Name that Medicaid Program
This Medicaid program provides coverage to eligible children with income too high to qualify for Medicaid, but too low to afford private coverage.
CHIP
What does Part A coverage for?
Hospital Insurance
What is APRIL?
A Path to Research, Information & Links
What system do we use to review a SOP?
Knowledge Central
What is the name of the system you can see claim denials reason and possible next steps?
The Denial Look-up Tool
What plan is for adults 65 and older or anyone who is disabled according to Social Security.
ABD (Aged, Blind, and Disabled)
What is Part D coverage?
Prescription Drugs Plans. (D for Drugs)
What is C&S?
Community and State
What is the system that we use to look up State Specific information. ex: phone numbers, hours of operations, and any state call outs.
Medicaid/DSNP State Specific Tool
You service AP plans but there is one type of AP that you don't handle, which type AP plan is that?
Exchange plan
This is a federally funded program. Primarily aims to support low-income families with dependent children.
TANF (Temporary Assistance for Needy Families)
What is Part B coverage?
Medical Insurance
What is the name of the system we use to help the providers?
Spire
What is the name of the system we use to help the providers?
Spire
If you are completely stuck, how /who can you reach out to?
Your Team meeting chat. SMERT chat. Helping Hands
This supports those at risk of going into a long-term care facility and keeping people home or in their community rather than a facility.
LTSS (Long term Support and Services)
What coverage is Part C?
Medicare Advantage Plan
What does HMO stand for?
Health Maintenance Organization
What is the name of the system we use to check a fee schedule or contract rates and if a code has been billed within the last 5 years?
Facets
What is the website we use to check and see the member's "Care Team"?
CommunityCare
This is apart of the Affordable Care Act (ACA). This gives states a chance to provide Medicaid coverage to people earning 138% of the federal poverty level.
Medicaid Expansion (We don't service Exchange plans)
What does HMO stand for?
Health Maintenance Organization
MediMedi
Medicare claims that crossed over to Medicaid.
For Medicaid plans, where do you check to see if a code requires auth?
Intake Tool > Community & State > EPAL/SSG
What is the website we use to let eh provider know if a code is covered or a non-covered code for the members plan.
UHCprovider.com> Coverage and payments > policies and protocols > For Community Plans > Reimbursement Policies for Community Plan > scroll down and select I agree > Filter and sort for either Covered or Non-Covered codes.