CareSource I H C P 2 0 1 7 A n n u a l S e m i n a r 101 1 - PowerPoint PPT Presentation

CareSource I H C P 2 0 1 7 A n n u a l S e m i n a r 101 1

Agenda About CareSource Member ID Cards & Copayments Working with CareSource Covered Services Resources 2

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 4

Health Care With Heart MISSION FOCUSED Comprehensive, member-centric health and life services EXPERIENCED With over 27 years of service , CareSource is a leading non-profit health insurance company DEDICATED We serve over 1.8 million members through our Medicaid, Marketplace, and Medicare Advantage Plans. 5

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. 6

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 SERVICES Upon 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. 7

Member ID Cards & Copayments 8

Hoosier Healthwise Member ID Cards HOOSI SIER ER HEALTH THWISE WISE HOOSI SIER ER HEALTH THWISE WISE + MATERN RNITY TY 9

HIP Member ID Cards HEALTH THY Y INDIA DIANA NA PLAN HIP MATERN RNITY 10

Basic Copayments 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 11

Basic Copayments Hoosier 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 12

Working with CareSource We 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 wi t h u s e a s i e r 12

Claim Submissions ELECTRONIC DATA INTERCHANGE CareSource currently accepts electronic claims through the clearinghouses listed below. CLEARINGHOUSE WEBSITE PHONE www.availity.com 1-800-AVAILITY Availity (RealMed) www.changehealthcare.com 1-800-845-6592 Change Healthcare (formerly Emdeon) www.quadax.com 1-440-777-6305 Quadax connectcenter.relayhealth.com 1-800-527-8133 Relay Health 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 support@instamed.com 14

Online Claim Submissions Provider Portal 15

Online Claim Submission continued 1. Select New Claim 2. Select Provider 3. Select Document Type 4. Select Create 16

Online Claim Submission (continued) Continue to complete each form and finish by clicking Submit. 17

Cultural Competency Health partners are expected to provide Contact our Health Partner services in a culturally competent manner, Services Department, at 1-844- including: 607-2831 to arrange for • Removing all language barriers to service interpreter services Accommodating unique cultural, ethnic, and social needs of members • Meeting the requirements of all applicable state and federal laws RESOURCES We provide cultural competency training sources in the Health Partner Manual and online at CareSource.com. 18

Pharmacy PARTNERSHIP 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 19

Care and Disease Management REFERRING A WE CAN HELP: PATIENT • Coordinate medications You may refer a patient for care or • Provide education disease management in the following ways: • Arrange follow-up services ONLINE • Reduce readmission risks CareSource.com through the Provider Portal PLEASE HELP by identifying CALL patients who may need individualized attention to help them manage their 1-844-607-2829 complex health care needs. 20

Covered Services 121

HHW & HIP Benefits HHW & HIP BENEFITS OVERVIEW: ENHANCED BENEFITS:  PCP and specialist office visits  Life Services  ER services  Non-emergent transportation (additional  Inpatient hospital above NET, for certain special populations)  Mental health and substance abuse services  HELP4U  Urgent care  Wellness & disease management  Family planning  Smartphone referrals  Diagnostic services (ex: lab & radiology)  Text4Babies  Preventative services (routine well visits and  Medication therapy management screenings)  Boys & Girls Club membership (ages 6 –  Maternity services  18) at no cost to the member Pharmacy  Girl Scout membership (grades K – 8) at  Transportatin no cost to the member HOOSIER HEALTHWISE & HIP PLUS ONLY:  Vision services  Dental – no limitations on fillings or extractions (HIP PLUS only) 22

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 23

Resources We p a r t n e r wi 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 we r s y o u n e e d 20

CareSource Provider Portal SAVE TIME. SAVE MONEY. Use CareSource’s secure online Provider Portal. With this tool you can:  Check member eligibility and Submit claims and verify benefit limits claim status  Find prior authorization Verify or update Coordination requirements of Benefits information (COB) Submit and check the status  of a prior authorization And more! request Access the Provider Portal 24 hours a day, 7 days a week, at CareSource.com. 25

Register for the CareSource Provider Portal 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. 26

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 27

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 28