UniCare Health Plan of West Virginia, Inc. A true partnership with our provider community
|
|
- Imogene Brown
- 5 years ago
- Views:
Transcription
1 A true partnership with our provider community Medicaid Managed Care
2 Welcome! We would like to thank everyone for taking time out of their busy schedule to be here today! Thank you for the dedicated care and time you provide our UniCare members each day. 2
3 Provider Enrollment All providers who would like to offer services to Medicaid members are federally required to enroll and revalidate with West Virginia Medicaid through Molina Medicaid Solutions A provider s UniCare contract will be terminated and you will no longer be eligible to provide services to Medicaid members if enrollment with Molina is not completed per the federal guidelines. This enrollment does not authorize or require the provider to render services to non-mco/fee-forservice Medicaid members. 3
4 Provider education Resources available
5 Provider education materials UniCare provides a wide range of education materials for providers and their office staff: Provider manuals Clinical and policy guidelines Provider bulletins/updates Provider newsletters Reimbursement Policies Forms Health Education Material Quality Improvement Resources 5
6 Submitting claims Effective 6/1/17, timely filing is 180 days from Date of Service Submit via EDI: o EDI Payer ID #80314 o Technical Support: Phone: E-Solutions.Support@unicare.com Live chat: Submit paper claims to: o P.O. Box 91 Charleston, WV
7 Provider Orientation Webinars UniCare offers a monthly provider orientation webinar the third Tuesday of each month from 12:00 p.m.--1:00 p.m. Topic covered o Who we are o Health Care Management Services o Case Management o Community Outreach o Resources Available o Many more topics.. 7
8 Provider changes UniCare requires all providers, including hospitals, to send any administrative change requests to us so that we have correct information in our system. This includes changes in your practice or facility name, address, fax and information, tax identification number (TIN), and other similar changes. All providers with the exception of hospital-based providers must be credentialed. Submit the information via: o Fax: o ssbdatamanagementservices@anthem.com 8
9 Prenatal Risk Screening Instrument (PRSI) Effective January 1, 2017, UniCare is discontinuing our pregnancy notification form and adopting the West Virginia Prenatal Risk Screening Instrument(PRSI) The PRSI is intended to promote early and accurate identification of prenatal risk factors. Submit PRSI to UniCare within seven days of the first prenatal visit. o the completed form to prsi.unicare@anthem.com. Please type SECURE PRSI in the subject line. o Fax the completed form to
10 Clinic days These are designed to improve our compliance rates for preventive services. Our HEDIS results indicate a significant number of members are not receiving timely preventive services. Clinic days bring members and providers together to improve access to care and patient compliance. Appointment scheduling with members and providers will be coordinated by UniCare. In partnership with our network providers, clinic days will be hosted for members who have not received well-child visits or immunizations. Clinic days target members who are due for diabetes care or postpartum care. Members will be directed to the office of the provider identified as their PCP. 10
11 Availity Web Portal Expansion of our provider website services through Availity o Availity Web Portal ( a multi-payer website that gives physicians, hospitals and other health care professionals access to multiple payer information with a secure, single log-in o Availity s Web Portal offers a variety of online functions to help providers reduce administrative costs by eliminating paperwork and phone calls or faxes to obtain Prior Authorizations. o Target date for Access Point retirement: December
12 Availity Web Portal (cont.) Multiple payers, one website, one log-in o Claim status inquiry and claims submission o Eligibility and benefits check o Remittance advices retrieval o Monthly member rosters access o Prior Authorization requests, and responses o 24/7 availability from any computer with internet access o Real-time information exchange means highest accuracy of information o Free services for providers 12
13 Provider Online Reporting Tool PCP s can access the new reporting tool to retrieve monthly member rosters on Unicare s new provider web portal through Availity. If you haven t already, register for Unicare s provider web portal through Availity, you can do so at o How to register o Basic Navigation o Resource Available Requirement: Active Availity account 13
14 Utilization Management criteria Medicaid Managed Care 14
15 Medical Policies and Clinical UM Guidelines Outpatient procedures o T&A o Genetic testing o Spinal surgery Durable medical equipment o Wheelchairs o Life vests o Insulin pumps Home health care Physical/occupational/ speech therapy All policies are available at > Providers > State Sponsored Plan providers > West Virginia - Medicaid Managed Care. 15
16 AIM Specialty Health (AIM) Our nurses review requests for advanced imaging, cardiology, radiation therapy and sleep management services using AIM criteria. Both pediatric and adult guidelines are available and are separated by the area to be imaged. All policies are available at 185/index.html. Effective November 1, 2017, AIM s functions will increase. They will take over the management of prior authorization for advanced imaging, cardiology and radiation therapy services. 16
17 Interactive Care Reviewer (ICR) tool Medicaid Managed Care
18 Interactive Care Reviewer (ICR) Our ICR tool improves efficiency during the preapproval process. Physicians and facilities can submit medical and behavioral health preapproval requests for both outpatient and inpatient services. Ordering and servicing physicians and facilities can use the inquiry feature to find information on any preapproval affiliated with their TIN/organization. 18
19 ICR Overview Highlighted features include: View determination letters for the case. Save ordering and servicing providers to your favorites to easily populate provider information fields. Print a hard copy of a case or convert it to a PDF from the inquiry options. 19
20 Changes to prior authorization(pa) requests Claims must match what was entered in the PA request. To request a change, call or fax UM intake to make sure it s processed appropriately. Examples of items you may need to change include: An MRI without contrast to an MRI with contrast. The date(s) of service. You can make changes on the ICR tool as long as the service hasn t been rendered. If it has been rendered, please contact UM to make the change. 20
21 Coming Soon 4 th Quarter Provider Newsletter Educational Webinars Annual Provider Surveys Member Identification Number Change Online submission for provider changes 21
22 Questions? 22
23 Thank you for teaming up with UniCare Health Plan of West Virginia, Inc. 23
UniCare Health Plan of West Virginia, Inc. A true partnership with our provider community
A true partnership with our provider community Medicaid Managed Care Welcome! We would like to thank everyone for taking time out of their busy schedule to be here today! Thank you for the dedicated care
More informationMY HEALTH WITH HEALTH CROWD YOU CAN GET IMPORTANT MESSAGES SUMMER 2018
SUMMER 2018 MY HEALTH www.unicare.com/medicaid YOU CAN GET IMPORTANT MESSAGES WITH HEALTH CROWD UniCare Health Plan of West Virginia, Inc. wants to communicate with you in the way that s most convenient
More informationNew provider orientation. IAPEC December 2015
New provider orientation IAPEC-0109-15 December 2015 Welcome 2 Agenda Introduction to Amerigroup Provider resources Preservice processes Member benefits and services Claims and billing Provider responsibilities
More informationWest Virginia Children s Health Insurance Program (WVCHIP) Crystal Fox, Benefit and Eligibility Specialist Fall 2017 Provider Workshop
West Virginia Children s Health Insurance Program (WVCHIP) Crystal Fox, Benefit and Eligibility Specialist Fall 2017 Provider Workshop Annual Income Guidelines for WVCHIP Family Size Medicaid Max WVCHIP
More informationHealth Alliance. Utilization Management Changes Overview. Maxine Wallner Director Provider Services. February 2017
Health Alliance Utilization Management Changes Overview February 2017 Maxine Wallner Director Provider Services Agenda Decision Overview Utilization Management Program Changes Expansions and modifications
More informationWV Bureau for Medical Services & Molina Medicaid Solutions
WV Bureau for Medical Services & Molina Medicaid Solutions On January 1, 2014, Medicaid eligibility was expanded to qualified individuals ages 19 to 64 making 138% of the Federal Poverty Level. 112,464
More informationCareCore National & Alliance Provider Training Material
EVIDENCE-BASED HEALTHCARE SOLUTIONS CareCore National & Alliance Provider Training Material Prepared for: March 6, 2014 Contents CareCore National... 3 Alliance and CareCore National Partnership... 4 Radiology
More informationProvider s Frequently Asked Questions Availity in California
Page - 1 - of 6 Provider s Frequently Asked Questions Availity in California Who is Availity? Availity is a multi-payer portal at availity.com that gives physicians, hospitals and other health care professionals
More informationPROVIDER NEWSLETTER. Table of Contents. UniCare Health Plan of West Virginia, Inc. February 2018
www.unicare.com February 2018 PROVIDER NEWSLETTER Table of Contents Levoleucovorin calcium, elosulfase alfa, histrelin acetate, idursulfase and fulvestrant to require prior authorization Availability of
More informationMedical Management. G.2 At a Glance. G.2 Procedures Requiring Prior Authorization. G.3 How to Contact or Notify Medical Management
G.2 At a Glance G.2 Procedures Requiring Prior Authorization G.3 How to Contact or Notify G.4 When to Notify G.7 Case Management Services G.10 Special Needs Services G.12 Health Management Programs G.14
More informationMedical Management. G.2 At a Glance. G.3 Procedures Requiring Prior Authorization. G.5 How to Contact or Notify Medical Management
G.2 At a Glance G.3 Procedures Requiring Prior Authorization G.5 How to Contact or Notify Medical Management G.6 When to Notify Medical Management G.11 Case Management Services G.14 Special Needs Services
More informationPrecertification Tips & Tools
Working with Anthem Subject Specific Webinar Series Precertification Tips & Tools Access to Audio Portion of Conference: Dial-In Number: 877-497-8913 Conference Code: 1322819809# Please Mute Your Phone
More informationAnthem Blue Cross and Blue Shield. Medicaid
Anthem Blue Cross and Blue Shield Medicaid Introduction Ken Groves Manager, Provider Network Management Jackie Richie Network Relations Specialist 2 Service Area Statewide - except Region 3 counties We
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 informationAmerigroup Kansas Provider Training Program
Amerigroup Kansas Provider Training Program Agenda About NIA The Provider Partnership The Program Components How the Program Works: The Precertification Process The Precertification Appeals Process The
More informationEnterprise Health Solutions (EHS) Processing Platform
1 Enterprise Health Solutions (EHS) Processing Platform West Virginia Family Health Plan (WVFH) transitioned to the EHS claims processing platform on 1/1/18. The system transition will provide you with
More informationMagellan Healthcare 1 Frequently Asked Questions (FAQ s) For Magellan Complete Care of Florida Providers
Magellan Healthcare 1 Frequently Asked Questions (FAQ s) For Magellan Complete Care of Florida Providers Question GENERAL Why did Magellan Complete Care implement a Medical Specialty Solutions Program?
More informationQuick Reference Card
Amerigroup District of Columbia, Inc. Quick Reference Card Precertification/notification requirements Important contact numbers n Revenue codes https://providers.amerigroup.com/dc DCPEC-0176-17 Important
More informationMagellan Healthcare 1 Frequently Asked Questions (FAQ s) For Magellan Complete Care of Virginia Providers
Magellan Healthcare 1 Frequently Asked Questions (FAQ s) For Magellan Complete Care of Virginia Providers Question GENERAL Why is Magellan Complete Care of Virginia implementing a Medical Specialty Solutions
More informationThank you for joining us today. We ll start momentarily.
Quality & Incentives Thank you for joining us today. We ll start momentarily. If you haven t already, please call into the webinar to hear us speak. Your phone will automatically be set to mute. Conference
More informationThis document is updated quarterly. Please check this document before a Prior Authorization (PA) submission since codes may be removed or added
This document is updated quarterly. Please check this document before a Prior Authorization (PA) submission since codes may be removed or added All codes listed require PA Non-PAR Providers require PA
More informationParticipant Eligibility. Why should you check eligibility? To verify a participant has Medicaid coverage on actual date of service
Eligibility Overview Importance of checking eligibility Define the eligibility receipt Review examples of eligibility responses Review benefit plans and coverage Identify resources available to check benefit
More information2017 BENEFIT ENROLLMENT
2017 BENEFIT ENROLLMENT 2017 Medical Plans. All medical plans will be on the Wichita Preferred Quality Point of service (QPOS) plans in the Wesley preferred narrow network. Employees will be required to
More informationGuide to Provider Forms
Guide to Provider Forms ACTION Add a Provider to the group YOU WILL NEED TO COMPLETE THE SECTIONS IDENTIFIED BELOW ON THE PROVIDER INFORMATION UPDATE FORM (PIF) AND ANY ADDITIONAL DOCUMENTS LISTED. ALL
More informationBasic Covered Benefits and Services
Basic Covered Benefits and A prior authorization is when UnitedHealthcare Community Plan gives the doctor permission to perform certain services. Bed Liners Coverage Covered for members age 4 and up; Prior
More informationMedicaid Managed Care Program (STAR) and Children s Health Insurance Program (CHIP) Provider Transition Orientation December 1, 2015
Medicaid Managed Care Program (STAR) and Children s Health Insurance Program (CHIP) Provider Transition Orientation December 1, 2015 PWP-9002-15 A Division of Health Care Service Corporation, a Mutual
More informationNY 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)
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 informationProviderNews2014 Quarter 3
TEXAS ProviderNews2014 Quarter 3 Our Quality Improvement program The Amerigroup* Quality Improvement (QI) program is committed to excellence in the quality of service and care our members receive and the
More informationDate: Illinois Health Connect PCP 6/23/14 Page 1 of 8. Signature:
Illinois Department of Healthcare and Family Services Illinois Health Connect Primary Care Provider Agreement This Agreement pertains only to the relationship between the Illinois Department of Healthcare
More informationProviderNews2013. Recent and upcoming changes to our precertification, utilization management and clinical practice guidelines NEW JERSEY
NEW JERSEY ProviderNews2013 Recent and upcoming changes to our precertification, utilization management and clinical practice guidelines We already faxed or mailed and posted notices on our website about
More informationChoice PPO Retired Employees Health Program Non-Medicare Eligible Retired Members
Choice PPO Retired Employees Health Program Non-Medicare Eligible Retired Members DEDUCTIBLE (per calendar year) Annual in-network deductible must be paid first for the following services: Imaging, hospital
More informationFall Provider Workshops 2017
Fall Provider Workshops 2017 West Virginia Department of Health and Human Resources Bureau for Medical Services (BMS) Sarah Young, Deputy Commissioner Joy Dalton, Director of Provider Services Dee Ann
More informationBlue Choice PPO SM Provider Manual - Preauthorization
In this Section Blue Choice PPO SM Provider Manual - The following topics are covered in this section. Topic Page Overview E 3 What Requires E 3 evicore Program E 3 Responsibility for E 3 When to Preauthorize
More informationBlueCare/TennCareSelect. Improving health care for TennCare members
Improving health care for TennCare members Obtain member eligibility by: Using BlueAccess, the secure area of vshptn.com* and bcbst.com Calling Provider Service - BlueCare 1-800-468-9736 - TennCareSelect
More informationWest Virginia New Medicaid Management Information System (MMIS) Provider Training. January 2016
West Virginia New Medicaid Management Information System (MMIS) Provider Training January 2016 Agenda Welcome and Introductions Billing and Procedure Updates Addition of WV Children s Health Insurance
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 informationCovered (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
More informationSECTION V. HMO Reimbursement Methodology
SECTION V. HMO Reimbursement Methodology Overview V-2 SFHN s Financial Responsibility Provider Payment Methodology Chart Primary Care Physicians V-4 Overview Capitated Primary Care Services Services Reimbursed
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 information11/2/2017. Blue Cross Blue Shield of Michigan and Blue Care Network
Blue Cross Blue Shield of Michigan and Blue Care Network Michigan Medical Group Management Association Third Party Payer Day November 10, 2017 Heather Peterson, Provider Relations Consultant Agenda Physician
More informationHPHC Insurance Company, Inc. THE HPHC INSURANCE COMPANY DEDUCTIBLE TIERED COPAYMENT PPO PLAN MAINE
ID: MD0000003250 X Schedule of s HPHC Insurance Company, Inc. THE HPHC INSURANCE COMPANY DEDUCTIBLE TIERED COPAYMENT PPO PLAN MAINE This Schedule of s summarizes your benefits under the The HPHC Insurance
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 informationSuper Blue Plus 2000 WVHTC High Option-B (Non-Grandfathered) $200 Deductible
BENEFIT HIGHLIGHTS 1 Super Blue Plus 2000 WVHTC High Option-B (Non-Grandfathered) $200 Group Effective Date December 1, 2017 Benefit Period (used for and Coinsurance limits) January 1 through December
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 informationSchedule of Benefits-EPO
Schedule of Benefits-EPO [Plan Information] [Health Plan:] [Ambetter Balanced Care 3 (2018)-Standard Silver On Exchange Plan] [Primary Member:] [John Doe] [Member ID:] [01213456] [Date of Birth:] [08/12/62]
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 informationST. TAMMANY PARISH SCHOOL BOARD SCHEDULE OF BENEFITS
PLAN NAME ST. TAMMANY PARISH SCHOOL BOARD SCHEDULE OF BENEFITS St. Tammany Parish School Board Active Employee Plan PLAN'S ORIGINAL BENEFIT PLAN DATE PLAN'S AMENDED BENEFIT PLAN DATE GROUP NUMBER 78B03ERC
More informationKentucky Spirit Health Plan Provider Training Program
Kentucky Spirit Health Plan Provider Training Program Provider Training Program Agenda Welcome and Opening Remarks About NIA The Provider Partnership The Program Components The Provider Assessment Program
More informationSchedule of Benefits HDHP WITH HSA MASSACHUSETTS
Schedule of Benefits HDHP WITH HSA MASSACHUSETTS ID: MD0000017710_A9 X This Schedule of Benefits states any Benefit Limits and amounts you must pay for Covered Benefits. However, it is only a summary of
More informationHealthChoice Radiology Management. March 1, 2010
HealthChoice Radiology Management March 1, 2010 Introduction Acting on behalf of our Medicaid customers in Maryland (HealthChoice), UnitedHealthcare has worked with external physician advisory groups to
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 informationAetna/Coventry Pennsylvania and West Virginia Physical Medicine Overview for Providers
Aetna/Coventry Pennsylvania and West Virginia Physical Medicine Overview for Providers Aetna Physical Medicine Overview What: When: Who: Aetna will initiate a Utilization Management Prior Authorization
More informationRSNA EMPLOYEE BENEFIT TRUST PLAN II S2502 NON GRANDFATHERED PLAN BENEFIT SHEET
BENEFIT SHEET GENERAL PLAN INFORMATION Coordination of Benefits Standard COB Dependents Children birth to age 26 Filing Limit 1 year from date of service Mailing Address & PPO Company. Remit claims to:
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 informationBenefits. 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
More information2017 Provider Satisfaction Improvement Goals
2017 Provider Satisfaction Improvement Goals Provider Relations Expand Network Health s competitive advantage in the areas of provider relations, satisfaction and loyalty Communicate 2016 Provider Satisfaction
More informationCONRAD INDUSTRIES, INC. S2489 NON GRANDFATHERED PLAN BENEFIT SHEET
BENEFIT SHEET GENERAL PLAN INFORMATION Coordination of Benefits Standard COB Dependents Children to age 26 Filing Limit 12 months from date of service Mailing Address & PPO Company. PPO Co.: PPO CIGNA
More informationNEIGHBORHOOD HEALTH PARTNERSHIP POS SUMMARY OF BENEFITS
XV-2 $30/$60/$200/$1,000/80% R NEIGHBORHOOD HEALTH PARTNERSHIP POS SUMMARY OF BENEFITS A quick glance at this Summary of Benefits will introduce you to the Point of Service (POS) Plan you have with Neighborhood
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 informationHOME BANK - S2395 NON-GRANDFATHERED CONSUMER DRIVEN HEALTH PLAN BENEFIT SHEET
CONSUMER DRIVEN HEALTH PLAN BENEFIT SHEET GENERAL PLAN INFORMATION Coordination of Benefits Standard COB Dependents Children birth to 26 180 days from incurred Filing Limit date, except when 180 days would
More informationSummary of Benefits CCPOA (Basic) Custom Access+ HMO
Blue Shield of California is an independent member of the Blue Shield Association Summary of Benefits CCPOA (Basic) Custom Access+ HMO CCPOA Effective January 1, 2019 HMO Benefit Plan This Summary of Benefits
More informationPA/MND Review of Spine Surgery services Questions & Answers
PA/MND Review of Spine Surgery services Questions & Answers 1. What is the Musculoskeletal Program? Horizon BCBSNJ has expanded our Pain Management Program with evicore to include Pain Management and Spine
More informationCovered Behavioral Health Services
Behavioral Health Services Covered Behavioral Health Services Cenpatico, Buckeye s behavioral health affiliate, has been delegated the provision of covered mental health and substance use disorder services
More informationServices 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
More informationGIC 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
More informationMEDICARE BENEFICIARY SCAM - LIDOCAINE CREAM
NEWS FOR PHYSICIANS AND PROVIDERS QUARTER 2 2018 ALOHA TO MARLENE TURNER ALOHACARE S NEW SENIOR DIRECTOR OF NETWORK DEVELOPMENT AlohaCare proudly announces the arrival of Marlene Turner to Oahu in April
More informationAetna Better Health of West Virginia
Provider Newsletter Summer 2017 Aetna Better Health of West Virginia Table of Contents Pharmacy Change... 1 Telehealth Services... 2 Continuity and Coordination of care... 2 Drug Screen Policy Update...
More informationPlan Overview. Health Net Platinum 90 HSP. Benefit description Member(s) responsibility 1,2
PureCare HSP is available through Covered CA in Kings, Madera, Sacramento, and Yolo counties, and parts of El Dorado, Fresno, Nevada, Placer, and Santa Clara counties. Plan Overview Health Net Platinum
More informationBlue Choice PPO SM Physician, Professional Provider, Facility and Ancillary Provider - Provider Manual Table of Contents (TOC)
THIS MANUAL CONTAINS A REQUIRED DISCLOSURE CONCERNING BLUE CROSS AND BLUE SHIELD OF TEXAS CLAIMS PROCESSING PROCEDURES Blue Choice PPO SM Physician, Professional Provider, Facility and Ancillary Provider
More informationDIVISION OF MEDICAID Provider Workshop 2016 MSCAN & CHIP
DIVISION OF MEDICAID Provider Workshop 2016 MSCAN & CHIP Magnolia Health MississippiCAN Overview 2011 30,000 Members December 2012 77,000 Members December 2014 98,000 Members January 2015 115,000 Members
More informationBenefit Name In Network Out of Network Limits and Additional Information. N/A Pharmacy. N/A Pharmacy
Excellus BluePPO Drug Coverage Excluded Benefit Time Period: 01/01/2018-12/31/2018 HOBART & WILLIAM SMITH COLLEGES General Information Cost Sharing Expenses Deductible - Single $0 $500 Deductible - Family
More informationVeterans Choice Program and Patient-Centered Community Care VAMC Scheduling Initiatives Provider Orientation Webinar
Veterans Choice Program and Patient-Centered Community Care VAMC Scheduling Initiatives Provider Orientation Webinar January 2018 Scheduling Initiatives Introduction The U.S. Department of Veterans Affairs
More informationHMO West Pennsylvania Employees Benefit Trust Fund Benefit Highlights Active Eligible Members. Providers None $6,850 single / $13,700 family
Benefit Provision HMO Network Providers None $6,850 single / $13,700 family DEDUCTIBLE (Per Calendar Year) OUT-OF-POCKET MAXIMUM (includes costs for medical, mental health and substance abuse benefits
More informationALOHACARE CHANGE IN REFERRAL POLICY
NEWS FOR PHYSICIANS AND PROVIDERS QUARTER 3 2017 ALOHACARE CHANGE IN REFERRAL POLICY We are pleased to announce the elimination of Referral Notifications when you refer an AlohaCare member to other in-network
More informationServices 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
More informationMMA 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
More informationCovered 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
More informationUnitedHealthcare SignatureValue TM Offered by UnitedHealthcare of California
UnitedHealthcare SignatureValue TM Offered by UnitedHealthcare of California HMO 20 (20/0%) EFFECTIVE JULY 1, 2017 These services are covered as indicated when authorized through your Primary Care Physician
More informationUnitedHealthcare SignatureValue TM Offered by UnitedHealthcare of California
CALIFORNIA SCHOOLS VEBA UnitedHealthcare SignatureValue TM Offered by UnitedHealthcare of California Performance HMO Schedule of Benefits (Benefit Package B, Network 2) 20/500A These services are covered
More informationUnitedHealthcare SignatureValue TM Offered by UnitedHealthcare of California
CALIFORNIA SCHOOLS VEBA UnitedHealthcare SignatureValue TM Offered by UnitedHealthcare of California Performance HMO Schedule of Benefits (Package A, Network 1) 10/0% These services are covered as indicated
More informationProvider Manual. Physical Therapy (PT), Occupational Therapy (OT) and Speech Therapy (ST) TNGA Provider Manual (3)
Provider Manual Physical Therapy (PT), Occupational Therapy (OT) and Speech Therapy (ST) TNGA Provider Manual (3) Table of Contents Table of Contents... 2 Welcome!... 3 Important Contact Information...
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 informationProvider Manual Rev. August, 2016
Provider Manual 1-866-769-3085 Rev. August, 2016 http://www.nhhealthyfamilies.com Table of Contents INTRODUCTION... 7 Welcome... 7 About NH Healthy Families... 7 Mission... 7 How to Use This Manual...
More informationAnthem HealthKeepers Medicare-Medicaid Plan (MMP), a Commonwealth Coordinated Care plan, provider orientation presentation
Anthem HealthKeepers Medicare-Medicaid Plan (MMP), a Commonwealth Coordinated Care plan, provider orientation presentation Anthem HealthKeepers MMP HealthKeepers, Inc. participates in the Virginia Commonwealth
More informationBlueChoice HealthPlan Medicaid. Provider education 2017
BlueChoice HealthPlan Medicaid Provider education 2017 Provider Relations 2 What s new Process for obtaining Makena New website feature Availity Portal Pharmacy reports now available Provider report card
More informationUnitedHealthcare SignatureValue TM Offered by UnitedHealthcare of California
CALIFORNIA SCHOOLS VEBA UnitedHealthcare SignatureValue TM Offered by UnitedHealthcare of California HMO Schedule of Benefits 20/250A These services are covered as indicated when authorized through your
More informationWorking with Anthem Subject Specific Webinar Series
Working with Anthem Subject Specific Webinar Series Special Session Working with Anthem Medicaid Access audio conference: 877-497-8913 Conference code: 132-281-9809# Please Mute Your Phone Use the mute
More informationCovered 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
More informationDirect Care Deductible 2000 Hybrid Benefit Summary Benefits effective January 1, 2018 and beyond
Direct Care Deductible 2000 Hybrid Benefit Summary Benefits effective January 1, 2018 and beyond The Fallon difference Direct Care is a Limited Provider Network. With Direct Care Deductible 2000 Hybrid,
More informationIHCP bulletin INDIANA HEALTH COVERAGE PROGRAMS BT AUGUST 30, 2016
IHCP bulletin INDIANA HEALTH COVERAGE PROGRAMS BT201648 AUGUST 30, 2016 2016 IHCP Annual Provider Seminar scheduled for October 18-20 in Indianapolis The Indiana Family and Social Administration (FSSA)
More information3/6/2017. Health Net Federal Service Veterans Choice Program. Minnesota Chiropractic Association 69 th Annual Convention March 9-11, 2017
Minnesota Chiropractic Association 69 th Annual Convention March 9-11, 2017 Billing Procedures Presented by Joan Olson, Chiropractic Assistant Nona Peterson, Chiropractic Assistant What is (VCP)? In August
More informationNew provider orientation
New provider orientation Welcome 2 Agenda Introduction to Amerigroup Provider resources Contact numbers and questions Provider responsibilities Member benefits and services Claims and billing Preservice
More informationUNIVERSITY OF THE CUMBERLANDS MEDICAL BENEFITS SCHEDULE
November 1, 2016 UNIVERSITY OF THE CUMBERLANDS MEDICAL BENEFITS SCHEDULE NETWORK NON-NETWORK Lifetime Maximum Benefit Unlimited Unlimited Annual Deductible (Single/Family) $500/$1,000 $1,000/$2,000 Maximum
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 informationYour Out-of-Pocket Type of Service
Calendar Year Deductible (CYD) 1 $3,000 single/ 3x family Out-of-Pocket Maximum - Deductibles and copays all accrue towards the out-of-pocket $6,200 single/ 2x family maximum. With respect to family plans,
More informationMust meet specific criteria. Prior authorization required. Must meet specific criteria
MIDWEST HEALTH Acupuncture NOT A BENEFIT NOT A BENEFIT NOT A BENEFIT Acute Care Observation Post Operative Emergency Room Allergy Testing/Allergy Injections Ambulance-Emergency Land Plan Notification Not
More informationWILLIS KNIGHTON MEDICAL CENTER S2763 NON GRANDFATHERED PLAN BENEFIT SHEET
BENEFIT SHEET GENERAL PLAN INFORMATION Coordination of Benefits Customized COB Dependents Children birth to 26 Filing Limit 12 months For employees that work in a WKHS location within the primary HealthPlus
More informationUnitedHealthcare SignatureValue TM UnitedHealthcare SignatureValue Advantage Offered by UnitedHealthcare of California
CALIFORNIA SMALL GROUP UnitedHealthcare SignatureValue TM UnitedHealthcare SignatureValue Advantage Offered by UnitedHealthcare of California 20-40/300d HMO Schedule of Benefits These services are covered
More informationSelect Care Deductible 1200 Hybrid Benefit Summary Benefits effective January 1, 2018 and beyond
Select Care Deductible 1200 Hybrid Benefit Summary Benefits effective January 1, 2018 and beyond The Fallon difference With Select Care Deductible 1200 Hybrid, you get everything you need to live a healthy
More information