The member received the letter because a Medicaid Application was submitted. The letter informs them to wait for approval from DCF before calling to enroll into a LTC plan.
The letter informs the member they were not approved for LTC.
The letter includes the member's LTC auto-assignment and start date.
The member has submitted a Medicaid Application and has established a Level of Care; therefore the member is Application Pending and has the ability to enroll into an LTC plan.
A Good Cause plan change request to CMS.
A 90 day plan change request to CMS.
A 60 day plan change request to CMS.
SMMC Long-Term Care (LTCC) effective 09/01/2014
SMMC MMA Capitated effective 09/01/2014
Medicaid HMO effective 12/01/2012
SMMC MMA Capitated effective 11/01/2014
Tell the caller to fax the letter so it can be sent to AHCA for verification.
Tell the caller they have to wait until open enrollment to change.
Refer the caller to the health plan to request a new doctor.
Tell the caller to get an out of network authorization.
The grievance is a formal complaint filed by the recipient with the plan concerning issues.
The grievance is a formal complaint made by the plan against the recipient for complaining.
The grievance is when the recipient calls AHS and complains about the plan.
The grievance is a court setting in which the member, health plan, and AHCA meet.
Then the member must call PACE.
Then the member must complete another CARES assessment.
Then the member must call DOEA.
Then a disenrollment request can be completed.
Member can enroll in any plan except PACE.
Member can only enroll in an HMO.
Member can enroll in any plan including PACE.
Member can only enroll in PACE.
The member has a PACE exemption.
The member is receiving medical services through a private insurance.
PACE provides medical services as well as LTC services.
This member can change to a LTC plan.
This member can disenroll and use FFS.
This member can request to disenroll from the LTC program or may remain in their current plan.
This member must stay enrolled into PACE for a year.
Process the plan change request through the wizard.
Place the request on a discrepancy log.
Inform mom the plan cannot be changed.
Inform mom she has to change her plan first.
The cut-off date is the 2nd to the last day of the month.
The cut-off is the last day of the month
The cut-off is the Thursday before the 2nd to the last Saturday of the month.
The cut-off is immediately after the green check mark appears in HealthTrack.
Advise the caller to contact DCF.
Advise the caller to contact the AHCA Medicaid Helpline.
Refer the caller to Freedom Health.
Place this on the discrepancy log.
Use the 'convert to voluntary choice' feature to allow the recipient to voluntarily select their current plan.
Advise the caller, that they need to be in the specialty plan because they qualify for it with the special condition on their file.
Place the request on the specialty plan discrepancy log.
Click on the gray arrow for the specialty plan Auto-Assignment and try to cancel the request.
Place on the discrepancy log for an Exemption to be requested from AHCA, so the recipient can see the doctor under FFS.
Disenroll the recipient so they can use FFS to see their doctor because they have an established active relationship.
Tell the caller ALL providers must participate in MMA and refer to the Medicaid Area Office.
Explain continuity of care and file a Complaint against the provider.
Explain continuity of care and tell the caller to call the new plan and provide them with prescription information.
Tell the caller they will have to pay out of pocket for prescription refills and refer to the Medicaid Area Office.
File a complaint against the new MMA plan for not covering prescriptions.
Tell the caller they can use Enhanced Benefits credits to pay for the prescriptions.
Medical Equipment and Supplies
Here's an interesting quiz for you.