December 1, 2017 | Issue 19 | Volume 2
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Transition Updates and Reminders:
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Billing for Medicaid Services During the AmeriHealth Caritas Withdrawal Transition
The purpose of Informational Letter 1864-MC-FFS is to clarify the billing and authorization requirements for services provided to members who are transitioning from AmeriHealth Caritas.
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Temporary Suspension of MCO Choice
Members were
notified that they were able to make a choice to change their MCO. This has changed. Amerigroup Iowa has notified the department they do not currently have the capacity to take new membership. Members who self-elected Amerigroup Iowa on or before November 16, 2017, will transition to Iowa Medicaid Fee-for-Service (FFS) until Amerigroup Iowa has capacity.
All other former AmeriHealth Caritas members who did not elect a change to their MCO will be assigned to United HealthCare Community Plan of Iowa.
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Deemed Provider Enrollment with Managed Care Organizations (MCOs)
During the transition from Amerihealth Caritas, providers currently enrolled with the Iowa Medicaid Enterprise (IME) will be considered to have "deemed enrollment" with both UnitedHealthcare and Amerigroup for the month of December 2017.
"Deemed enrollment" means that Medicaid enrolled providers are provisionally considered credentialed with each MCO to allow for continued access to
care.
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Member Mailings:
Confirmation of Coverage for Members Enrolled With UnitedHealthcare Community Plan of Iowa
AmeriHealth Caritas members have been tentatively assigned to UnitedHealthcare. Previously the Department
notified members they would be able to choose Amerigroup Iowa. Due to concerns with capacity, Amerigroup Iowa is not currently accepting any additional members.
These members have coverage through UnitedHealthcare Community Plan of Iowa effective December 1, 2017. Member letters have been sent confirming their coverage, which can be viewed
here.
Confirmation of Coverage for Limited Group of Fee-for-Service (FFS) Members
Members who were AmeriHealth Caritas members and chose Amerigroup Iowa by November 16, 2017, will have coverage through Iowa Medicaid Fee-for-Service. Member letters have been sent confirming their coverage, which can be viewed
here.
- This includes 10,121 Iowa Medicaid members.
- FFS is limited to this small group of members for a limited period, which includes a mix of members including some medical, behavioral and Long-Term Services and Supports (LTSS).
- These members may have received an ID card from Amerigroup Iowa, as their choice triggered cards to be mailed. However, Amerigroup Iowa is not accepting new members.
- These members will have coverage through Iowa Medicaid FFS and have been sent a notice from DHS confirming their coverage. These members will show their Iowa Medical Assistance Eligibility Card when they receive services.
- These members may choose to be reassigned to UnitedHealthcare.
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Providers are Encouraged to Verify Eligibility
The Eligibility and Verification Information System (ELVS) line is very busy during the first of the month. The
ELVS web portal is another option for providers in lieu of calling the ELVS line but each provider must enroll through the Electronic Data Interchange Support Services (EDISS). The ELVS web portal allows for multiple eligibility checks and batch submission, where as the ELVS phone system only allows for one at a time.
Login ID and password may be obtained through EDISS by submitting the following
Access Request Form to EDISS or calling EDISS at 1-800-967-7902.
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Tiered Rates Phase-in Begins December 1, 2017
Per House File 653, the Department of Human Services (DHS) was directed to implement tiered rates for providers of daily supported community living (SCL), full day-habilitation and full day-adult day care for persons with an intellectual disability under the home- and community-based services (HCBS) waiver program.
Tiered rates aligns reimbursement based on the severity of the individuals' disabilities and will standardize reimbursement for all providers. Approximately 5,000 members will have their services reimbursed using tiered rates.
Tiered rate reimbursement for daily SCL will be phased in over 19 months beginning December 1, 2017. This phased in approach allows providers time to adjust their business practices. For more information view the
Tiered Rates FAQ and
Informational Letter 1846-MC-FFS.
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Non Emergency Medical Transportation (NEMT)
Scheduling FFS Trips for Dates of Service Occurring on or after December 1, 2017: Members who are considered FFS or not enrolled with an MCO will continue to have their NEMT provided by Access2Care (AC2). Members should contact A2C to schedule rides for December.
Phone:
866-572-7662
(Toll Free)
Operating Hours: 8 a.m. - 5 p.m. Monday to Friday
Scheduling Trips with an MCO for Dates of Service Occurring on or after December 1, 2017:
AmeriHealth members who transitioned to UnitedHealthcare Plan of the River Valley, Inc. (UHC) and need to schedule a December trip should contact UHC.
Phone:
1-800-464-9484
Operating Hours: 7:30 a.m. - 6 p.m., Monday to Friday
Members who have been with Amerigroup will continue to schedule trips with Amerigroup's NEMT vendor LogistiCare.
Phone:
1-844-544-1389 or
1-844-544-1390 Operating Hours: 7:30 a.m. - 6 p.m., Monday to Friday
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Provider Tools and Resources:
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Provider Resource Pages
Comprehensive provider resource pages are available for each Managed Care Organization (MCO), featuring provider training manuals, webinars and important updates. View them below:
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Member Choice Guidelines for Providers
All health care providers delivering services to Iowa's Medicaid population in the IA Health Link managed care program are welcome to inform their patients of the health plans in which they have chosen to participate. However, there are strict prohibitions against patient steering, which all providers must observe.
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Looking for an Old Issue of the Medicaid e-News?
Each edition features useful tools and important updates. Now you can quickly access old issues to find what your looking for. Visit the
Iowa Medicaid newsletter page
where you'll find links to each issue.
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IA Health Link Member Services
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1-800-600-4441
1-855-332-2440
1-800-464-9484
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IA Health Link Provider Services
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1-800-454-3730
1-844-411-0579
1-888-650-3462
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Dental Wellness Plan Member Services
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Dental Wellness Plan Provider Services
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Informational Letters
Informational letters are posted through the Iowa Medicaid Portal Application (IMPA) system and are available on the DHS website
here
.
These letters communicate important policies and procedures for providers and their administrative staff.
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100 Army Post Rd., Des Moines, IA 50315
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Copyright © 2017. All Rights Reserved.
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The Iowa Medicaid Enterprise (IME), has been named a 2016 All Star Award winner by
Constant Contact
, part of the
Endurance International Group, Inc.'s
(Nasdaq: EIGI) family of brands and the trusted marketing advisor to hundreds of thousands of small organizations worldwide. The annual award recognizes the most successful 10 percent of Constant Contact's customer base, based on their significant achievements using email marketing to engage their customer base and drive results for their organization during the prior year.
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