Provider Orientation. Or togethercchp.org

Transcription

1 Provider Orientation Or togethercchp.org

2 What is Together with Children s Community Health Plan? A local health plan for individuals and families Affiliated with Children s Hospital of Wisconsin Plans for Everyone not just kids Coverage sold On Exchange and Off Exchange Offers access to high-quality health care in Southeast Wisconsin An Exclusive Provider Organization (EPO)

3 Service Area Together with CCHP is offered in the following counties: Milwaukee Washington Ozaukee Waukesha Kenosha Racine

4 Infrastructure/Operations Administrative Services Agreement with UPMC Health Plan for provider service and claims. Why UPMC Health Plan they are provider owned, experience with coverage on and off Exchange.

5 Infrastructure/Operations CCHP is responsible for: Credentialing Case Management Complaints and Appeals Provider Contracting & Relations Quality Improvement Sales and Broker support Utilization Management

6 Provider Network Please note that the Together with CCHP provider network is different from our Medicaid provider network

7 Together ID Card - front

8 Together ID Card - back

9 Together Plan Designs

10 Together Benefits Bronze, Silver, Silver Standard and Gold Plans Preventive Care Coverage Pediatric Routine Vision Prescription Drug Coverage Healthy Mom, Health Baby Provider Incentive Referrals to in-network Specialists not required Care outside of the provider network is not covered with the exception of urgent and emergency care Members receive an Evidence of Coverage which is located on our web site under Members tab

11 Pediatric Vision Avesis (Pediatric Vision only) Annual eye exam included with no cost sharing Benefit includes lenses (contacts or glasses) and frames Customer Service:

12 Prescription Drug Benefits Express Scripts Broad network of pharmacies to choose from, including Walgreens and CVS Prescription drug formulary available online Mandatory generic drug substitution Convenient mail order available $0 preventive prescriptions

13 Prescription Drug Benefits To see if the drug being prescribed is covered, pharmacists and clinical staff can: Call Together with CCHP Pharmacy Services at Refer to the Together with CCHP Pharmacy Benefit Guide which can be found on the web site at togethercchp.org/formulary

14 Together Pharmacy Benefit Guide

15 Notifications/Prior Authorization Prior authorization list available at Must submit a prior authorization request online Use your current CCHP login No retro authorizations Call with questions or refer to the Provider Manual

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17 Provider Portal

18 Registration Page

19 Provider Portal Login Page

20 Provider Portal

21 Together Provider Portal

22 Provider Forms

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24 Claim Submission File claims timely Bill on appropriate claim forms Payment made within 30 days on clean claims Hand written claims not accepted

25 Claims Submission Electronic Claims Preferred: Please submit claims electronically to Together with CCHP EDI Payer ID#: 251CC Electronic Remittance Advice (ERA) and Electronic Fund Transfers (EFT) are available forms available on web site Paper Claims: Mailing Address: Together with CCHP P.O. Box Pittsburgh, PA

26 Where to call with claims questions? For questions regarding claims and Explanation of Payment (EOP), please contact Together with CCHP Provider Service at

27 Claim Appeals Please call Provider Services to discuss claim denials prior to submitting a written appeal. To file a written appeal: Complete the Together with CCHP Provider Appeal Form, which is available on the Provider Forms page at togethercchp.org Submit the form, along with copies of any supporting documentation to: Together with CCHP ATTN: Appeals Department P.O. Box 1997, MS 6280 Milwaukee, WI

28 Grace Period If member is terminated due to lack of payment Claims are paid for days 1-30 Claims paid during days days will be recouped

29 Provider Updates For Provider demographic changes complete the Provider Update/Change Form available on our web site. Examples: TIN change Address change Billing address change

30 Together with CCHP Reference Guide

31 & Contact Information Send us your and contact information for future updates and news. Send s to

32 Questions?