Have You Heard?

As we head into a new year, we want to highlight some of the key identifiers that will enable you and your staff to easily recognize the new member ID cards for the various AdventHealth Advantage Plans (AHAP). AHAP continues to offer both Medicare Advantage and Individual and Family Plans. As of January 1, 2022, Health First Health Plans instituted an Administrative Services Agreement (ASA) with Oscar to combine expertise with a new 2022 Provider Portal within myAHplan.com and administrative services offered by Oscar.
 
AHAP no longer sells new small or large group plans. However, any small or large group that had a renewal option for 2022 will continue to be serviced by AHAP. Below are sample images of the cards you will see in your offices for 2022 for AHAP insurances. Per CMS standards, the Medicare Advantage Card will have a HFHP logo. 
 
The AHAP Provider Service phone number is 844-522-5278.

Electronic Data Interface (EDI) Submissions 

AdventHealth Advantage Plans allow for electronic claims submissions. Providers should update their claims systems and procedures to take advantage of this new connection. For assistance submitting claims electronically, please contact your Practice Management System Vendor directly.
 
No enrollment is necessary for claims submission.


Claims with dates of service 2021
for Small/Large Group Plans:

SSI Claimsnet 800.356.0092
Helpdesk_dallas@ssigroup.com
Payer ID: 95019

 
Claims with dates of service 2022 for Medicare Advantage and Individual Plans:
 
Change Healthcare
Payer ID: RP039
 
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Immunizations – Not Just for Children

Vaccines are required for school entry unless exempted for medical reason (allergy), religious beliefs, or philosophical opposition. Not all states accept all the exemption reasons. As more is known about diseases and immunity, schedules of vaccinations may change. An example is the need for a booster to protect against COVID-19 or SARS-CoV-2.

Facts vs. myths. Talk through side effects and risks versus benefits with your patients or parents of patients. Address their concerns and answer their questions. Acknowledge prevalence of misinformation. Listen and talk to develop a shared goals for health. There is help for providers: Web-based immunization training courses are available at You call the shots. There is a Vaccine Adverse Event Reporting System to track effects of US licensed vaccines.

According to World Health Organization (WHO), there are vaccines to prevent 20 life-threatening diseases. WHO developed an Immunization Agenda 2030: A Global Strategy to Leave No One Behind. Still many people around the world – including nearly 20 million infants each year – have insufficient access to vaccines. To learn more and to access vaccine schedules visithttps://www.cdc.gov/vaccines.

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WHAT IS CAHPS®?
The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey is a patient experience survey regarding the patient’s interactions and experience with their providers and health plan. The questions focus on how patients perceived key aspects of their care, including access to care and conversations with health care providers.
 
The survey is conducted annually from March through May and completed by Medicare patients or their designated representative. Survey results contribute to 35% of the Medicare Star Rating
 
AdventHealth Advantage Plans conducts a “simulation” CAHPS® survey to gather additional information. In January, these patients will receive a welcome letter that also lets them know that they may receive a CAHPS® survey and how their survey answers would help providers improve. Below are some topics patients will be asked about that can be directly impacted by you and your staff: 


  • Annual Flu Vaccine
  • Care Coordination
  • Getting Appointments and Care Quickly
  • Getting Needed Care
  • Getting Needed Prescription Drugs
  • Rating of Healthcare Quality
 
What can Providers do?
Focus on CAHPS® measures that you directly impact.

Office presentationPatients notice the cleanliness of the office and exam rooms, including the availability of hand sanitizers and chairs being spaced out enough. 
Wait timesThe amount of time a patient spends waiting in the lobby after check-in and the overall time until they see their provider.

Getting needed careQuick and easy to understand test results, medications ordered timely, and promptly scheduled tests and other specialist appointments. 

CommunicationDiscuss the patient's current health and medications during visits and specifically ask questions the member may not think to ask or may be uncomfortable asking about. They want to feel sure their providers are up to date on the member’s specialty care.
Medicare Advantage - Open Enrollment Period
 
The Medicare Advantage Open Enrollment Period (OEP) is from January 1 through March 31. This is a great time to ensure your patients are in a plan that fits their needs.
 
Individuals can make any changes to their plans and add or drop Part D coverage. Medicare Advantage plans typically offer prescription benefits, while Original Medicare does not (except in specific situations, such as if you are admitted to the hospital).
 
During OEP, individuals enrolled in either a Medicare Advantage Prescription Drug Plan or Medicare Advantage-only plans can switch to:
 
  • A Medicare Advantage Prescription Drug Plan, or
  •  Medicare Advantage only, or
  • Original Medicare (with or without a standalone Part D plan).
 
The effective date for a Medicare Advantage OEP election is the first of the month after receipt of the enrollment request.