Clarion Health Plan has decided not to renew its Medicare Advantage Plan contract with the Center for Medicare and Medicaid Services (CMS). As a result the contract between Best Care Partners, INC and your skilled nursing facility will be terminated April 15,2021. There will be a “run out” period from January 1,2021 through March31,2021 to ensure all claims provided through December 31,2020 will be processed as per the contract.
Any questions please contact the plan at 844 865-8059 or email firstname.lastname@example.org.
Managed Medical Assistance - MMA
Florida has worked very hard to offer proper healthcare to the State's income elderly, disabled and families. Many are confused by the different types of Medicaid plans available. Hopefully, this will clear it up some.
Florida’s Statewide Medicaid Managed Care has five types of programs. Managed Medicaid Assistance (MMA), Long Term care plus, comprehensive, Specialty and dental. Specialty plans serve special populations, such as HIV/AIDS or serious mental illness. Strictly MMA plans cannot provide services to recipients that are enrolled in LTC services. Long Term care Plus cannot provide services to members that are only enrolled in MMA products. Those eligible for Long term care can receive those services in a nursing facility, assisted living or at home. Comprehensive plans provide services to both MMA and LTC. Most plans in the state of Florida are comprehensive plans. Not all plans operate in all counties. Only certain plans per region were awarded contracts. You can go to this link to view the regions: AHCA Medicaid Region Map.
MMA plans add another layer to your bottom line and are usually pretty easy to work with.
Best practices when verifying benefits for Medicaid members is to always run a Medicare verification, Medicaid eligibility, as well as contact the plan. Make sure that if you are admitting a skilled Medicaid member that they do not have long term benefits. If they have long term benefits you will be reimbursed at the long- term care rate. Verify how many benefit days the member has. Some plans only offer 30 days where others offer 120 days. Prior authorization is required and are obtained through various routes as identified on your contract grid. Just a reminder that Medicaid residents will not be issued a NOMNC. It is recommended that discharge planning begin on day of admission to avoid holding up discharge. Most plans offer carve outs for specialized DME, wound care and occasionally high-cost meds. Do not hesitate to contact your MCCFL liaison with any questions.
Most MMA plans offer exceptional at home services as well. Social services can coordinate with the members case workers to make sure they receive home health, DME, transportation services or even cell phone services. As always, your MCCFL liaisons are here to assist and provide resources to best serve your managed care patients.
United Healthcare and naviHealth
naviHealth is a post-acute care manager working with health care organizations, to lower post- acute care costs by empowering the patient, improving care coordination, and using a proven data and technology-driven approach to better assist patients and their families through the entire continuum of post-acute care. United Healthcare in Florida has delegated naviHealth to handle post acute care authorization.
- Utilization of naviHealth begins 2/1/21- for United Healthcare members admitting on or after 2/1
If a member is already in house come the 1st, they will continue as usual, and will NOT utilize NH
- If a member was in house with an Auth from UHC, but went to the ER overnight- they must obtain a new auth from NH
- Use of Navi health for UHC is for delegated part A benefits only. Commercial plans will continue as usual
- Facilities should continue to use UHC to verify benefits
- They may continue to request the auth through the UHC portal, however as best practice we are pushing all centers to get registered on the Navi Health site (we know at some point they will not be able to initiate auth via the UHC portal)
- It is very easy and fast to get registered for the Navi Health portal
- Initial authorization is for 3-5 days
- Facility must provide clinical update within 48 hours of admission
- Clinicals will be due every 5-7 thereafter
- Off hours admissions will be authorized, but should be rare, and will be subject to criteria- auth request must be made the next business day- denials are possible
- Claims will continue to be processed and paid directly through UHC