Having trouble reading this newsletter? Click HERE to view it in your browser.

April 18, 2019

MEDICARE ADVANTAGE PLANS AND NOMNC PROCESS

NOMNC Process Training and Review

The health plans are providing additional training and clarification on the NOMNC process to FAHA H&S members. Last week, Florida Blue provided a NOMNC training session with a FAHA H&S member. This training addressed Florida Blue’s NOMNC policy as well as an agreement to improved communication and accountability processes. Because this session was considered successful, Florida Blue has offered to repeat the training session for all FAHA H&S members. We are in the process of scheduling this session and will send out an invitation in the coming weeks.

Freedom Health/Optimum is reviewing each skilled nursing facility participating in their network to identify those struggling with Plan and/or regulatory guidelines and communications. Issues may include timeliness of initial evaluations and updates, correctly issuing NOMNC letters as well as communication issues between the Plan and facility staff.

If identified, they may send a Notice of Concern letter stating they’ve found deficiencies in the compliance of these policy or processes. The letter will explain the specific issue that requires attention and potentially correction. Freedom has reiterated their intention to work closely with the provider to ensure assistance with any challenges in process or communication. They are interested in working together to ensure quality of care for their Medicare advantage members. A group training on Freedom/Optimum’s NOMNC and other communication processes has been requested. A webinar invitation will be sent to the FAHA H&S members as soon as the training has been scheduled.

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






Medicaid Provider Enrollment Policy and Process in One Reference Document

On Friday, April 12, 2019, AHCA held a public meeting at the Agency headquarters regarding their intention to compile all the existing Medicaid provider enrollment policy into one document. Previously, the Medicaid enrollment policy information could be found in multiple areas organized by provider or service type. The purpose of this new format is to provide the information in one location for ease of use. Providers are encouraged to submit comments on the new format.


RIPPED FROM THE HEADLINES

Centene, WellCare deal Raises Antitrust Questions Centene Corp.’s proposed $17.3 billion acquisition of WellCare Health Plan would make Centene the third-largest publicly traded managed care provider, according to S&P Global Market Intelligence’s analysis of membership data. Read more...

 

Medicaid Plan Complaint Process. All Medicaid health and dental plans have a provider complaint system to allow providers to dispute plan policies, procedures, or any aspect of a plan’s administrative functions, including proposed actions, claims/billing disputes, and service authorizations. Read more...

Health plan updates

Network NewsBrief. When all providers are on the same page, patients win. Care continuity and coordination has been linked to improved care outcomes, lower costs and a better overall patient experience. Learn more here…


BayCarePlus Medicare Advantage Provider Portal
As a provider and medical professional, the BayCarePlus provider portal offers easy access to information related to member eligibility, claims status, authorizations and 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. 

The information provided via this newsletter is provided “as is” without representations or warranties, express or implied. LeadingAge Florida makes no representations or warranties in relation to the legal information on this website.