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March 21, 2019


Residents Assigned Incorrectly to an MMA plan vs Comprehensive or LTC+ Health Plans

The final phase of the SMMC rollout occurred in February. The health plans new to the Medicaid LTC space have received new enrollees throughout the state. This process has been relatively smooth with a few items that have caused some confusion in the rollout. These items have included some health plan provider portal and claims systems alignment issues. And, what appears to be some long-term care enrollees being assigned to an MMA plan versus a comprehensive or LTC+ health plan.

Below is a breakdown of the Medicaid long-term care health plan enrollment statewide:

Please ensure eligibility has been verified on all Medicaid long-term care enrollees and assigned to one of the above health plans. If the long-term care enrollee has been assigned to an MMA plan please confirm the enrollee is ICP eligible by reviewing the aid category. The aid category indicator should begin with an MI if the resident is ICP eligible. AHCA is aware of an issue related to the health plan assignment. They are in the process of identify those that need to be reassigned to a long-term care plan, with the first batch having been reassigned effective March 1.

AHCA is indicating the MMA plan is responsible for the payment prior to March 1. If the claim is denied, AHCA needs the denial reason and claim number when filing a complaint via the AHCA website. The reason for this needed information is for AHCA to investigate and to identify further enrollees to be assigned correctly.

If you have questions, please contact Dana McHugh via email or by calling her at (850) 339-2909.

SMMC Health Plan Provider Portals - Update

Provider portals include key tools for staff members to access member eligibility, file claims, check status and file adjustments.

If your staff is having difficulty enrolling in or accessing the portal, please let me know and I will obtain assistance for them from the health plan. There have been circumstances where additional assistance was needed in the portal enrollment process due to clarification of the group contract and obtaining individual portal access.

Please ensure all applicable staff members have access to the health plans provider portals. It is simple to enroll in these portals and directions are provided on most of the health plan websites.


Claims Denials and Appeals in ACA Marketplace Plans. In this report, we analyze transparency data released by the Centers for Medicare and Medicaid Services (CMS) to examine claims denials and appeals among issuers offering individual market coverage on healthcare.gov from 2015-2017. Read more...


Avoiding Million-Dollar Medicaid Eligibility Mistakes in Nursing Facilities. Skilled nursing operators can’t control day-to-day Medicaid rates in their states, but they do have a broad toolbox that can help them avoid eligibility errors and oversights that can cause millions in losses. Read more...

Health plan updates

Simply Health – Provider Opioid Toolkit. The Opioid toolkit provides training on issues related to opioid abuse to all managed care and provider staff who address, prescribe or treat patients receiving opioids. This training helps providers manage the growth of opioid abuse and fraud. The toolkit can be accessed by clicking here.

Staywell (WellCare) Provider Portal Overview Training. Our all-new provider port is here. You have access to a portal that streamlines your work, keeps you up-to-date more than ever before and provides critical information. We have a variety of video training available, so you can learn about all the features available. Read more...

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

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