Managed Care Minute
September 2021 Volume 27
D-SNP Product Coming 2022
(This applies to 23 states)
Click here to find your state
Effective January 1, 2022, Aetna will be offering its new Medicare Assure Premier Dual-Eligible Special Needs Plan (D-SNP). You will be able to see and care for these D-SNP members through your current Medicare Advantage agreement with Aetna and will be reimbursed at your current rates. This is a Medicare Advantage plan for those who are dually eligible for Medicare and Medicaid.

This plan offers various support and benefits to its members. Every D-SNP member will have access to a dedicated Care Team, which includes a registered nurse, social worker, non-clinical care coordinator, and member advocate. The plan includes all Original Medicare benefits as well as benefits for dental, vision, hearing, transportation, a food card to buy healthy groceries, and an over-the-counter allowance.

CMS requires that Medicare providers and their staff that serve D-SNP members complete an annual training on the D-SNP Model of Care. There will be training information coming up in Aetna’s Q4 Provider Newsletter which will be found here. 

Assisted Living Long Term Care Medicaid Best Practices
(This applies to Florida and only ALF's)

Many assisted living communities are positioning themselves in the market to be true community partners by accepting Medicaid funded residents. Since 2018, Florida Medicaid has been awarded to many Managed Care Organizations to provide services in the different regions. We would like to share some pearls of wisdom on how to best manage your managed care contracts.
  • Read and understand your contracts-                                   
  1. Pay attention to when they expire, share of cost/patient responsibility, timely filing limits, bed hold requirements and time limits and what codes you can bill for.
  • Request an on boarding with your provider reps.
  1. Demonstrations on portal utilization
  2. How to verify eligibility, authorizations, claims filing, bed holds
  3. Build your relationship with them
  • Get to know your plan case managers.
  • Verify Medicaid eligibility and that proper status code is used.
  • Keep a copy of the Medicaid eligibility history.
  • Keep up with your credentialing packets. Mark on your calendar when its due. Keep the needed items handy and organized.
  • Make sure all team leads/ Key staff understand the necessity to notify plans of member discharges.
  • If Authorization is required, make sure they are correct and complete
  • Understand the members expanded benefits and assist in utilization of them. Again, building relationship with case managers.
  • Utilize Availity where appropriate.
  • Keep exceptional documentation regarding claims issues.
  • Follow the claims resolution process.
  • Verify Member eligibility MONTHLY with health plan!
If you would like to have your managed care liaison meet with your team to discuss best practices, please do not hesitate to reach out to schedule a meeting.
Educational Opportunities
(This applies to Florida)
Ambetter Sunshine Health and CareCentrix has notified you about the relationship between these organizations that will take effect in Florida on Oct. 1, 2021.
To support a smooth transition, CareCentrix is inviting your team members to join a Post-Acute Program training, which will be available on multiple dates and times. At the end of the training, participants will be able to:
  • Describe CareCentrix’s role with Ambetter from Sunshine Health members.
  • Describe the authorization process that will go into effect on Oct. 1, 2021.
  • Access CareCentrix resources and support for the Post-Acute Program.
The training is approximately one hour. To register please see below for schedule and instructions.
  • Please register team members involved in discharge planning, case management or authorizations.
Click on the link below to register for a session for training information.

(This applies to Mississippi)
Beginning October 1, 2021 naviHealth will be managing the post-acute benefit for UnitedHealthcare members seeking care in skilled nursing facilities (SNF), acute inpatient rehabilitation (AIR) and long-term acute care (LTAC) facilities. Please register for a class below.

This session is intended for SNF:
  • Administrators
  • Directors of Rehabilitation
  • Directors of Case Management/Discharge Planning
  • Directors of Nursing
  • Social Workers
Click the date and time link below to register for an upcoming Delaware, Louisiana, Mississippi, Pennsylvania, and West Virginia session:

Webinars hosted by MCCFL
  • Direct Admissions: Hints and Tips on how to handle Manage Care admissions from another setting other than the hospital hosted by Regina Wild.
  • LASSO and MSA: MSA (Medical Savings Account) Medicare Advantage plans and Lasso Healthcare hosted by Nanette Johnson Smith.
Reach out to your Managed Care Liaison to get links to join webinars!
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Paying Attention To The Details!
Housekeeping items...
  • As best practice we suggest reverification of all Medicare benefits on ALL skilled members on the 1st and 15th of the month to catch potential payer changes.
  • When reviewing fax authorizations, ensure to verification of dates of service are correct and authorization is for your provider's name.
  • When employees are no longer employed by a facility, please remember to remove their access to insurance portals. This practice will assist in keeping the facility HIPAA compliant. 
  • Do you need access to our client portal? Reach out to your liaison for direction.