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CareNet/Southern Health Services, Inc. MCO Plan Exits From Eleven (11) Localities — Effective September 1, 2010

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Memo
Effective Date:

To:
All Providers and Managed Care Organizations (MCOs) participating in the impacted localities/surrounding areas in the Virginia Medical Assistance Programs
From:
Gregg A. Pane, MD, MPA, Director Department of Medical Assistance Services

The purpose of this memorandum is to advise you of changes to the Medicaid, FAMIS Plus, and FAMIS Managed Care programs, effective September 1, 2010. CareNet/Southern Health Services, Inc. notified the Department of Medical Assistance Services (DMAS) that they will be leaving eleven (11) localities, effective September 1, 2010. The localities include:

 

Albemarle County

Fluvanna County

Orange County

Augusta County

Greene County

Staunton County

Buckingham County

Louisa County

Waynesboro County

Charlottesville County

Nelson County

 

 

All Affected Counties

Medicaid and FAMIS Plus individuals enrolled in CareNet/Southern Health Services, Inc. in these localities will go  to fee-for-service as of September 1, 2010. They will receive services through Medicaid's fee-for-service program until the pre-assignment and assignment processes are completed. Enrollment into a new health plan will not be effective until October 1, 2010.

 

Depending on the MCO option in each locality, members will be able to choose between at least two  of  the following plans: Anthem Healthkeepers Plus, Optima Family Care, Virginia Premier Health Plan, Inc. and/or AMERIGROUP Community Care. Please refer to the DMAS website under Managed Care/Medallion II at http://dmasva.dmas.virginia.gov/Content_pgs/mc-medallion2.aspx for health plans participating in your area after September 1, 2010.

 

FAMIS and FAMIS MOMS enrollees residing in these localities will be moved from CareNet/Southern Health Services, Inc. to another available health plan effective September 1, 2010, with no break in managed care coverage. These enrollees may contact the FAMIS Central Processing Unit (CPU) at 1-866-873-2647 (TDD: 1-888-221-1590) for information on other available options.

 

Medicaid Memo: Special August 17, 2010

Page 2

 

Newborn Coverage for All Eleven (11) Localities

Consistent with existing guidelines, newborns born on or before August 31, 2010, to CareNet/Southern Health will  be covered for the birth month plus two additional months. Therefore, providers rendering services to babies born on or before August 31, 2010, to eligible CareNet/Southern Health mothers should bill CareNet/Southern Health where the date of service falls within the birth month plus 2 months timeframe.

 

Impact on Providers

Providers should verify eligibility and MCO enrollment prior to each service  being  rendered.  Eligibility  verification information is provided at the end of this memo.

 

If you wish to consider contracting with any of the other MCOs operating in these areas, contact information for the MCOs is provided below:

 

MCO Provider Services Contact Information

 

Anthem Healthkeepers Plus

1-800-901-0020

www.anthem.com

Optima Family Care

1-800-229-8822

www.Optimahealth.com

Virginia Premier Health Plan, Inc.

1-800-727-7536

www.vapremier.com

Amerigroup Community Care

1-800-454-3730

www.myamerigroup.com

 

Impact on Enrollees

All affected individuals have been notified via letter of these changes. All Medicaid and FAMIS Plus recipients enrolled in a managed care program may contact the Managed Care HelpLine at 1-800-643-2273 (TDD: 1-800-817- 6608) or find more information about Managed Care  at  http://dmasva.dmas.virginia.gov/Content_pgs/mc- home.aspx on the DMAS website.

 

FAMIS and FAMIS MOMS enrollees should contact the FAMIS Central Processing Unit at 1-866-873-2647 (TDD: 1-888-221-1590) for assistance with choosing a MCO or visit the website at www.famis.org.

 

VIRGINIA MEDICAID WEB PORTAL

DMAS offers a web-based Internet option to access information regarding Medicaid or  FAMIS member  eligibility,  claims status, check status, service limits, service authorizations, and electronic copies of remittance advices. Providers must register through the Virginia Medicaid Web Portal in order to access this information. The Virginia Medicaid Web Portal can be accessed by going to: www.virginiamedicaid.dmas.virginia.gov. If you have any questions regarding the Virginia Medicaid Web Portal, please contact the ACS Web Portal Support Helpdesk, toll free, at 1-866-352-0496 from 8:00 A.M. to 5:00 P.M. Monday through Friday, except holidays. The MediCall audio response system provides similar information and can be accessed by calling 1-800-884-9730 or 1-800-772-9996. Both options are available at no cost to  the provider.

 

“HELPLINE”

The “HELPLINE” is available to answer questions Monday through Friday from 8:30 a.m. to 4:30 p.m., except on state holidays. The “HELPLINE” numbers are:

 

1-804-786-6273            Richmond area and out-of-state long distance

1-800-552-8627            All other areas (in-state, toll-free long distance)

 

Please remember that the “HELPLINE” is for provider use only. Please have your Medicaid Provider Identification Number available when you call.