FLORIDA UPDATES EVELYN LEADBETTER, MPA NETWORK SERVICES MANAGER - - PowerPoint PPT Presentation

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FLORIDA UPDATES EVELYN LEADBETTER, MPA NETWORK SERVICES MANAGER - - PowerPoint PPT Presentation

Apr 01, 2024 221 likes •398 views

FLORIDA UPDATES EVELYN LEADBETTER, MPA NETWORK SERVICES MANAGER HOMETOWN HEALTH TRANSITION TO CVS/CAREMARK Effective March 1, 2017 Coventry Health Care of Florida, Inc/Aetna Better Health of Florida Pharmacy Benefits Manager (PBM) 60

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SLIDE 1

FLORIDA UPDATES

EVELYN LEADBETTER, MPA NETWORK SERVICES MANAGER HOMETOWN HEALTH

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TRANSITION TO CVS/CAREMARK

Effective March 1, 2017

 Coventry Health Care of Florida, Inc/Aetna Better Health of Florida

Pharmacy Benefits Manager (PBM)

 60 day continuity of care period (May 1, 2017)  The pharmacy claim processing information to CVS/Caremark for Aetna

MMA Plan is noted below:

RXBIN: 610591

RXPCN: ADV

RXGRP: RX8840

Member ID Format: 11-14 digits

 https://ahca.myflorida.com/Medicaid/statewide_mc/pdf/mma/Continuity_of

_Care_Requirements.pdf

 CVS/Caremark Pharmacy Help Desk: 1-866-693-4445  Aetna MMA plan: 1-800-441-5501

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CMS STREAMLINES ICD-10 RESOURCES

 Now phasing out the Road to 10 site, with an

anticipated completion date of April 3.

 Please be sure to update all your bookmarks and links

for Roadto10.org to point to cms.gov/ICD10.

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SLIDE 4

FIVE-YEAR WAIVER RENEWAL AND PUBLIC NOTICE

1915(c) Adult Cystic Fibrosis (ACF) Waiver

(FL.0392)

1915(c) Traumatic Brain and Spinal Cord Injury

(TBI/SCI) Waiver (FL.0342) Through March 28, 2017 You can view the full waiver renewal requests at the following link: http://ahca.myflorida.com/Medicaid/Policy_and_Qual ity/Policy/federal_authorities/federal_waivers/index.s html

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OPEN DOOR FORUM

 As a reminder, the remaining open door forums will be

held at the following times:

 Tuesday, March 28, 2017: Benefit Enhancements

Overview

 Tuesday, April 11, 2017: Overview of Population-

Based Payments and All-Inclusive Population-Based Payments

 Tuesday, April 15, 2017: Deep Dive:

Completing Your Next Generation ACO Model Participant List

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MARCH IS NATIONAL KIDNEY MONTH

1 in 3 American adults is at risk for kidney disease. Medicare Part B covers preventive screening tests that help detect diabetes and high blood pressure - 2 conditions that may lead to kidney damage. Visit Medicare.gov/coverage/preventive- and-screening-services.html for more information. Medicare Part B also covers up to 6 sessions of kidney disease education services if a person has Stage IV chronic kidney disease that will usually require dialysis or a kidney

  • transplant. For more information,

visit Medicare.gov/coverage/kidney-disease-edu.html.

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SOCIAL SECURITY NUMBER REMOVAL INITIATIVE: CLICK HERE FOR NEW DETAILS Find provider information including:

  • What does the Social Security Number

Removal Initiative (SSNRI) mean for providers?

  • How will providers get patients' MBIs?
  • How you can help your patients
  • Eligibility transaction responses
  • When and how providers use MBIs?
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STATEWIDE MEDICAID MANAGED CARE PHARMACY NETWORK STANDARDS

  • Plans must now have pharmacy providers

available within 30 minutes and 20 miles of their enrollees’ residences.

  • Summer 2017: standards to require plans to

have a pharmacy available within 15 minutes and 10 miles of enrollees’ residences

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REMINDER:

Live Open Payments Question & Answer Session

  • n the Open Payments Data Correction Period

Wednesday, April 12th: 1:00 - 2:00 p.m. (ET).

To ask a question: Go online and register here by 12:45 p.m. (ET). After you register, you will receive an email with how to join the call and ask a question. To listen only: Call 1-844-396-8222 and enter the meeting number (907 076 877) when prompted.

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REMINDER:

New PASRR Forms Effective March 29th

  • Preadmission Screening and Resident Review (PASRR)

Level I Screen, MedServ Form 004 Part A, effective March 2017.

  • Resident Review – Evaluation Request form, MedServ Form

004 Part A1, effective March, 2017. These forms are available for preview before the effective date above on AHCA’s Rules Web Site, and will be posted on AHCA’s PASRR Web Site when they are effective.

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REMINDER:

FloridaHealthFinder.gov Webinar Please register for the FloridaHealthFinder.gov webinar: Friday, March 24, 2017 at 10:00 a.m. ET: https://attendee.gotowebinar.com/register/595211751797 3182467

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MEET VA’S OFFICE OF TRIBAL GOVERNMENT RELATIONS

Click here to register for today’s webinar 03/22/2017 @ 2:00pm Eastern In this panel discussion, you’ll learn:

  • How does VA’s Office of Tribal Government

Relations help connect tribal communities to services for Veterans?

  • Who is my VA regional tribal relations specialist?

How do I contact them?

  • What successful VA-tribal activities are taking

place in VA’s regions right now? What is planned for the future? https://www.va.gov/tribalgovernment/

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PRESTIGE PROVIDER TRAINING SCHEDULE

Click here to access the links associated with the Prestige Provider Training and Education

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SLIDE 14

STAYWELL/WELLCARE

Monthly Webinar Information News & Events

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SLIDE 15

SUNSHINE HEALTH NEWS

Provider Resources

Click here for full training flyer

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WEBINAR INFORMATION

HomeTown Health Florida Medicaid Information:

http://hthu.net/florida/