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

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CareSource 101

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 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.

Provider Network

• Until further notice, Hoosier Healthwise and HIP will be
• perating 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 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.

Member ID Cards & Copayments

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Hoosier Healthwise Member ID Cards

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HOOSI SIER ER HEALTH THWISE WISE HOOSI SIER ER HEALTH THWISE WISE + MATERN RNITY TY

HIP Member ID Cards

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HEALTH THY Y INDIA DIANA NA PLAN HIP MATERN RNITY

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 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

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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

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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

support@instamed.com

Online Claim Submissions

Provider Portal

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Online Claim Submission continued

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• 4. Select

• 2. Select

• 3. Select

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

RESOURCES

We provide cultural competency training sources in the Health Partner Manual and

• nline at CareSource.com.

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Contact our Health Partner Services Department, at 1-844- 607-2831 to arrange for interpreter services

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

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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 PATIENT

You 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) at no 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

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

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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

• f a prior authorization

request Submit claims and verify claim status Verify or update Coordination

• f Benefits information (COB)

And more!

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 

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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DENI NISE EDIC ICK | 317-361-5872

denise.edick@caresource.com Manager, Health Partnerships

ENGAG AGEME MENT NT SPECI CIAL ALIST ASSIGNED D COUN OUNTIE TIES / HEAL ALTH TH SYSTEMS MS MELISS ISSA A KAMEN | 317-509-2768

melissa.kamen@caresource.com IU Health and Suburban Health Organization

TONY NYA A THOMPSON OMPSON | 219-214-3950

tonya.thompson2@caresource.com Counties: Benton, Cass, Fulton, Jasper, Lake, LaPorte, Marshall, Newton, Porter, Pulaski, Starke, White Health Systems: Franciscan & Beacon Health Systems

SUSAN AN SCHU HURMAN RMAN | 574-253-7599

susan.schurman@caresource.com Counties: Adams, Allen, DeKalb, Elkhart, Huntington, Kosciusko, LaGrange, Miami, Noble, St. Joseph, Steuben, Wabash, Wells, Whitley Health Systems: Parkview, Lutheran & SJRMC

TROY Y MCK CKIN INLEY Y | 765-425-5636

troy.mckinley@caresource.com Counties: Bartholomew, Blackford, Decatur, Delaware, Fayette, Franklin, Grant, Henry, Jay, Madison, Randolph, Rush, Union, Wayne Health Systems: Community Health Network

PAUL ULA A DRYE YE | 317-430-2076

paula.drye@caresource.com Counties: Boone, Hamilton, Hendricks, Johnson, Marion, Hancock, Morgan and Shelby

AMY WILLIAM IAMS | 317-741-3347

amy.williams@caresource.com Counties: Brown, Carroll, Clay, Clinton, Fountain, Howard, Monroe, Montgomery, Owen, Parke, Putnam, Tippecanoe, Tipton, Vermillion, Vigo, Warren Health System: American Health Network & Eskanazi Health

BONN NNIE IE WAELDE | 812-454-5832

bonnie.waelde@caresource.com Counties: Daviess, Dubois, Gibson, Greene, Knox, Lawrence, Martin, Perry, Pike, Posey, Spencer, Sullivan, Vanderburgh, Warrick Health System: Deaconess & St. Vincent Health

VACAN ANT

Counties: Clark, Crawford, Dearborn, Floyd, Harrison, Jackson, Jefferson, Jennings, Ohio, Orange, Ripley, Scott, Switzerland, Washington Health System: KentuckyOne & Norton Health

ANGELIN INA WARR RREN N | 317-658-4904

angelina.warren@caresource.com Statewide Behavioral Health

CONTRACT ONTRACTIN ING MANAG AGERS RS – HOSPITAL PITALS / LARGE HEAL ALTH TH SYSTEMS MS MAND NDY Y BRATT TTON ON | 317-209-4404

mandy.bratton@caresource.com

TENI NISE HILL | 317-220-0861

tenise.hill@caresource.com

Partners with Purpose

Are you contracted with all our plans? Join us

• n 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: 9/20/17

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