DC
If provider needs a Home and Community Services Case built for a DC Medicaid member where would you refer the provider?
The Case Manager listed in ICUE Or United at Home contact # 855-409-7073 if no Case Manager is listed. (Per SSG)
For TN Medicaid how do we handle Vanderbilt Intake Requests?
Refer to the Facility Exceptions - Authorization Requirements line to verify Vanderbilt facility or Provider Tax Ids.
Determine if Provider is In-Network or Out-of-Network.
In-Network Provider Request:
Create case and refer to the service specific line and follow directions for Prior Authorization requirements
Out-of-Network Provider Request:
1. Create case.
2. Refer to the service specific line of request for Prior Authorization requirements and proceed as follows:
- If service does not require a Prior Authorization, Administratively Approve.
- If unable to Administratively Approve, assign case. Refer to the Work Queues line for applicable work queues.
If member has DC DSNP plan that is QMB do they have full Medicaid benefits?
No Medicaid only covers Medicare cost share amounts. (Per provider manual)
Is there a PCP Lock In on TN Medicaid plans?
Yes – Found in CSP Lock In SOP.
TNLTSSCHOICES
10. What DOS are processed using the New TN Medicare/Medicaid Crossover process?
DOS 1/1/2024 and going forward.
Are crossover claims processed according to the provider’s fee schedule or the state’s fee schedule?
Crossover claims will be processed according to state fee schedules.