26

MEDICAID MANAGED CARE ORGANIZATION (MCO) TRAINING CONDUCTED BY : THE DEPARTMENT FOR PUBLIC HEALTH & CUSTOM DATA PROCESSING October 18 th, 2011

Download PPT Report

Upload
georgia-nash
View
213
Download
0

Tags:

Embed Size (px)

Citation preview

Page 1: MEDICAID MANAGED CARE ORGANIZATION (MCO) TRAINING CONDUCTED BY : THE DEPARTMENT FOR PUBLIC HEALTH & CUSTOM DATA PROCESSING October 18 th, 2011

Page 2: MEDICAID MANAGED CARE ORGANIZATION (MCO) TRAINING CONDUCTED BY : THE DEPARTMENT FOR PUBLIC HEALTH & CUSTOM DATA PROCESSING October 18 th, 2011

MCO CARD OR LETTER

Page 3: MEDICAID MANAGED CARE ORGANIZATION (MCO) TRAINING CONDUCTED BY : THE DEPARTMENT FOR PUBLIC HEALTH & CUSTOM DATA PROCESSING October 18 th, 2011

Page 4: MEDICAID MANAGED CARE ORGANIZATION (MCO) TRAINING CONDUCTED BY : THE DEPARTMENT FOR PUBLIC HEALTH & CUSTOM DATA PROCESSING October 18 th, 2011

Identified with #6

Log on to www.directprovider.com

Call CoventryCares IVR line @ 1-855-300-5528

http://chcmedicaid-kentucky.coventryhealthcare.com/

Page 5: MEDICAID MANAGED CARE ORGANIZATION (MCO) TRAINING CONDUCTED BY : THE DEPARTMENT FOR PUBLIC HEALTH & CUSTOM DATA PROCESSING October 18 th, 2011

Identified with #7

Log on to www.KentuckySpiritHealth.com

Search by date of service and Medicaid ID # or KY Spirit ID #

Call automated system(IVR) at 1-866-643-3153 from a touch tone phone

Call Ky Spirit Health Plan Provider Services @ 1-866-643-3153

Page 6: MEDICAID MANAGED CARE ORGANIZATION (MCO) TRAINING CONDUCTED BY : THE DEPARTMENT FOR PUBLIC HEALTH & CUSTOM DATA PROCESSING October 18 th, 2011

Identified with #8

Log on to www.kentucky.wellcare.com

Call WellCare’s IVR @ 1-877-389-9457

Call WellCare’s Customer Service @1-877-389-9457

Page 7: MEDICAID MANAGED CARE ORGANIZATION (MCO) TRAINING CONDUCTED BY : THE DEPARTMENT FOR PUBLIC HEALTH & CUSTOM DATA PROCESSING October 18 th, 2011

VERIFY PATIENT ELIGIBILITY

•Verify Medicaid # and MCO member #.

•Print both initially and place in patient chart.

•This will provide proof for billing/inquiries in case there are any problems.

•If no card or letter use KY Health Net & call the MCO listed there.

•Key into Registration.

Page 8: MEDICAID MANAGED CARE ORGANIZATION (MCO) TRAINING CONDUCTED BY : THE DEPARTMENT FOR PUBLIC HEALTH & CUSTOM DATA PROCESSING October 18 th, 2011

8

Page 9: MEDICAID MANAGED CARE ORGANIZATION (MCO) TRAINING CONDUCTED BY : THE DEPARTMENT FOR PUBLIC HEALTH & CUSTOM DATA PROCESSING October 18 th, 2011

Page 10: MEDICAID MANAGED CARE ORGANIZATION (MCO) TRAINING CONDUCTED BY : THE DEPARTMENT FOR PUBLIC HEALTH & CUSTOM DATA PROCESSING October 18 th, 2011

10

Page 11: MEDICAID MANAGED CARE ORGANIZATION (MCO) TRAINING CONDUCTED BY : THE DEPARTMENT FOR PUBLIC HEALTH & CUSTOM DATA PROCESSING October 18 th, 2011

11

Medicaid MCO – drop down of available MCO’s. Previously shown as:“Managed Care Region”

MCO Member # - up to 20 characters availablePreviously shown as:“Managed Care Member #”

Page 12: MEDICAID MANAGED CARE ORGANIZATION (MCO) TRAINING CONDUCTED BY : THE DEPARTMENT FOR PUBLIC HEALTH & CUSTOM DATA PROCESSING October 18 th, 2011

12

Page 13: MEDICAID MANAGED CARE ORGANIZATION (MCO) TRAINING CONDUCTED BY : THE DEPARTMENT FOR PUBLIC HEALTH & CUSTOM DATA PROCESSING October 18 th, 2011

13

Page 14: MEDICAID MANAGED CARE ORGANIZATION (MCO) TRAINING CONDUCTED BY : THE DEPARTMENT FOR PUBLIC HEALTH & CUSTOM DATA PROCESSING October 18 th, 2011

14

Page 15: MEDICAID MANAGED CARE ORGANIZATION (MCO) TRAINING CONDUCTED BY : THE DEPARTMENT FOR PUBLIC HEALTH & CUSTOM DATA PROCESSING October 18 th, 2011

15

PEF label will show MCO/REGN#

Registration label will show MCO Member #

Page 16: MEDICAID MANAGED CARE ORGANIZATION (MCO) TRAINING CONDUCTED BY : THE DEPARTMENT FOR PUBLIC HEALTH & CUSTOM DATA PROCESSING October 18 th, 2011

16

Page 17: MEDICAID MANAGED CARE ORGANIZATION (MCO) TRAINING CONDUCTED BY : THE DEPARTMENT FOR PUBLIC HEALTH & CUSTOM DATA PROCESSING October 18 th, 2011

17

MCO COV

Page 18: MEDICAID MANAGED CARE ORGANIZATION (MCO) TRAINING CONDUCTED BY : THE DEPARTMENT FOR PUBLIC HEALTH & CUSTOM DATA PROCESSING October 18 th, 2011

18

1234567890 MCO

Page 19: MEDICAID MANAGED CARE ORGANIZATION (MCO) TRAINING CONDUCTED BY : THE DEPARTMENT FOR PUBLIC HEALTH & CUSTOM DATA PROCESSING October 18 th, 2011

CODING IS THE SAME AT THIS TIME

Anything currently covered by Preventive.

Page 20: MEDICAID MANAGED CARE ORGANIZATION (MCO) TRAINING CONDUCTED BY : THE DEPARTMENT FOR PUBLIC HEALTH & CUSTOM DATA PROCESSING October 18 th, 2011

ENTER PEF

Page 21: MEDICAID MANAGED CARE ORGANIZATION (MCO) TRAINING CONDUCTED BY : THE DEPARTMENT FOR PUBLIC HEALTH & CUSTOM DATA PROCESSING October 18 th, 2011

VERIFY

Appropriate Medicaid status is in MDCD Field on Encounter Entry Screen

Put Y in bill screen field

On Bill Screena). If not payor code 2, re-verify system informationb). If not working properly call LHO Help Desk at 502-564-6663, option [email protected]

Page 22: MEDICAID MANAGED CARE ORGANIZATION (MCO) TRAINING CONDUCTED BY : THE DEPARTMENT FOR PUBLIC HEALTH & CUSTOM DATA PROCESSING October 18 th, 2011

22

Page 23: MEDICAID MANAGED CARE ORGANIZATION (MCO) TRAINING CONDUCTED BY : THE DEPARTMENT FOR PUBLIC HEALTH & CUSTOM DATA PROCESSING October 18 th, 2011

23

Page 24: MEDICAID MANAGED CARE ORGANIZATION (MCO) TRAINING CONDUCTED BY : THE DEPARTMENT FOR PUBLIC HEALTH & CUSTOM DATA PROCESSING October 18 th, 2011

24

Page 25: MEDICAID MANAGED CARE ORGANIZATION (MCO) TRAINING CONDUCTED BY : THE DEPARTMENT FOR PUBLIC HEALTH & CUSTOM DATA PROCESSING October 18 th, 2011

CDP is working with each MCO to program their specific requirements. IE: VFC modifiers.

New E-reports must be created.

Testing of billing files-live during first week.

Page 26: MEDICAID MANAGED CARE ORGANIZATION (MCO) TRAINING CONDUCTED BY : THE DEPARTMENT FOR PUBLIC HEALTH & CUSTOM DATA PROCESSING October 18 th, 2011

Chapter 108D. Medicaid and NC Health Choice Managed Care ... · – As defined in G.S. 122C-3. (22) Local Management Entity/Managed Care Organization or LME/MCO. – As defined in

Chapter 108D. Medicaid and NC Health Choice Managed Care ... · – As defined in G.S. 122C-3. (22) Local Management Entity/Managed Care Organization or LME/MCO. – As defined in

Documents

Medicaid Managed Care Final Rule - Epstein Becker & Green · Medicaid Managed Care Final Rule Modernizes and More Closely Aligns Medicaid Managed Care with Medicare Advantage and

Medicaid Managed Care Final Rule - Epstein Becker & Green · Medicaid Managed Care Final Rule Modernizes and More Closely Aligns Medicaid Managed Care with Medicare Advantage and

Documents

Session 6: Medicaid Managed Care

Session 6: Medicaid Managed Care

Documents

Welcome to Virginia Medicaid Managed Caredmasva.dmas.virginia.gov/Content_atchs/mc/mc-fsw6.pdfWelcome to Virginia Medicaid Managed Care . 2 MCO Program An MCO is a managed care organization

Welcome to Virginia Medicaid Managed Caredmasva.dmas.virginia.gov/Content_atchs/mc/mc-fsw6.pdfWelcome to Virginia Medicaid Managed Care . 2 MCO Program An MCO is a managed care organization

Documents

Damon Terzaghi Senior Director NASUAD · Medicaid Managed Care (MMC) • Relationship: State contracts with a Managed Care Organization (MCO), not a direct service provider. • Service

Damon Terzaghi Senior Director NASUAD · Medicaid Managed Care (MMC) • Relationship: State contracts with a Managed Care Organization (MCO), not a direct service provider. • Service

Documents

HEALTHCARE ENFORCEMENT COMPLIANCE INSTITUTE · 10/7/2017 8 Managed care Losses often shared between MCO and FFS Many Medicaid programs heavily utilize MCO 73.5% of Medicaid beneficiaries

HEALTHCARE ENFORCEMENT COMPLIANCE INSTITUTE · 10/7/2017 8 Managed care Losses often shared between MCO and FFS Many Medicaid programs heavily utilize MCO 73.5% of Medicaid beneficiaries

Documents

Who is Responsible for Care Coordination · Organization (MCO): The state Medicaid agency provides a risk-based capitation payment for each Medicaid client enrolled in an MCO which

Who is Responsible for Care Coordination · Organization (MCO): The state Medicaid agency provides a risk-based capitation payment for each Medicaid client enrolled in an MCO which

Documents

Managed Care...Managed Care Organization Accountability Increasing MCO utilization by public payers makes tracking that much more important and difficult • Medicaid: 238 MCOs: 70%

Managed Care...Managed Care Organization Accountability Increasing MCO utilization by public payers makes tracking that much more important and difficult • Medicaid: 238 MCOs: 70%

Documents

Managed Care Organization (“MCO”) Application · 2019. 1. 10. · Managed Care Organization (“MCO”) Application for Medicaid Managed Care Plan Contract 2012-2014 NEW JERSEY

Managed Care Organization (“MCO”) Application · 2019. 1. 10. · Managed Care Organization (“MCO”) Application for Medicaid Managed Care Plan Contract 2012-2014 NEW JERSEY

Documents

Managed Care Organization (“MCO”) Application · Managed Care Organization (“MCO”) Application for Medicaid Managed Care Plan Contract 2012-2014 NEW JERSEY DEPARTMENT OF HUMAN

Managed Care Organization (“MCO”) Application · Managed Care Organization (“MCO”) Application for Medicaid Managed Care Plan Contract 2012-2014 NEW JERSEY DEPARTMENT OF HUMAN

Documents

Texas Medicaid Managed Care and Children’s Health ... · Texas Medicaid Managed Care and Children’s Health Insurance Program . ... Texas Medicaid Managed Care and Children’s

Texas Medicaid Managed Care and Children’s Health ... · Texas Medicaid Managed Care and Children’s Health Insurance Program . ... Texas Medicaid Managed Care and Children’s

Documents

Managed Care Organization (“MCO”) Application - New Jerseynj.gov/humanservices/providers/grants/rfprfi/RFPfiles/Medicaid... · Managed Care Organization (“MCO”) Application

Managed Care Organization (“MCO”) Application - New Jerseynj.gov/humanservices/providers/grants/rfprfi/RFPfiles/Medicaid... · Managed Care Organization (“MCO”) Application

Documents

Key Findings from the Medicaid MCO Learning Hub Discussion … Managed Care... · 2020. 12. 21. · MCO representatives noted that they have seen a dramatic increase in the need for

Key Findings from the Medicaid MCO Learning Hub Discussion … Managed Care... · 2020. 12. 21. · MCO representatives noted that they have seen a dramatic increase in the need for

Documents

Containing Medicaid Costs: Moving Toward Medicaid Managed … · Containing Medicaid Costs: Moving Toward Medicaid Managed Care April 20, 2012

Containing Medicaid Costs: Moving Toward Medicaid Managed … · Containing Medicaid Costs: Moving Toward Medicaid Managed Care April 20, 2012

Documents

Medicaid Managed Care Final Rule FINAL...Overview of Medicaid Managed Care Final Rule Overhaul of 2002 regulations governing Medicaid managed care (implementing Balanced Budget Act

Medicaid Managed Care Final Rule FINAL...Overview of Medicaid Managed Care Final Rule Overhaul of 2002 regulations governing Medicaid managed care (implementing Balanced Budget Act

Documents

IOWA MEDICAID MANAGED CAREdhs.iowa.gov/sites/default/files/CMSApprovedQAPlan.pdfIOWA MEDICAID MANAGED CARE ... related problems at both the programmatic and ... Medicaid Managed Care

IOWA MEDICAID MANAGED CAREdhs.iowa.gov/sites/default/files/CMSApprovedQAPlan.pdfIOWA MEDICAID MANAGED CARE ... related problems at both the programmatic and ... Medicaid Managed Care

Documents

Statewide Medicaid Managed Care (SMMC) - Apteanportals.computility.com/Portals/46/Statewide Medicaid Managed Care... · Statewide Medicaid Managed Care (SMMC) ... Statewide Medicaid

Statewide Medicaid Managed Care (SMMC) - Apteanportals.computility.com/Portals/46/Statewide Medicaid Managed Care... · Statewide Medicaid Managed Care (SMMC) ... Statewide Medicaid

Documents

Ohio Medicaid Managed Care Program

Ohio Medicaid Managed Care Program

Documents

Medicaid Managed LTSS

Medicaid Managed LTSS

Documents

Medicaid Managed Care Preventive Services and Vaccinations€¦ · Medicaid Managed Care Preventive Services and Vaccinations . ... Medicaid Managed Care Preventive Services and Vaccinations

Medicaid Managed Care Preventive Services and Vaccinations€¦ · Medicaid Managed Care Preventive Services and Vaccinations . ... Medicaid Managed Care Preventive Services and Vaccinations

Documents

Statewide Medicaid Managed Care Managed Medical Assistance … · 2015. 11. 12. · Statewide Medicaid Managed Care Managed Medical Assistance (MMA) Program Overview of Medicaid Express

Statewide Medicaid Managed Care Managed Medical Assistance … · 2015. 11. 12. · Statewide Medicaid Managed Care Managed Medical Assistance (MMA) Program Overview of Medicaid Express

Documents

A Profile of Medicaid Managed Care Programs in … · A Profile of Medicaid Managed Care Programs in 2010: ... MCO Network Adequacy Requirements, by State ... outpatient behavioral

Documents

Final Comments on Medicaid MCO Proposed Rule

Final Comments on Medicaid MCO Proposed Rule

Documents

Medicaid MCO Network Adequacy Overview June 2016tahp.org/wp-content/uploads/2016/11/TAHP-Presentation-Medicaid-MCO...Medicaid MCO Network Adequacy Overview June 2016 ... • Create

Medicaid MCO Network Adequacy Overview June 2016tahp.org/wp-content/uploads/2016/11/TAHP-Presentation-Medicaid-MCO...Medicaid MCO Network Adequacy Overview June 2016 ... • Create

Documents

EXTERNAL QUALITY REVIEW · 2019-08-08 · MCD (M): Medicaid . MCO: Managed Care Organization . MLTC: Managed Long ... State agencies must contract with an External Quality Review

EXTERNAL QUALITY REVIEW · 2019-08-08 · MCD (M): Medicaid . MCO: Managed Care Organization . MLTC: Managed Long ... State agencies must contract with an External Quality Review

Documents

Statewide Medicaid Managed Care Long-term Care...Statewide Medicaid Managed Care (SMMC) program. • Medicaid recipients are required to enroll in a Medicaid managed care plan unless

Statewide Medicaid Managed Care Long-term Care...Statewide Medicaid Managed Care (SMMC) program. • Medicaid recipients are required to enroll in a Medicaid managed care plan unless

Documents

MEDICAID MANAGED CARE ORGANIZATION (MCO) DRUG ......42 CFR 438.3(s)(4) and (5) require that each Medicaid managed care organization (MCO) must operate a drug utilizati on review (DUR)

MEDICAID MANAGED CARE ORGANIZATION (MCO) DRUG ......42 CFR 438.3(s)(4) and (5) require that each Medicaid managed care organization (MCO) must operate a drug utilizati on review (DUR)

Documents

REQUEST FOR APPLICATIONS Ohio Medicaid Managed Care ...Contractor means a successful Applicant who executes an MCO Provider Agreement with ODM. Also referred to as MCO. ET means Eastern

REQUEST FOR APPLICATIONS Ohio Medicaid Managed Care ...Contractor means a successful Applicant who executes an MCO Provider Agreement with ODM. Also referred to as MCO. ET means Eastern

Documents

Medicaid Managed Care Complaint Form · Managed Care Organization (MCO) Department of Human Services Medicaid Provider: _____ Case Manager: _____ Other: _____ Would you like to be

Medicaid Managed Care Complaint Form · Managed Care Organization (MCO) Department of Human Services Medicaid Provider: _____ Case Manager: _____ Other: _____ Would you like to be

Documents

Medicaid Managed Care

Medicaid Managed Care

Healthcare