Home Health and Hospice
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1 Home Health and Hospice
2 Overview Eligibility Fee Schedule Prior Authorizations Resources Enrollment 2
3 3 Eligibility
4 Participant Eligibility Why check eligibility? To verify that participant has Medicaid coverage on date of service. To review participant s eligibility plan and coverage. Note: A Medicaid card does not guarantee current Medicaid coverage. 4
5 Verifying Eligibility Three ways to check eligibility: MACS Medicaid Automated Customer Service 1(866) HIPAA compliant vendor software Health PAS-OnLine Trading Partner To obtain eligibility information, submit any two pieces of identifying information from the following list: Medicaid ID number (10 digits add three zeroes to the beginning if the MID is only seven digits) Social Security Number (SSN) Last Name, First Name Date of Birth 5
6 Trading Partner Account 6
7 7 Patient Roster
8 Patient Roster Build Roster Two pieces of identifying information required; MID and DOB recommended 8
9 9 Patient Roster
10 Verifying Eligibility Trading Partner Eligibility 10
11 Verifying Eligibility Trading Partner Eligibility Two pieces of identifying information required; MID and DOB recommended 11
12 Verifying Eligibility Trading Partner Eligibility 12
13 13 Verifying Eligibility
14 Coverage Medicaid offers several coverages that are aligned with health needs and include an emphasis on prevention and wellness. Coverage codes: Basic Coverage Enhanced Coverage (includes Katie Beckett) Pregnant Women Coverage (PW) Medicare Co-insurance & Deductible (QMB) Part B Premium Coverage (SLMB) MMCP Coverage 14
15 Coverage Basic Coverage The Medicaid Basic Coverage type is for healthy, lowincome children, and adults with eligible dependent children. Provides complete health, prevention, and wellness Note: Most Medicaid participants will be enrolled with this coverage type. Visit for list of detailed services covered by each Medicaid plan. 15
16 Coverage Basic Plan Example 16
17 Coverage Enhanced Plan The Medicaid Enhanced Coverage type is for participants with disabilities or special health needs. Includes all benefits in Basic Coverage, plus additional benefits: o Nursing Facility o ICF/ID o Private Duty Nursing o Home & Community Based Waiver Services o Service Coordination Many of the services in this plan have medical eligibility and prior authorization requirements 17
18 Coverage Enhanced Plan Example 18
19 Coverage The Pregnant Women (PW) program is for pregnancy-related services only. Pregnant Women Program This coverage ends on the last day of the month in which the 60 th day after delivery occurs Women have access to prenatal and postpartum care, including: o Normal prenatal services o Nutrition counseling o Risk reduction follow-up o Social service counseling o Chiropractic and physical therapy services o Family planning, including sterilization w/consent o Dental coverage 19
20 Coverage PW Program Example 20
21 Coverage Medicaid and Medicare Not everyone qualifies for regular Medicaid, but they may be eligible for Qualified Medicare Beneficiary (QMB) programs where Medicaid helps pay for Medicare costs including: Monthly Medicare premiums Medicare co-insurance Medicare deductibles 21
22 Coverage QMB Example 22
23 Coverage Specified Low-Income Medicare Beneficiary Program What expenses does SLMB cover? Specified Low-Income Medicare Beneficiary (SLMB) Medicare Part B premium only Note: No Medicaid coverage for services. 23
24 Coverage SLMB Example 24
25 Coverage Medicare and Medicaid Eligible What expenses are covered for participants who are fully eligible for both Medicare and Medicaid? Medicare covered services Medicaid covered services 25
26 Coverage Medicare and Medicaid Eligible Example 26
27 Coverage Medicare-Medicaid Coordinated Plan The Medicare-Medicaid Coordinated Plan (MMCP) is for participants who are 21 years old or older, enrolled in Medicare Part A and Part B, eligible for full Medicaid, and reside in an MMCP coverage area. Participants voluntarily enroll in MMCP; after the participant is selected as part of the plan, it is administered by Blue Cross of Idaho. Note: Once a participant is on MMCP, they can choose to revert back to Medicare and Medicaid. 27
28 Coverage MMCP Example 28
29 29 Home Health
30 Home Health Medicaid covered services include: Skilled nursing Home Health aide Physical, occupational, and speech-language pathology therapies Durable Medical Equipment Idaho requires that all enrolled home health agencies are first enrolled with Medicare. Note: All home health services are provided in the participant s residence. 30
31 Home Health Refer to the Provider Handbook - Agency Institutional for additional information to include but not limited to: Participant eligibility Limits Prior authorizations Plan of Care Medical equipment and supplies 31
32 32 Hospice
33 Hospice Hospice agency is responsible for management and coordination of the Plan of Care Hospice agency is responsible to inform other providers the participant is eligible for hospice Participant may elect or revoke hospice services at any time during the benefit period. 33
34 Hospice Refer to the Provider Handbook - Agency Institutional for additional information to include but not limited to: Participant eligibility Hospice election and recertification Prior authorization for Skilled Nursing Room and Board Covered services and restrictions 34
35 35 Claims Submission
36 36 Claim Submission Methods
37 Patient Roster Submit Claim 37
38 Claim Submission Institutional (UB04) Claim 38
39 Claim Submission Coordination of Benefits 39
40 Claim Submission Institutional (UB04) Claim 40
41 41 Fee Schedule
42 42 Fee Schedule
43 43 Fee Schedule
44 44 Home Health Fee Schedule
45 45 Hospice Fee Schedule
46 46 Authorizations
47 47 Authorization Status
48 Authorization Status Search 48
49 Authorization Status Details 49
50 50 Did You Know?
51 Did You Know? Announcements & IRs 51
52 Did You Know? Provider Handbook 52
53 Did You Know? Fee Schedules 53
54 Did You Know? Fee Schedules 54
55 Did You Know? MedicAide Newsletters 55
56 Did You Know? MedicAide Newsletter 56
57 Did You Know? User Guides 57
58 Did You Know? Training 58
59 Did You Know? Training 59
60 Did You Know? Training Opportunities Monthly WebEx Trainings Available to all providers Calendar is located at Regional Workshops Yearly Information will be posted to Individual Training or Questions Contact your local Provider Relations Consultant 60
61 61 Enrollment and Maintenance
62 Enrollment/Maintenance Be sure to keep your information up to date. Current contact Mailing/W9/physical addresses Adding and terming rendering providers Adding and terming service locations Change of ownership 62
63 63 Enrollment/Maintenance
64 Enrollment/Maintenance Maintenance 64
65 Provider Maintenance Maintenance is required when any information changes: Address Add, term, update service locations Rendering or service provider changes Name changes Change in ownership Note: Contact updates are made through Maintenance Demographic. 65
66 66 Maintenance Forms
67 Maintenance Forms General Category 67
68 Tips Use current forms Complete all sections of the form use N/A when appropriate Utilize the Provider Enrollment Requirements document in the Provider Handbook for type and specialty information, as well as additional requirements New W9 for 1099 changes W9 name and tax ID must match IRS records Update provider credentials (licenses, certifications, insurance, etc.) 68
69 Tips License Updates Updated Credentials: License As long as there are no changes to information, license updates are not required if you are licensed with the following: Idaho State Board of Nursing Idaho State Board of Medicine Idaho State Board of Pharmacy 69
70 Tips Provider Maintenance The Molina Medicaid website ( has the following resources: o Provider Enrollment - Verifying Enrollment Application Status o Provider Handbook o User Guides Contact Molina at 1 (866) or idproviderenrollment@molinahealthcare.com for assistance with enrollment or maintenance 70
71 Provider Relations Consultants Region 1 and the state of Washington 1 (208) Region.1@MolinaHealthCare.com Region 2 and the state of Montana 1 (208) Region.2@MolinaHealthCare.com Region 3 and the state of Oregon 1 (208) Region.3@MolinaHealthCare.com Region 4 and all other states 1 (208) Region.4@MolinaHealthCare.com Region 5 and the state of Nevada 1 (208) Region.5@MolinaHealthCare.com Region 6 and the state of Utah 1 (208) Region.6@MolinaHealthCare.com Region 7 and the state of Wyoming 1 (208) Region.7@MolinaHealthCare.com 71
72 Thank you for attending our Home Health and Hospice Training. Please take a few minutes to complete the evaluation. This provides us with valuable information for future trainings. 72
Home Health and Hospice
Home Health and Hospice Overview Eligibility Fee Schedule Prior Authorizations Resources Enrollment 2 Eligibility Participant Eligibility Why should you check eligibility? To verify a participant has Medicaid
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