A
What is the phone number for member services?
844 366 2880
page 10
What tool is used on the website if member needs assistance finding Radiology/Imaging Centers?
FAP
Does immunizations require a PA?
Not for members age 21 and younger.
benefits and services--->prior auth and referrals tab
Telehealth services are provided by who?
Teladoc.
Under benefits and services tab
Does SSHP require a referral for services?
You may need to see a specialist. Your PCP can coordinate your care. SilverSummit Healthplan does not need a referral from your PCP to cover the service. The specialist may still need a referral from your PCP. This helps them give you the right treatment. They will tell you if they need a referral
page 38
What are the operation days and hours for SSHP?
Monday- Friday 8am-6pm
page 11
What are the ways members can renew their NV medicaid coverage?
Online
Phone
In person
What is the dispensing limit for medications?
Drugs may be dispensed up to a 34-day supply with the exception of maintenance medications that can be dispensed up to a 100-day supply.
page 21
Is a Prior Auth required for Hearing Aids?
Yes, for cochlear implants.
Prior auth and referrals tab
How is Fraud, Waste and Abuse Reported?
Potential Fraud, Waste or Abuse should be reported to SilverSummit Healthplan at:
SilverSummit Healthplan
Attn: Compliance Department
2500 N. Buffalo Drive
Suite 250
Las Vegas, NV 89128
or contact SilverSummit Healthplan's anonymous and confidential hotline at 1-866-685-8664 or by contacting the Healthplan's Compliance Officer at 1-844-366-2880 or ReportFWA@SilverSummithealthplan.com
What are SSHP non covered prescriptions?
Drugs that do not have Food and Drug Administration (FDA) approval ▪ Experimental or investigational drugs ▪ Drugs to help you get pregnant ▪ Drugs used for weight loss ▪ Cosmetic or hair-growth drugs ▪ Drugs used to treat erectile problems
page 19
What is included with doula services?
Our Members have access to licensed, in-home doula and birthing coach services for pregnancy, postpartum, and newborn care
page 24
Where can members access the list of maintenance medications?
Benefits and services--->Pharmacy--->can i get a prescription with more than a 30 day supply?
What are the Vision benefits for SSHP?
▪ Annual preventive eye exams ▪ Eyewear (frames and lenses) every year, when requirements are met ▪ Medically necessary eye care services, including treatment of eye conditions ▪ Frame repair or replacement of eyeglasses once per year to Members of all ages (restrictions may apply) ▪ Other services as outlined in the Nevada Department of Health and Human Services Medicaid Services Manual: http://dhcfp.nv.gov/Resources/AdminSupport/Manuals/MSM/MSMHome/ Members 21 years of age and older may receive a $100 allowance every year to use toward the purchase and the fitting of medically necessary contact lenses in lieu of standard eyeglasses
page 24
Does SSHP cover acupuncture services?
No. SilverSummit Healthplan does not pay for these services: ▪ Experimental and/or investigational procedures, drugs and equipment. Please note: routine costs associated with qualifying clinical trials are covered. ▪ Acupuncture ▪ Treatment for infertility ▪ Lasik Surgery/Keratotomy
page 26
When does the my health pays rewards card expire?
Funds expire 90 days after termination of coverage or 365 days after date reward was earned, whichever comes first.
under benefits and services
Are out of network emergency services covered?
Out-of-network emergency services do not need approval from SilverSummit Healthplan
page 28
Pregnant member needs NOP form where does she access this?
Member Resources/forms
Do SSHP members have cost sharing?
Cost-sharing is the share of costs covered by your insurance that you pay out of your own pocket. SilverSummit does not collect any costs from you for getting services you need or using your benefits. A Medicaid provider who accepts you as a patient for treatment accepts the responsibility to make certain you receive all medically necessary Medicaid covered services at no cost to you.
page 40
Where do members access the over the counter brochure?
benefits and services--->pharmacy--->enhanced OTC benefits
What happens if the pcp or specialist decides to leave our provider network?
full answer on page 37
Does emergency room surgeries require a PA?
No.
Surgery Yes, except in an emergency
benefits and services -->Prior auth and referrals tab
Who can members contact for non emergency transportation?
If you need a ride to and from your medical appointments for routine visits, call Member services at 1-844-366-2880, TTY: 1-844-6086, Relay 711. Select the option for transportation. You will be connected to Medical Transportation Management (MTM)
page 33
Where can a member get details about the Baby Bounty Diaper Events happening in Las Vegas?
Benefits and Services---->events tab