CareSource IHCP 2017 Annual Seminar - IN.gov ihcp 2017 annual seminar presentation...• Arrange...
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1 CareSource 101 IHCP 2017 Annual Seminar
Transcript of CareSource IHCP 2017 Annual Seminar - IN.gov ihcp 2017 annual seminar presentation...• Arrange...
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CareSource
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I H C P 2 0 1 7 A n n u a l S e m i n a r
Agenda
About CareSource
Member ID Cards &
Copayments
Working with CareSource
Covered Services
Resources
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About CareSource
H e a l t h C a r e W i t h H e a r t
About CareSource
OUR MISSION:To make a lasting difference in our members’ lives by transforming their health and well-being
OUR PLEDGE: Make it easier for you to work with us
Partner with providers to help members make healthy choices
Direct communication
Timely and low-hassle medical reviews
Accurate and efficient claims payment
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Health Care With Heart
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MISSION FOCUSEDComprehensive, member-centric health and life services
EXPERIENCEDWith over 27 years of service, CareSource is a leading non-profit health
insurance company
DEDICATEDWe serve over 1.8 million members through our Medicaid,
Marketplace, and Medicare Advantage Plans.
Provider Network
• Until further notice, Hoosier Healthwise and HIP will be operating as open networks.
• Any active Indiana Health Coverage Program (IHCP) provider may render covered services to a CareSource member.
• Please note that services requiring prior authorization apply to CareSource participating and non-participating providers.
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Provider Network
CareSource members choose or are assigned a primary medical provider (PMP)
upon enrollment. However, the PMP does NOT appear on the members ID card.
When referring patients, we strongly encourage other providers are in-network to
ensure coverage.
Use our Find A Doc tool at CareSource.com to help you locate a participating
CareSource provider by plan.
OUT OF NETWORK SERVICESUpon closure of our Hoosier Healthwise and HIP network, out-of-network services will
NOT be covered unless they are emergency services, self-referral services or prior
authorized by CareSource.
A provider must be enrolled as an IHCP provider to receive reimbursement for any
Medicaid services, including emergency and self-referral services.
A 45 day advance notice will be given prior to network closure.
Member ID Cards & Copayments
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Hoosier HealthwiseMember ID Cards
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HOOSIER HEALTHWISE HOOSIER HEALTHWISE + MATERNITY
HIP Member ID Cards
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HEALTHY INDIANA PLAN HIP MATERNITY
Basic Copayments
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Healthy Indiana Plan
Healthy Indiana Plan Basic & Healthy Indiana Plan State Plan Basic members are required to make the following copayments at the time services are rendered:
• $4 copayment for outpatient services, including office visits and preferred drugs
• $8 copayment for non-preferred drugs
• $8 copayment for initial non-emergent ER visit
• $25 for each subsequent non-emergency ER visit
• $75 copayment for inpatient service
Copayments at time of service for HIP Plus:
• $8 copayment for initial non-emergent ER visit
• $25 copayment for each subsequent non-emergent ER visit
NOTE: No copayment is required for preventive care, including early periodic screening, diagnostic and
testing services, or family planning services
Basic CopaymentsHoosier Healthwise
• Package C
• $3 copayment for generic, compound and sole-source prescriptions
• $8 copayment for initial non-emergent ER visit
• $10 copayment for emergency ambulance & non-emergent ambulance services
between medical facilities when requested by a participating physician
• $10 copayment for brand-name prescriptions
• $25 copayment for each subsequent non-emergent ER visit
• Package C copayment, for some services, is based on family income
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Working with CareSource
W e p a r t n e r t o m a k e d o i n g b u s i n e s s w i t h u s e a s i e r
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Claim Submissions
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ELECTRONIC DATA INTERCHANGE
CareSource currently accepts electronic claims through the clearinghouses listed below.
CLEARINGHOUSE WEBSITE PHONE
Availity (RealMed) www.availity.com 1-800-AVAILITY
Change Healthcare
(formerly Emdeon)
www.changehealthcare.com 1-800-845-6592
Quadax www.quadax.com 1-440-777-6305
Relay Health connectcenter.relayhealth.com 1-800-527-8133
NOTES• Please list your NPI number on all claims
• Please ensure you list the correct billing provider taxonomy code
• Please use member RID number
WE ENCOURAGE ELECTRONIC PAYMENTS
• Our Electronic Funds Transfer partner is InstaMed
• Health Partners must enroll with InstaMed to participate
• Find the enrollment form @ www.caresource.com and email it to
Online Claim SubmissionsProvider Portal
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Online Claim Submission continued
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1.
Select
New
Claim
4. Select
Create
2. Select
Provider 3. Select
Document
Type
Online Claim Submission (continued)
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Continue to complete each form and finish by clicking Submit.
Cultural Competency
Health partners are expected to provide services in a culturally competent manner, including:
• Removing all language barriers to service Accommodating unique cultural, ethnic, and social needs of members
• Meeting the requirements of all applicable state and federal laws
RESOURCESWe provide cultural competency training sources in the Health Partner Manual and online at CareSource.com.
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Contact our Health Partner
Services Department, at 1-844-
607-2831 to arrange for
interpreter services
PharmacyPARTNERSHIP WITH CVS
• CVS Caremark is the delegated pharmacy benefit manager for CareSource
• Phone: 1-800-364-6331
• Fax: 866-930-0019
SPECIALTY DRUGS• CVS Specialty Pharmacy provides all specialty medications
E-PRESCRIBING• Once providers are set up through CVS Caremark, they are ready to prescribe
electronically
RESOURCES• Authorization requirements for prescriptions may be found on your plan’s
Provider pages under the Pharmacy section.
• Formulary Search Tool and Prior Authorization lists are available on CareSource.com under Member Documents
• MTM (Medication Therapy Management) – allows pharmacists to work collaboratively with physicians
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Care and Disease Management
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WE CAN HELP:• Coordinate medications
• Provide education
• Arrange follow-up services
• Reduce readmission risks
PLEASE HELP by identifying
patients who may need individualized attention to help them manage their complex health care needs.
REFERRING A
PATIENTYou may refer a patient for care or
disease management in the following
ways:
CareSource.com through the
Provider Portal
1-844-607-2829
ONLINE
CALL
Covered Services
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HHW & HIP Benefits
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ENHANCED BENEFITS:
Life Services
Non-emergent transportation (additional above NET, for certain special populations)
HELP4U
Wellness & disease management
Smartphone referrals
Text4Babies
Medication therapy management
Boys & Girls Club membership (ages 6 –18) at no cost to the member
Girl Scout membership (grades K – 8) atno cost to the member
HHW & HIP BENEFITS OVERVIEW:
PCP and specialist office visits
ER services
Inpatient hospital
Mental health and substance abuse services
Urgent care
Family planning
Diagnostic services (ex: lab & radiology)
Preventative services (routine well visits and screenings)
Maternity services
Pharmacy
Transportatin
HOOSIER HEALTHWISE & HIP PLUS ONLY:
Vision services
Dental – no limitations on fillings or extractions (HIP PLUS only)
Services Not Covered
• Medically unnecessary services
• Services received from a non-network provider, unless the member has prior authorization or CareSource is operating as an open network
• Experimental or investigational services
• Alternative or complimentary medicine
• Cosmetic procedures or services
• Assisted reproductive therapy
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Resources
W e p a r t n e r w i t h r e s o u r c e s t h a t h e l p y o u n a v i g a t e t o t h e a n s w e r s y o u n e e d
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CareSource Provider Portal
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Check member eligibility and
benefit limits
Access the Provider Portal 24 hours a day, 7 days a week, at CareSource.com.
SAVE TIME. SAVE MONEY. Use CareSource’s secure online Provider
Portal.
With this tool you can:
Find prior authorization
requirements
Submit and check the status
of a prior authorization
request
Submit claims and verify
claim status
Verify or update Coordination
of Benefits information (COB)
And more!
Register for the CareSource Provider Portal
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Go to CareSource.com. On the right side of the page, click on Provider
Portal under Provider Resources
Select Indiana.
Click register here under Register for the Provider Portal.
Enter your information, including your CareSource Provider
Number (located in your welcome letter).
Follow remaining steps to register.
Health Partner Resources
Visit the CareSource.com Plan Resources page to access the following resources:
• Printable Health Partner Manual
• Printable orientation slides
• Formularies
• Covered benefits
• Quick reference guides
• And more
CareSource Provider Portal: https:providerportal.caresource.com/IN
CareSource.com/Providers
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Member Resources Page
Help your CareSource patients understand their insurance coverage.
Encourage them to visit our website, where they can access:
• Searchable online formulary
• Find a Doctor/Provider tool
• Member handbook
• Forms
• And more
CareSource.com/Members
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How to Reach Us
Provider Services 1-844-607-2831
Hours Monday to Friday
8 a.m. to 8 p.m. (EST)
Member Services 1-844-607-2829
Hours Monday to Friday
8 a.m. to 8 p.m. (EST)
Engagement Specialist
Assignments
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DENISE EDICK | 317-361-5872
[email protected], Health Partnerships
ENGAGEMENT SPECIALIST ASSIGNED COUNTIES / HEALTH SYSTEMS
MELISSA KAMEN | 317-509-2768
[email protected] Health and Suburban Health Organization
TONYA THOMPSON | 219-214-3950
Counties: Benton, Cass, Fulton, Jasper, Lake, LaPorte, Marshall, Newton, Porter, Pulaski, Starke, White
Health Systems: Franciscan & Beacon Health Systems
SUSAN SCHURMAN | 574-253-7599
Counties: Adams, Allen, DeKalb, Elkhart, Huntington, Kosciusko, LaGrange, Miami, Noble, St. Joseph,
Steuben, Wabash, Wells, Whitley
Health Systems: Parkview, Lutheran & SJRMC
TROY MCKINLEY | 765-425-5636
Counties: Bartholomew, Blackford, Decatur, Delaware, Fayette, Franklin, Grant, Henry, Jay, Madison,
Randolph, Rush, Union, Wayne
Health Systems: Community Health Network
PAULA DRYE | 317-430-2076
[email protected] Counties: Boone, Hamilton, Hendricks, Johnson, Marion, Hancock, Morgan and Shelby
AMY WILLIAMS | 317-741-3347
Counties: Brown, Carroll, Clay, Clinton, Fountain, Howard, Monroe, Montgomery, Owen, Parke, Putnam,
Tippecanoe, Tipton, Vermillion, Vigo, Warren
Health System: American Health Network & Eskanazi Health
BONNIE WAELDE | 812-454-5832
Counties: Daviess, Dubois, Gibson, Greene, Knox, Lawrence, Martin, Perry, Pike, Posey, Spencer, Sullivan,
Vanderburgh, Warrick
Health System: Deaconess & St. Vincent Health
VACANT Counties: Clark, Crawford, Dearborn, Floyd, Harrison, Jackson, Jefferson, Jennings, Ohio, Orange, Ripley,
Scott, Switzerland, Washington
Health System: KentuckyOne & Norton Health
ANGELINA WARREN | 317-658-4904
[email protected] Behavioral Health
CONTRACTING MANAGERS – HOSPITALS / LARGE HEALTH SYSTEMS
MANDY BRATTON | 317-209-4404
[email protected] HILL | 317-220-0861
Partners with Purpose
Are you contracted with all our plans? Join us on the next journey to healthy outcomes in Indiana.
Visit CareSource.com/Contracting to start the contracting process.
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Thank You!
IN-P-0276; Date Issued: 10/17/17 Date Approved: 9/20/1732
