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February 21, 2019

MEDICARE ADVANTAGE PROCESS EXPECTATIONS – NOMNC TIMELY RESPONSE

Medicare Advantage Plans Review Requirements and Expectations

The Medicare Advantage plans are highly regulated with stringent reporting requirements via their contract with the federal government. Because of these requirements the health plans are diligent about requesting data and responses in a timely fashion. One such requirement, is the NOMNC (Notice of Medicare Non-Coverage) completed form that must be delivered to beneficiaries receiving covered skilled nursing services at lease two calendar days prior to the Medicare covered services ending.

The health plans send the completed NOMNC to the skilled nursing facilities to obtain the signature and send back to them. The health plans are required to demonstrate the NOMNC process is completed timely and within the requirement standards. According to a Florida Medicare Advantage health plan medical director, “they have terminated skilled nursing facilities who repeatedly do not comply timely with the NOMNC requirement”. Please consider reviewing your NOMNC process and implementing process improvement steps where necessary to comply timely.

Additionally, this medical director indicated another area for the SNF to consider reviewing internal processes is the timely response to the QIO process. He indicated some SNFs are struggling to respond in the required time allowed for this process especially on weekends. The Medicare beneficiary can appeal the discharge from services through the QIO process. When the beneficiary appeals the decision the skilled nursing facility is required to submit complete medical records to the QIO the next day.



Statewide Medicaid Managed Care Continuity of Care Information

There have been several questions recently related to continuity of care with the shifting Medicaid LTC membership. Some health plans and AHCA have provided additional guidance to assist and ensure claims are paid timely during the transition. Below is the information provided by AHCA health plan continuity of care:

SMMC Plan Website Links with Continuity of Care Information

Aetna

https://www.aetnabetterhealth.com/florida/providers/

CCP

https://www.ccpcares.org/providers/providers-for-mma/provider-services

CMS Plan

http://www.floridahealth.gov/programs-and-services/childrens-health/cms-plan/updates-events/index.html

Florida Community Care

https://fcchealthplan.com/

Humana

http://apps.humana.com/marketing/documents.asp?file=2520076

Lighthouse

https://lighthousehealthplan.com/en/

Magellan

https://magellancompletecareoffl.com/for-providers/continuity-of-care-provisions/

Miami Children's

https://www.miamichildrenshealthplan.com/

Molina

https://www.molinahealthcare.com/members/fl/en-US/Pages/home.aspx

Positive

https://positivehealthcare.net/florida/phc/about/coc/

Prestige

https://prestigehealthchoice.com/provider/index.aspx#continuity

Simply

https://www.simplyhealthcareplans.com/florida-provider/home

Staywell

https://www.wellcare.com/Florida/Providers/Bulletins

Sunshine

https://www.sunshinehealth.com/content/dam/centene/Sunshine/pdfs/EIS-TCM-billing-guidelines.pdf

United

https://www.uhcprovider.com/en/health-plans-by-state/florida-health-plans/fl-comm-plan-home.html

https://www.uhcprovider.com/en/health-plans-by-state/florida-health-plans/fl-comm-plan-home/fl-cp-prior-auth.html

Vivida Health

https://vividahealth.com/en/

Dental Plan Website Links with Continuity of Care Information

DentaQuest

http://dentaquest.com/state-plans/regions/florida/fl-dentist-page/

Liberty

https://client.libertydentalplan.com/FLMedicaid/Provider/FAQ

MCNA

https://www.mcnafl.net/dentists/

 

If you are having problems accessing the health plans provider portals or electronic claims systems, please contact Dana McHugh via email or by calling her at (850) 339-2909.

 

 

 


RIPPED FROM THE HEADLINES

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Drive to Home, Medicare Changes Are Creating More Integrated Senior Care - In the years to come, cross-continuum collaboration and the formation of integrated care delivery models that keep people away from the hospitals will be the main catalysts for lowering U.S. health care spending. For senior housing, assisted living and independent living providers, in particular, that makes establishing relationships with home-and-community based partners all the more important. Read more...

Health plan updates

Update Your Information - FCC’s provider manual is offered as a reference guide to assist with many items including information on how to file claims and enroll in the provider portal. Read more...

 

UnitedHealthcare Network Bulletin, February 2019 - Front and Center. Stay up to date with the latest news and information. Read more...

Copyright 2019 — Publication of FAHA H&S
Chair: Brian Robare
President/CEO: Steve Bahmer
Principal/Editor: Dana McHugh

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