ValueOptions Presents: Colorado Medicaid eligibility and YOU. Presenter: Amie Adams, LMFT Director of Clinical Services, Value Options Colorado

Transcription

1 ValueOptions Presents: Colorado Medicaid eligibility and YOU Presenter: Amie Adams, LMFT Director of Clinical Services, Value Options Colorado 1

2 Topics Authorizations and Eligibility Expectations for Provider Verification of Eligibility How to determine Medicaid Eligibility and BHO Participation Using Provider Connect to Verify Eligibility Using the Department of Health Care Policy and Financing (HCPF) Eligibility Website System issues and eligibility 2

3 Eligibility The first step in the authorization process is determining member eligibility and assuring that they are assigned to our Behavioral Health Organization (Foothills Behavioral Health Partners, Northeast Behavioral Health Partnership or Colorado Health Partnerships You can check eligibility 24/7 on Provider Connect, and it is expected that you are verifying eligiblity prior to requesting authorization. 3

4 4 Authorization is dependent on eligibility Members with Medicaid have fairly frequent changes to eligibility. Members must show as eligible in the CO Web Portal AND as assigned to our BHO to be considered eligible. We recommend that you check eligibility prior to each service. Eligibility can be verified through Provider Connect

5 Provider expectations eligibility Verify Medicaid eligibility prior to start of treatment Understand how to check eligibility Verify Medicaid eligibility prior to each service Understand where to refer members if their Medicaid becomes ineligible Understand the connection between eligibility and authorization Without eligibility- an authorization becomes meaningless

6 Colorado Medicaid Eligibility Eligibility is based on where a member lives. For children, this is based on where the parent/guardian lives. If a member moves, they need to re-apply for Medicaid. Value Options doesn t have control over a member s eligibility. We are dependent upon checking the member s eligibility status per the State information, just like providers. To apply or re-apply for Medicaid, members need to go to their local Department of Human Services for the county they reside in. Medicaid members often have frequent changes in eligibility- they have to periodically submit paperwork to DHS to verify their eligibility. Eligibility can change based on income or if paperwork is not submitted. If a member is ineligible, VO cannot authorize services. If a member moves to an area and is re-assigned to another BHO, VO will refer you to the new BHO (CO Access or BHI) for authorizations.

7 What is Provider Connect? (Provider Online Services) ProviderConnect is an online tool where providers can: Verify Member eligibility View Authorizations Request Authorizations Submit Claims View Claim Status Access Provider Summary Voucher Access and Print Authorization Letters Submit inquiries to Customer Service Submit updates to provider demographic information Access and print forms Increased convenience & decreased administrative burden! 7

8 ProviderConnect Benefits What are the benefits of ProviderConnect? Free, online, secure application Easily access routine information 24 hours a day, 7 days a week Complete multiple transactions in a single sitting View and print information Reduce calls for routine information 8

9 How to Access ProviderConnect? All In Network providers will be able to obtain online registration per provider ID number via the website To obtain additional logons for ProviderConnect contact the ValueOptions EDI Helpdesk at (888) and press option 3, Monday thru Friday, 8a.m. 6 p.m. EST The turn around time for additional logons is 48 hours 9

10 Eligibility on Provider Connect

11 Provider Connect Eligibility

12 Provider Connect Eligibility

13 Eligible or Not Eligible: How to determine Medicaid Eligibility Methods to determine if a recipient is Medicaid eligible : Use Provider Connect Call Value Options 24/7 HCPF (Department of Health Care Policy and Financing) Eligibility Website Call HCPF (Colorado Department of Health Care Policy and Financing) (303) (800) TTY: (303)

14 What is HCPF? The Department of Health Care Policy and Financing (HCPF) administers the Medicaid and Child Health Plan Plus (CHP+) programs as well as a variety of other programs for Colorado's low income families, the elderly and persons with disabilities. The HCPF website has information useful to both consumers and providers of mental health services: It has a public section with general information and guidelines, accessible to everybody It has a secure section with very specific information to providers:

15 HCPF Main Website

16 HCPF Eligibility Verification Page

17 How to Verify Eligibility Under Client Details Check Address: is it correct? Check County Does it match address? Under Client Eligibility Details Does the Eligibility Status = Eligible? Does the Eligibility Benefit Date period cover the DOS (Dates of Service)? Under Prepaid Health Plan Do the dates cover the DOS (Dates of Service)? Who is the MHPROV (Mental Health Provider)? To be eligible, a member must show with Eligible status in the Web Portal AND be assigned to one of the VO BHO s (Foothills Behavioral Health Partners, Colorado Health Partnerships, Northeast Behavioral Health Partnership)

18 Pitfalls and Things to Look For Look for more than the words ELIGIBLE The Web Portal can only provide eligibility for dates of service 364 days earlier than the current date Try to search with the Member ID number and DOB, if possible Searching with name and any other info could cause inaccurate results (typos, misspellings). Be careful to note the message/response from the Web Portal, often you will see an error message Ineligible or Not Insured/Not Found. QMB Medicaid member has Medicaid only to pay for Medicare copays

19 Examples Other things you may see in Web Portal The Web Portal is used by providers from all different types of disciplines, for many services a Medicaid member may receive. Therefore, many things listed there are more salient to physical health. An example is shown below. ACC information pertains to a program designed to manage services for physical healthcare issues.

20 Examples continued

21 Summary of HCPF Website Content Many strange things can be found Some make sense and some do not The contents can fluctuate day to day and hour to hour When researching note the Guarantee Number on the HCPF screen HCPF is not always the problem Client information not updated after changing residences Some counties are slow to acknowledge changes Information has to be entered in multiple computer systems before it will reflect a change on the Web Portal

22 Guarantee Number

23 Questions?

24 Thank you for attending!