Managed care plans to assist enrollees in completing the Medicaid renewal process

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Bulletin

August 16, 2023, 9:21AM

To:

All Providers and Managed Care Organizations Participating in the Virginia Medicaid and FAMIS Programs

From:

Cheryl J. Roberts, Director Department of Medical Assistance Services (DMAS)

The purpose of this bulletin is to notify providers that CMS has approved a request from DMAS to allow managed care organizations (MCOs) to assist enrollees in completing the Medicaid renewal process, including completing certain parts of the renewal forms, to help reduce the number of procedural terminations during the state’s Return to Normal Operations period.

This flexibility is in effect immediately and will be in effect through February 28, 2024.

MCOs and MCO employees must adhere to guidelines when performing this work, including:

Complete the Sign Up Now (SUN) renewal training prior to assisting any individual with a paper renewal packet or CommonHelp redetermination process.
Only assist with renewals that have been initiated by the state.
Not assisting with any application fields associated with managed care plan selection.
Not acting as the enrollee’s authorized representative.
Not performing activities that must be provided by an enrollment broker, including choice counseling.
Avoid all forms of marketing and potential conflicts of interest and protect managed care enrollees’ confidentiality.
Tracking and reporting on all activities.

PROVIDER CONTACT INFORMATION & RESOURCES

Virginia Medicaid Web Portal Automated Response System (ARS)

Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice.

https://vamedicaid.dmas.virginia.gov/

Medicall (Audio Response System)

Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice.

1-800-884-9730 or 1-800-772-9996

Acentra Health

Service authorization information for fee-for-service members.

https://dmas.kepro.com/

Provider Appeals

DMAS launched an appeals portal in 2021. You can use this portal to file appeals and track the status of your appeals. Visit the website listed for appeal resources and to register for the portal.

https://www.dmas.virginia.gov/appeals/

Managed Care Programs

Medallion 4.0, Commonwealth Coordinated Care Plus (CCC Plus), and Program of All-Inclusive Care for the Elderly (PACE). In order to be reimbursed for services provided to a managed care enrolled individual, providers must follow their respective contract with the managed care plan/PACE provider. The managed care plan may utilize different guidelines than those described for Medicaid fee-for-service individuals.

Medallion 4.0

http://www.dmas.virginia.gov/#/med4

CCC Plus

http://www.dmas.virginia.gov/#/cccplus

PACE

http://www.dmas.virginia.gov/#/longtermprograms

Magellan Behavioral Health

Behavioral Health Services Administrator, check eligibility, claim status, service limits, and service authorizations for fee-for-service members.

www.MagellanHealth.com/Provider

www.magellanofvirginia.com, email: VAProviderQuestions@MagellanHealth.com,or

Call: 1-800-424-4046

Provider Enrollment