January 9, 2018 | Issue 1 | Volume 3
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Integrated Health Home (IHH) Update for UnitedHealthcare Members:
UnitedHealthcare follows a process to ensure there is no unnecessary duplication in care coordination and case management provided to its members. Therefore, effective February 1, 2018, UnitedHealthcare members are assigned care coordination/case management as follows:
Long-Term Services and Supports (LTSS) Members:
The UnitedHealthcare community-based case managers will provide case management and care coordination for UnitedHealthcare members that receive services through the Intellectual Disability, Physical Disability, Elderly, AIDS, Health and Disabiilty, or Brain Injury 1915c waiver programs. These members will not be authorized for IHH, since it would duplicate care coordination services.
Childrens Mental Health (CMH) and Habilitation Waiver Eligible Members:
The IHH will continue to provide care coordination services to UnitedHealthcare members receiving services through the CMH waiver, or the 1915i Habilitation waiver, that are not enrolled in another 1915c waiver.
Non-LTSS Members with a Serious Mental Illness (SMI) or Serious Emotional Disturbance (SED)
- The Accountable Care Organization (ACO) will provide comprehensive care coordination, that meets the member's whole-person needs, to UnitedHealthcare members with an SMI or SED, who are actively enrolled with the ACO. These members will not be authorized for IHH, as this will duplicate care coordination services. UnitedHealthcare will monitor the effectiveness of the care coordination ACOs provide and, if needed, UnitedHealthcare will provide the ACO additional direction, guidance, and support to ensure the member's needs are met.
- If the member's primary care provider (PCP) is not part of an ACO, UnitedHealthcare will enroll the member with an IHH.
The Department is responsible to ensure all care coordination meets MCO member needs, including members with behavioral health needs.
For more information click here.
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Retroactive Medicaid Coverage
The Centers for Medicare and Medicaid Services (CMS) has approved Iowa's request to eliminate the three month retroactive eligibility period, except for pregnant women (and during the 60-day period beginning on the last day of the pregnancy) and infants under one year of age, for applications filed on or after November 1, 2017. This includes initial applications and applications to add new household members.
The elimination of retroactive coverage does
NOT impact presumptive eligibility, annual renewals/reviews, or the 90-day reconsideration period.
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Provider Tools and Resources:
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Providers are Encouraged to Verify Eligibility
The Eligibility and Verification Information System (ELVS) line is very busy during the first of the month. The
ELVS web portal is another option for providers in lieu of calling the ELVS line but each provider must enroll through the Electronic Data Interchange Support Services (EDISS). The ELVS web portal allows for multiple eligibility checks and batch submission, where as the ELVS phone system only allows for one at a time.
Login ID and password may be obtained through EDISS by submitting the following
Access Request Form to EDISS or calling EDISS at 1-800-967-7902.
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Provider Resource Pages
Comprehensive provider resource pages are available for each Managed Care Organization (MCO), featuring provider training manuals, webinars and important updates. View them below:
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Member Choice Guidelines for Providers
All health care providers delivering services to Iowa's Medicaid population in the IA Health Link managed care program are welcome to inform their patients of the health plans in which they have chosen to participate. However, there are strict prohibitions against patient steering, which all providers must observe.
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Looking for an Old Issue of the Medicaid e-News?
Each edition features useful tools and important updates. Now you can quickly access old issues to find what your looking for. Visit the
Iowa Medicaid newsletter page
where you'll find links to each issue.
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IA Health Link Member Services
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1-800-600-4441
1-855-332-2440
1-800-464-9484
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IA Health Link Provider Services
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1-800-454-3730
1-844-411-0579
1-888-650-3462
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Dental Wellness Plan Member Services
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Dental Wellness Plan Provider Services
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Informational Letters
Informational letters are posted through the Iowa Medicaid Portal Application (IMPA) system and are available on the DHS website
here
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These letters communicate important policies and procedures for providers and their administrative staff.
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100 Army Post Rd., Des Moines, IA 50315
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Copyright © 2017. All Rights Reserved.
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The Iowa Medicaid Enterprise (IME), has been named a 2016 All Star Award winner by
Constant Contact
, part of the
Endurance International Group, Inc.'s
(Nasdaq: EIGI) family of brands and the trusted marketing advisor to hundreds of thousands of small organizations worldwide. The annual award recognizes the most successful 10 percent of Constant Contact's customer base, based on their significant achievements using email marketing to engage their customer base and drive results for their organization during the prior year.
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