Medical Provider Update on New Medicaid Managed Care: Commonwealth Coordinated Care Plus

Medicaid is transitioning individuals 65 or older, children or adults with disabilities, nursing facility residents, or those receiving services and supports through a home and community based waiver from fee for service Medicaid to a Medicaid managed care program called Commonwealth Coordinated Care Plus (CCC Plus). Six health plans are participating in this program.

CCC Plus Health Plans

Aetna Better Health https://www.aetnabetterhealth.com/virginia Anthem HealthKeepers Plus https://mss.anthem.com/va/Pages/aboutus.aspx Magellan Complete Care of VA http://www.mccofva.com/ Optima Health Community Care https://www.optimahealth.com/communitycare/Pages/default.aspx UnitedHealthcare Community Plan http://www.uhccommunityplan.com/va/ Virginia Premier Health Plan https://www.vapremier.com/

Detailed information on CCC Plus populations, services, and regional implementation schedule is available on the CCC Plus webpage at: http://www.dmas.virginia.gov/Content_pgs/mltss- home.aspx.

How does this affect my patients?

Medicaid patients will have a CCC Plus Health Plan to provide their Medicaid coverage. If a patient has Medicare and Medicaid, their existing Medicare benefit coverage and providers do not have to change. Patients can continue their current Medicare plan and see their current Medicare providers.

CCC Plus Medicaid Health Plans will coordinate the benefits of their members. CCC Plus Medicaid Health Plans will pay up to the Medicaid allowable for the entire service for crossover claims for patients with both Medicare and Medicaid, even if the provider is out of network with the patient’s assigned CCC Plus Medicaid Health Plan.

A provider cannot balance bill a member for the crossover claim. Aetna Better Health, Magellan Complete Care of VA, UnitedHealthcare Community Plan and Virginia Premier Health Plan have Coordination of Benefits Agreements with Medicare in place to automatically pay crossover claims. Anthem Health Keepers and Optima Health Community Care will have this agreement at a later date and providers need to bill these plans directly for the Medicaid

1 claim at this time. CCC Plus Medicaid Health Plans can only require an authorization if they are the primary payer for that service.

Submitting Claims to CCC Plus Health Plans as a Non-Participating Provider Aetna Better If no provider information exists and a claim comes in, we will set up the Health provider as non-par and contract based upon program rules. For standard non-par setup, all information required is included in the claim from the provider. The provider will be paid at 100% of the DMAS rate and may not balance bill the member. Anthem A provider does not have to do anything in particular as long as they agree to HealthKeepers be paid at 100% of the DMAS rate. Our system is configured to pay non-par Plus providers at 100% of the DMAS rate. Out of Network providers who want to be paid via EFT will need to have registered with Anthem through CAQH. The provider will be paid at 100% of the DMAS rate and may not balance bill the member. Magellan As long as a provider, par or non-par, is registered with DMAS we are able to Complete Care process and pay their claims with no additional information beyond provider of VA demographic claim data. If the registered non-par provider submits via EDI, we are able to accept their claims via a clearinghouse. If they are enrolled in EFT via CAQH, we are able to submit payment via the EFT process. The provider will be paid at 100% of the DMAS rate and may not balance bill the member. Optima Health In order to process claims from non-participating providers the provider must Community Care submit: Provider Name, Address, Provider Tax ID #, Provider NPI, Provider Taxonomy (if known). The provider will be paid at 100% of the DMAS rate and may not balance bill the member. UnitedHealthcar We do not need any IRS documents for EFT or Checks. All claims can be e Community paid via information included on an incoming claim file. Should there be any Plan information discrepancy on demographics in our system and the incoming claim, a call will be made to request a W-9 from the provider. The provider will be paid at 100% of the DMAS rate and may not balance bill the member. Virginia Premier All Providers will need to submit a W-9 for payment. Electronic submitters Health Plan will need to submit an EDI enrollment form which is available on our website. Providers will be paid at 100% of the DMAS rate and may not balance bill the member. ARTS providers will also need to submit an attestation of their ASAM level. Early Intervention provider will also need to submit attestation of their certification if we cannot confirm certification from EI Rosters.