1 / 10

Managed Care Update

Managed Care Update. Centers for Medicare and Medicaid Services (CMS) I/T/U Conference Alisa Horn May 2018. Important facts about Medicaid for American Indian and Alaska Natives. Very important to identify as AI/AN on the Medicaid application.

bilger
Télécharger la présentation

Managed Care Update

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Managed Care Update Centers for Medicare and Medicaid Services (CMS) I/T/U Conference Alisa Horn May 2018

  2. Important facts about Medicaid for American Indian and Alaska Natives • Very important to identify as AI/AN on the Medicaid application. • Continue receiving services from local Indian Health Services provider. • Option to choose a Managed Care Organization (MCO) or stay with Fee-for-Service (FFS). • Organization can bill your insurance program. • Benefits to the tribal community. • Certain mental health and substance abuse services are referred to as B-3 services which are not covered by FFS. Members who want access to these services will need to choose an MCO.

  3. Managed Care Updates • Two Managed Care Organizations • Amerigroup Iowa, Inc. • UnitedHealthcare Plan of the River Valley, Inc. • AmeriHealth Caritas Iowa, Inc. left the IA Health Link program effective December 1, 2017. • RFP open now for new Managed Care Organization(s) to begin July 2019.

  4. Iowa Medicaid Updates • Elimination of retroactive coverage for new applicants • Verify eligibility to check MCO assignment and benefits through ELVS web portal or by calling the IME Provider Services call center • Informational Letter 1891 - Pharmacy Program Changes (effective April 1, 2018) • Informational Letter 1843 - Same day billing for multiple encounters with multiple diagnoses (effective April 1, 2017) • Draft for Medicaid Administrative Match is under review

  5. Amerigroup Resources • Provider Services • Phone: 1-800-454-3730 • Hours: M-F, 7:30 AM – 6 PM • Pharmacy Prior Authorization • Phone:1-855-712-0104 • Hours: 24 hours a day, 7 days a week • Member Transportation • Broker: Logisticare • Phone: 1-844-544-1389

  6. UnitedHealthcare Resources • Provider Services • Phone: 888-650-3462 • Hours: 7:30 AM – 6 PM • Pharmacy Prior Authorizations • Phone: 800-310-6826 • Hours: 24 hours a day, 7 days a week • Transportation • Broker: MTM • Phone: 1-888-513-1613

  7. Iowa Medicaid Enterprise Resources • Provider Services • Phone: 1-800-338-7909 • Hours: 7:30 AM – 4:30 PM • Pharmacy Prior Authorization • Phone: 1-877-776-1567 • Hours: 24 hours a day, 7 days a week • Transportation • Broker: Access2Care • Phone: 1-866-572-7662

  8. AI/AN: Online Resource • Includes Information On: • Historical background on government-to-government relationship. • Different health program options available to AI/Ans. • Special protections for AI/ANs, including cost-sharing exemptions, estate recovery protections and managed care protections. • Important facts about Medicaid for AI/ANs.

  9. AI/AN: Useful Websites Important Facts • https://dhs.iowa.gov/ime/members/FFS/AINA/important-facts B-3 Services • https://dhs.iowa.gov/sites/default/files/B-3_Mental_Health_and_SubstanceAbuse_Services.pdf Online Resources • https://dhs.iowa.gov/ime/members/FFS/AINA

  10. Questions? Alisa Horn – 515-256-4647 ahorn@dhs.state.ia.us www.dhs.state.ia.us

More Related