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Community Care Network of Virginia Medicaid Medallion II Expansion April 17 & 18, 2012. BILLING SYSTEM SET UP . Diane N. Harris Director, Central Business Office Community Care Network of Virginia dharris@ccnva.com www.ccnva.com 804-234-7690 x1126. INSURANCE PLANS. Amerigroup Famis Plus
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Community Care Network of VirginiaMedicaid Medallion II ExpansionApril 17 & 18, 2012
BILLING SYSTEM SET UP Diane N. Harris Director, Central Business Office Community Care Network of Virginia dharris@ccnva.com www.ccnva.com 804-234-7690 x1126
INSURANCE PLANS • AmerigroupFamis Plus • AmerigroupFamis • Anthem Healthkeepers Plus • Anthem Helathkeepers Plus Famis • Optima Family Care • Majesta Care • Majesta Care Famis • Optima Family Care Famis • Southern Health Carenet • Southern Health CarenetFamis • Virginia Premier • Virginia Premier Famis
INSURANCE FILE SET UP • CREATE NEW INSURANCE FILES PRIOR TO JULY 1, 2012 • ADD EACH MEDICAID HMO AND FAMIS PRODUCT AS AN INDIVIDUAL FILE • ENTER THE STANDARD INFORMATION IN THE INSURANCE FILE TO INCLUDE YOUR CLEARINGHOUSE PAYER ID NUMBER
INSURANCE FILE SET UP ll • CREATE NEW INSURANCE GROUPS IN YOUR INSURANCE GROUP FILE • ASSOCIATE EACH NEW PRODUCT TO THE CORRECT INSURANCE GROUP • CONFIGURE UDS MAPPING FOR NEW INSURANCE GROUPS IN TABLE 4 AND TABLE 9D
VERIFY-VERIFY-VERIFY-VERIFY • APPOINTMENTS SCHEDULED FOR DATES OF SERVICE ON OR AFTER JULY 1, 2012 MUST BE VERIFIED ON LINE • PRINT OUT THE PATIENT VERIFICATION FROM EACH WEBSITE SCAN INTO PATIENT DOCUMENTS OR INSERT INTO PATIENT CHART • UPDATE PATIENT REGISTRATION- DO NOT DELETE MEDICAID –EXPIRE PLAN
EDUCATE STAFF • EACH PLAN HAS INDIVIDUAL POLICIES IN REGARD TO PCP EFFECTIVE DATE CHANGE • INSURANCE PLAN CARD WILL HAVE THE FAMIS ICON TO ASSIST STAFF IN DIFFERENTIATING BETWEEN THE MEDICAID HMO AND THE MEDICAID FAMIS PRODUCTS
EDUCATE STAFF ll • REMIND STAFF NOT TO USE THE MEDICAID NUMBER AS THE SUBSCRIBER NUMBER WHEN REGISTERING PATIENTS WITH NEW PLAN • HAVE PCP CHANGE FORMS ON HAND TO ASSIST PATIENT WITH PCP CHANGE
MEDICAID MCO BEHAVIORAL HEALTH PRE- AUTHORIZATION REQUIREMENTS • AMERIGROUP-1-800-454-3730-NO AUTH IN NETWORK • ANTHEM HEALTHKEEPERS PLUS- • 1-800-991-6045- NO AUTH IN NETWORK • CARENET-1-800-235-2206-NO AUTH IN NETWORK FOR 90801 AND 90862. CPT CODES 90804 AND 90806 REQUIRE PRE-AUTHORIZATION-FILE CLAIMS TO MH NET-1-800-975-8919 • MAJESTACARE-1-866-996-9140-NO AUTH IN NETWORK • OPTIMA FAMILY CARE- • 1-800-648-8420-NO AUTH IN NETWORK • VIRGINIA PREMIER-1-800-727-7536-NO AUTH FOR IN NETWORK FOR THE FIRST 26 VISITS PER PROVIDER PER ROLLING YEAR
