield Gold 80 HMO 0/30 + Child Dental INF
Blue Shield Gold 80 HMO 0/30 + Child Dental INF Benefit Summary (For groups 1 to 100) (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California Effective January 1, 2017 THIS MATRIX
COVERED SERVICES FOR NHP MASSHEALTH MEMBERS
COVERED SERVICES FOR NHP MASSHEALTH MEMBERS Neighborhood Health Plan Covered Services for MassHealth Standard & CommonHealth, Family Assistance, and CarePlus Issued and effective October 1, 2015 nhp.org/member
Texas Medicaid F00106
Texas Medicaid Provider Enrollment Application Rev. XXXVI F00106 Introduction Dear Health-Care Professional: Thank you for your interest in becoming a Texas Medicaid provider. Participation by providers
What Does Medicaid Do?
Page 1 of 5 Texas Department of Health What Does Medicaid Do? Table 4.1 Medicaid Eligibility in Texas: 1998 TANF-Related Categories (dollar amounts = maximum income limit for eligibility: asset cap: $2000)
Covered Benefits Rhody Health Partners
Covered s Rhody Health Partners s Covered by UnitedHealthcare Community Plan As member of UnitedHealthcare Community Plan, you are covered for the following services. (Remember to always show your current
Benefits and Premiums are effective January 01, 2018 through December 31, 2018 PLAN DESIGN AND BENEFITS PROVIDED BY AETNA HEALTH PLANS INC.
Benefits and Premiums are effective January 01, 2018 through December 31, 2018 PLAN FEATURES Network Providers Annual Maximum Out-of-Pocket Amount $2,500 The maximum out-of-pocket limit applies to all
SUMMARY OF BENEFITS 2009
HEALTH NET VIOLET OPTION 1, HEALTH NET VIOLET OPTION 2, HEALTH NET SAGE, AND HEALTH NET AQUA SUMMARY OF BENEFITS 2009 Southern Oregon Douglas, Jackson, and Josephine Counties, Oregon Benefits effective
Summary of Benefits for SmartValue Classic (PFFS)
Summary of Benefits for SmartValue Classic (PFFS) Available in Select Counties in Nevada A health plan with a Medicare contract. Rocky Mountain Hospital and Medical Service, Inc. has contracted with the
SERVICES COVERAGE LIMITS/ EXCLUSIONS Alcohol, Drug, and Substance Abuse Services
SERVICES COVERAGE LIMITS/ EXCLUSIONS Alcohol, Drug, and Substance Abuse Services Alcohol, drug, and substance abuse treatment services are provided by the Department of Alcohol and Other Drug Abuse Services
Stanislaus County Medical Benefits EPO Option. In-Network Benefits (Stanislaus County Partners in Out-of-Network Benefits
Stanislaus County Medical EPO Option The following summary of benefits is a brief outline of the maximum amounts or special limits that may apply to benefits payable under the Plan. For a detailed description
AmeriHealth Caritas North Carolina Provider Data Intake Form
AmeriHealth Caritas North Carolina Provider Data Intake Form Section 1 instructions: Please complete all fields below for the provider. Entity name (as written on W9): IPA name (if applicable): Category:
Section. CPT only copyright 2005 American Medical Association. All rights reserved. 2Texas Medicaid Reimbursement
Section 2Texas Medicaid Reimbursement 2 2.1 Reimbursement.................................................... 2-2 2.1.1 Electronic Funds Transfer........................................ 2-2 2.1.1.1 Using
Information for Dual-Eligible Members with Secondary Coverage through California Regular Medi-Cal (Fee-for-Service)
Information for Dual-Eligible Members with Secondary Coverage through California January 1, 2015 December 31, 2015 Los Angeles County This publication is a supplement to the 2015 Evidence of Coverage and
This plan is pending regulatory approval.
Bronze Full PPO 3000 OffEx Benefit Summary (For groups 1 to 50) (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California Effective October 1, 2015 THIS MATRIX IS INTENDED TO BE USED
Our service area includes these counties in: Florida: Broward, Miami-Dade.
2018 SUMMARY OF BENEFITS Overview of your plan Preferred Medicare Assist (HMO SNP) H1045-012 Look inside to learn more about the health services and drug coverages the plan provides. Call Customer Service
Y0021_H4754_MRK1427_CMS File and Use PacificSource Community Health Plans, Inc. is a health plan with a Medicare contract
Y0021_H4754_MRK1427_CMS File and Use 08262012 PacificSource Community Health Plans, Inc. is a health plan with a Medicare contract Section I - Introduction to Summary of s Thank you for your interest in.