Eligibility
You receive a call from a member who received notification they were being enrolled into the My Care Ohio MMP, but they didn’t actively choose this plan. What is this also called?
Passive Enrollment
Our member called last week and spoke with another UHC representative about their vision coverage. Where can we find the documentation of that interaction?
Recent Interactions under the Member Tab
Are all OH MMP members assigned a Care Manager? Are all OH MMP members assigned a Waiver Service Coordinator?
Yes. No, only if approved for a Waiver Program.
Ruthie is a OHML member, does Ruthie’s plan cover lab work? How much is Ruthie’s cost share?
Yes, $0.
Which counties in Ohio does United Healthcare offer an MMP in?
Columbiana, Cuyahoga, Geauga, Lake, Lorain, Mahoning, Medina, Portage, Stark, Summit, Trumbull, and Wayne counties
If an account in Maestro is showing the coverage as OHML but the member insists they have Medicare with UHC. How do we handle this call?
Check OH Medicaid portal to confirm Medicaid is active. Check MARx to confirm Medicare MCO. If there is a discrepancy between Maestro and MARx/OH Medicaid Portal – route via Macess.
How do we identify if a member has been enrolled in a Waiver Program?
In the Plan tab beside the Members MMPlan name in Medicaid Maestro
Eddie is a OHMM member, he had a dental cleaning on 03/15/2024. Who was the Dental Vendor handing claims on that DOS?
Eddie is scheduled for a follow-up visit to the dentist 06/05/2024. Who will be the Dental Vendor handling claims on that DOS?
Dentaquest
UHC Dental
Does United Healthcare have Market Competition for MMP in Ohio? If so, who are the competing carriers?
Yes, Aetna, Molina, CareSource, and Buckeye
If a member is moving to a new permanent address and their email address, which intent(s) do you use to update this?
Member Address for physical address. Member Profile for email address.
If a member wants to enroll in a Waiver Program, how do we handle that call?
Connect member with their Care Manager
Maria is an OHML member, she was told by her neighbor (also a UHC MMP member) about an App that she can use on her phone to do a screening and assist with locating employment resources. She said the name of it sounded something like “Pixie”. What is the name of the benefit is Maria asking about? What services does this program offer?
Pyx. KM1313405
List the 4 eligibility requirements a member must have to enroll in the UHC My Care Ohio MMP?
Eligible for full Medicare, eligible for full Medicaid coverage, be 18 years old, and live in one of the 12 counties covered by UHC.
Do you need to advise the member to update this information with anyone else?
Yes, advise member to contact OH Medicaid office and SSA to share address change.
What services does a Care Manager assist with?
What services does a Waiver Program Coordinator assist with?
Effective Care Coordination will generally include these components but will vary based upon person’s medical, functional and behavioral needs: For high or Intensive risk members, frequent face to face meetings. Strong rapport with member’s primary care physician. May be face to face but may also be via fax, email or telephonic. Identify when MMP enrollees are hospitalized and provide support for transition home. Act as a communication hub for providers and MMP enrollees. Obtain and manage information about member’s prescriptions and access to pharmacists.
Waiver Coordinators will Monitor health and welfare. At least annually, assess needs, goals, and objectives. Schedule, coordinate and facilitate meetings with the care team. Authorize waiver services in the amount, scope, and duration to meet members’ needs. Connect and provide referrals to needed service providers. Work with the care team to develop a person‑centered service plan. Monitor the delivery of all services identified by the curated person‑centered service plan. Ensure adjustments are made in the event of significant life changes. Identify and report incidents, and complete prevention planning to reduce the risk of reoccurrence. Assist in developing a meaningful backup plan in the event a provider is unable to show up for work.
Albert is 67 years old, OHMM, with a Level One Waiver. He needs transportation to see his Rheumatologist who is 37 miles away. How can Albert schedule his ride?
Covered, contact Provide a Ride due to the distance.
What is the difference between OHMM and OHML?
OHMM have Medicare and Medicaid with UHC. OHML have only Medicaid with UHC.
A member is requesting an Member Handbook to be sent. How do we handle this request?
Use Maestro to document. Complete Member Material Intake Form via Macess.
What system is used to identify the members Care Manager and/or Waiver Service Coordinator?
Are they the same person?
Community Care, Care Team tab. Depends on the members age, over 60 – No, under 60 – Yes.
Albert is 67 years old, OHML, without a Waiver. He needs transportation to see his Rheumatologist who is 37 miles away. How can Albert schedule his ride?
Covered, contact Provide a Ride due to the distance.