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March 7, 2019

SMMC TRANSPORTATION BENEFIT

Non-Emergent Transportation Back to Nursing Home after Hospital Stay

Recently, a FAHA H&S member experienced a frustrating situation regarding transportation for a resident returning home from a hospital stay. It was a complex issue that included a hospital refusing to coordinate transportation back to the nursing home after a hospital stay, an AHCA complaint, the transportation company billing the FAHA H&S member and all of these were unintended consequences of a health plan terminating a hospital’s contract. This issue has since been resolved and through that process we have obtained clarification on the transportation benefit.

The health plans are required to provide non-emergent transportation for their members to and from medical related services. This includes the transportation back to the nursing home after a hospital inpatient stay. Below is an excerpt from the contract between the Agency and the health plans:


The process for transportation after a hospital stay back to the nursing home is as follows: the hospital discharge planner coordinates with the Medicaid LTC health plan’s transportation company and arranges the transportation after the hospital stay back to the nursing home. This should be a seamless process that is blind to the member and the nursing home.

The health plans have contracted with transportation companies to provide the non-emergent transportation benefit.



In addition to contact numbers, LogistiCare offers providers the ability to arrange transportation via their on-line portal. Providers can create an account at https://facility.logisticare.com.

This benefit includes transportation to health-related travel such as doctors visits, picking up prescriptions, therapy, urgent care centers. Below is an excerpt from the Sunshine transportation benefit FAQ’s:


Please let me know if your staff is experiencing problems with the transportation benefit process for your residents.

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





SMMC Health Plan Provider Portals

Health plan provider portals offer many useful tools. The portals allow providers to check eligibility, request and access authorizations, submit and track claims and submit claims adjustments when necessary.

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. An example of how to enroll in a portal is provided via the provider web portal directions for Aetna Better Health.


RIPPED FROM THE HEADLINES

What Hospitals Want: How SNFs Can Break into New Payment Partnerships. Skilled nursing facility operators frequently hear about how forging hospital partnerships is essential to their success under new payment models, but the intricacies of those interactions can often be difficult to navigate. Read more...

 

New Value-Based Agreement with AmeriHealth Caritas is Bayada’s Largest Yet.  Over the past few years, Bayada Home Health Care has entered into several value-based agreements with managed care organization partners, reflective of the U.S. health care system’s broader shift from quantity to quality. Read more...

Health plan updates

Simply Health – Provider Portal Information. Simply Health web portal can be accessed via registering on their site. There is a new provider portal since the rollout of the new SMMC contract. Please register for this new portal if previously enrolled in the Simply provider portal. Registration can be completed by clicking here.


Staywell (WellCare) Provider Resource Guide – Provider Portal Information. The provider portal offers providers many useful tools: member eligibility status, request authorizations/check status, submit claims, status, submit appeals/disputes and corrected claims. Read more...

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

Copyright Information: Copies of the articles and other information in this publication may be non-commercially reproduced for the purpose of educational or scientific advancement. Otherwise, no part of this publication may be reproduced or utilized in any form, or by any means, mechanical or electronic, including photocopying, microfilm and recording, or by any information storage and retrieval system, without the written permission of the managing editor. For permission to reproduce, contact the principal/editor via email or phone at (850) 999-6034. 

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