Acronyms
What does OHI stand for?
Other Health Insurance
If member does not provide written or verbal consent to an informal caller, what information can be discussed if any?
General information only.
What plan(s) can change MCO only within the first 90 days of enrollment?
CHIP or CHIP Perinate
Note: HCMS OCS Training Manual pg. 8
Who is CHIP Perinate for?
Pregnant women who can’t get Medicaid and don’t have any other health coverage.
For the STAR+Plus IDD plan, what services will Wellpoint cover?
Acute Care Services Only
Note: HCMS Training Document pg. 21
CTD pg. 46
**LIDDA can assist with LTC services. You can use the LIDDA resource to locate the ph. # for each county**
What does IDD stand for?
Intellectual or Developmental Disability
To HIPAA verify a provider, what information needs to obtain from the caller?
Caller's FIRST NAME & FIRST INITIAL OF LAST NAME, name of provider office/business, and National Provider Identifier (NPI) number; tax id# as secondary.
If a member is not showing eligible in Facets. Where should the member be referred to?
TX Enrollment Broker MAXIMUS
Note: Refer to CTD pg. 22
Can the Case Managment Dept services the STAR and CHIP members and what page in the CTD can this information be found?
Yes, on pg. 12 of CTD
Note: CMs will only service STAR, Non-Dual STAR Plus, CHIP and CHIP Perinate members.
Who determines if member is approved for the SPW plan (HCBS Program) and what is the name of the form that reflects the approval?
The State/Medicaid/Local Authorities determines if member is approved, and the Form is the H2065D-A
What does MPU stand for?
Member Privacy Unit
What are examples of documents and/or forms a caller can provide to be listed as a member's formal representative?
POA, Guardianship, HIPAA Member Authorization Form. (Legal court documents)
If a member under STAR, STAR+Plus or STARKids disenrolls by January 15th. When will the disenrollment take effect?
February 1st
Note: HCMS OCS Training Manual pg. 8
For the Medicaid for Breast and Cervical Cancer (MBCC) Program, how often is proof needed to be submitted by the treating doctor to continue with eligibility for this program?
Every 6 months. (Form H1551, Treatment Verification)
Note: Refer to CTD pg. 23 MBCC FAQ
For a Dual OCC CFC plan, what benefits are covered?
(Name the benefits)
PAS, HAB, ERS, and Support Management
Note: Refer to LTSS Benefit Structure
What does IL stand for?
Interest List
How long is a HIPAA Authorization Form valid for?
1 year from the members or callers signature date.
What do we instruct members if they are requesting a recertification package?
For the STAR+Plus Nursing Facility (NF) Plan. Name at least two of the add-on services and where would the provider submit the request to?
Emergency Dental Services/Physician-ordered Rehabilitative Services/Augmentative Communication Devices/Customized Power Wheelchairs and will be fax to the NF Fax #1-844-206-3445.
Note: Refer to CTD pg. 55
The STAR+Plus OCC plan, what LTSS benefits can they qualify for?
PAS & DAHS
Note: Refer to HCMS Training pg. 15
What does DADS stand for?
Department of Aging and Disability Services
Can an OCS mail any HIPAA Authorization Forms to members or callers? If yes, what forms and if no, why not?
No, the OCS should not mail any HIPAA Authorization Forms. Member Services is the designated dept. to mail this form. We can assist after getting member's consent to request the form with NCC Rep and document in corresponding system. (HIP or CC)
After a member was advised by OCS they are ineligible. Member calls Wellpoint back stating they contacted HHS/MAXIMUS and were informed they are enrolled with WLP. How should the OCS proceed?
OCS should make an additional call to MAXIMUS to confirm. If advise member is enrolled with WLP send email to TX Enrollment.
Note: Refer to CTD pg. 22
For TANF Adult members that call requesting LTSS, how would the OCS proceed with the call?
Educate caller LTSS is not covered and refer them to DADS 855-937-2372.
Note: Refer to TX Medicaid Programs and Products Chart