Factsheet on Accessing Care for Dual Eligible Clients
LA HAP staff has been working with Medicaid to address some of the questions and uncertainty voiced by our case management community around Medicaid eligibility, particularly for Medicare beneficiaries.
- 800-776-6323 or 225-216-7387: Recipient Eligibility Verification System (REVS), automated phone system for verifying Medicaid eligibility. Must have 10-digit NPI or 7-digit Medicaid Provider ID to access.
- PLEASE NOTE: While the information provided at this number is consistent with the information available in the online Medicaid Eligibility Verification System (MEVS), the order and manner in which the information is presented can be misleading. If you must use REVS, make sure you listen to the entire record before hanging up. MEVS is the preferred method of verifying eligibility until further notice.
- 888-342-6207 or 877-252-2447: Customer Service Center for eligibility-related tasks and questions. Apply for Medicaid, follow up on a letter from Medicaid, check application status, get help navigating the self-service enrollment portal, request a new card, update income information, etc. Both members and providers may call. Questions about plan coverage details, claims, and provider referrals for specific MCOs should be directed to the beneficiary’s MCO.
- 855-229-6848: General number for Managed Care Organization (“Healthy Louisiana”) tasks and questions, most appropriate for beneficiaries already enrollment in a Medicaid MCO. Can change health plan or request materials
- 800-473-2783 or 225-924-5040: Provider Relations Department housed at DXC Technology, claims administrator for Medicaid. Provider offices should direct questions about claim status here. This number should NOT be used to verify eligibility.
- 877-598-8753: Technical support on accessing the LAMedicaid/MEVS websites. No eligibility or claims information available at this number.
Information on improper billing for dual eligible/low income beneficiaries
A reminder that
all Medicare providers are prohibited from billing Qualified Medicare Beneficiaries (QMBs) for any cost-shares
with the exception of nominal pharmacy copayments (Specified Low Income Beneficiaries [SLMBs] and Qualified Individuals [QIs] may still incur cost-shares, however). This is true even when the QMB seeks services out of state. If a QMB reports receiving a copay, coinsurance or deductible bill from their provider:
- If contacting the provider is not successful: Elevate the issue to the Medicare Advantage plan administrator, if applicable, or to 1-800-MEDICARE.
- If neither contacting the provider nor the plan administrator/ Medicare is successful: Elevate the issue to Louisiana Medicaid at 225-342-3855.
- Please do NOT use HIA or other resources to pay these claims as this only encourages providers to improperly bill our clients.
Also note that as of April 1
2019, Medicaid beneficiaries with a family income of $800 or less per month are
no longer subject to pharmacy copays
. This is true for both dual eligible and full-Medicaid beneficiaries.
Incarcerated clients and late enrollment penalties
Unfortunately, a Medicare-eligible client
is not exempt from Parts B and D late enrollment penalties
due to incarceration. An incarcerated client who is able to afford their Part B premiums should work with Medicare to set up direct payments within 30 days of their conviction, since their SSA benefits will cease after this time and the premium will no longer be withdrawn from their Social Security check.
Clients who are not able to afford their premiums should actively withdraw from Part B
to avoid unpaid premiums accumulating as a debt during their incarceration and should apply for a Medicare Savings Program (MSP) as soon as possible upon release. MSP enrollees are exempt from late enrollment penalties.
Medicare Part B premium deductions for individuals with full Medicaid
Individuals with full Medicaid who age into or otherwise become eligible for Medicare often find that Part B premiums are being immediately withdrawn from their Social Security checks, despite being eligible for a Medicare Savings Program that should pay their Part B premium for them. This is simply an issue of capacity: there is a delay in how quickly Medicaid, Medicare, and the SSA are able to share eligibility data. The state
Senior Health Insurance Information Program
(SHIIP) recommends that
Medicaid enrollees becoming newly eligible for Medicare should actively apply for both LIS and an MSP
in order to return a timely eligibility decision.
Dual eligibles and LA HAP eligibility
policy allows for:
- Full LA HAP services for partial dual eligible clients (QMB only, SLMB only, QI)
- Limited LA HAP services (Part C or Medigap premiums, LA HAP/Guardian Dental Plan premiums/copays only) for full dual eligible clients (QMB Plus, SLMB plus)
This policy is currently under review and is subject to change based on continuing conversations with Medicaid and our case management community.
Please continue to keep LA HAP staff informed of any issues your dual eligible clients face accessing care.