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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.
If you have questions, please contact Dana McHugh via email or by calling her at (850) 339-2909.
SMMC Health Plan Provider Portals - Update
RIPPED FROM THE HEADLINES
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.
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