Presentation is loading. Please wait.

Presentation is loading. Please wait.

3047 Avenue U, Brooklyn, NY 11229, | 888-WCHEXPERTS |

Published byArnold Williams Modified over 7 years ago

Similar presentations

Presentation on theme: "3047 Avenue U, Brooklyn, NY 11229, | 888-WCHEXPERTS |"— Presentation transcript:

1 3047 Avenue U, Brooklyn, NY 11229, | 888-WCHEXPERTS | www.wchsb.com

2 FIDA AFFECTS EVERY SPECIALTY NEW YORK PROVIDER FIDA Counties Affected: Bronx, Kings, Nassau, New York, Queens, Richmond, Suffolk or Westchester

3 3047 Avenue U, Brooklyn, NY 11229, | 888-WCHEXPERTS | www.wchsb.com Who is eligible for FIDA? Reside in one of eight counties: Bronx, Kings, Nassau, New York, Queens, Richmond, Suffolk or Westchester; Age 21 or older at the time of enrollment; Entitled to benefits under Medicare Part A and enrolled in Medicare Part B and eligible to enroll in Part D, and receiving full Medicaid benefits; Individuals must also meet one of the two following criteria: i. Require community-based long term care services for more than 120 days. ii. Be eligible for but not already receiving facility-based or community-based LTSS (“New to Service”).

4 Some individuals are eligible to sign up for a FIDA Plan but will not be passively enrolled. In particular, some groups of people will not be passively enrolled but are eligible to opt-in, including but not limited to: Native Americans, PACE program enrollees, enrollees in a Medicare Advantage Special Needs Plan for institutionalized individuals, individuals participating in the CMS Independence at Home demonstration, enrollees in Employer or Union Sponsored coverage for employees or retirees, enrollees in a Health Home, individuals with coverage mandated by the Aliessa federal court decision, individuals eligible for the Medicaid coverage buy-in for working disabled, and individuals who are eligible for the Nursing Home Transition & Diversion (NHTD) 1915(c) waiver.

5

6 3047 Avenue U, Brooklyn, NY 11229, | 888-WCHEXPERTS | www.wchsb.com Can I continue to see my patients who join a FIDA Plan even if I’m not participating? Yes, for a limited amount of time (and possibly longer for patients whose care team or FIDA Plan has authorized their continuing to see you as an Out-Of-Network provider) All participants new to a FIDA Plan will have a transition period during which they can continue a current course of treatment with their existing provider. The transition period will last for ninety (90) days from the time of enrollment or until the FIDA Plan participant’s Person-Centered Service Plan is finalized and implemented, whichever is later. During the transition period, participants can maintain existing providers they’ve seen in the past 6 months, regardless of whether those providers are in the FIDA Plan's network. The FIDA Plan must make reasonable efforts to bring these providers into the FIDA Plan network

7 3047 Avenue U, Brooklyn, NY 11229, | 888-WCHEXPERTS | www.wchsb.com If the participant is receiving services from a behavioral health provider at the time of his/her enrollment, he/she may continue to get services from that provider until treatment is complete, but not for more than two years. This is the case even if the provider does not participate in FIDA Plan’s network. The FIDA Plan will receive payment for these services at least at the applicable Medicaid fee for service rate Please note: If a participant needs to get services from you and you are an out-of-network provider, he/she must work with their FIDA Plan or IDT to get approval to see an out-of-network provider. If he/she goes to an out-of-network provider without first getting Plan or IDT approval, he/she may have to pay the full cost of the services

8 3047 Avenue U, Brooklyn, NY 11229, | 888-WCHEXPERTS | www.wchsb.com How it affects Providers in New York? 1.Practices that only have MCB/MED patients that are receiving homecare services will be switched to FIDA plans if the doctors don’t participate with plans they lose income. So practices that have online Medicare and Medicaid enrollment cannot see these patients. a.Patients can refuse enrollment and be returned back to original plans. Provider offices must facilitate this change. 2. FIDA plans pay better than Medicare and there is no more secondary payer. FIDA becomes their one plan. FIDA pays 90-100% rate on claims but has like any other insurance authorization process and benefit limit. 3. Future plans of FIDA – Coordinate services for these patients in full. All services will be approved by RN or NP for each patient and will require authorization. Case worker will handle services for these patients.

9 3047 Avenue U, Brooklyn, NY 11229, | 888-WCHEXPERTS | www.wchsb.com How it affects WCH? 1.At least 20 practices that we have are operating only with Medicare and Medicaid enrollment, they don’t have any other insurance which FIDA joined. If the patients don’t decline FIDA these providers cannot see them, unless providers enroll. Takes time panels could be closed. Service Solution: Credentialing We will be creating FIDA Package credentialing for all providers in NY. Starting marketing it now. Webinar: I did not see any other company yet train providers in NY about FIDA impact. I want to create webinar 30 min once a week for NY providers for $59.99 to provide this education. 2. Billing and our payment process will also change for us. Still new FIDA Plans don’t all have EDI interchange set up. Unlike with Medicare and Medicaid claims payments will be coming later from payers. Some payers primary claims will need to sent on paper.

10 3047 Avenue U, Brooklyn, NY 11229, | 888-WCHEXPERTS | www.wchsb.com How it affects WCH? 3. Account representatives educate own clients 4. New Client search strategy: Concentrate on clients with younger than 65 age population Sign clients that participate with plan, credentialing is unavoidable now. Sign facility clients like urgent cares, facility base providers Pursue other states

11 3047 Avenue U, Brooklyn, NY 11229, | 888-WCHEXPERTS | www.wchsb.com Resources for help 1.https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and- Medicaid-Coordination/Medicare-Medicaid-Coordination- Office/FinancialAlignmentInitiative/Downloads/NYProviderFAQ.pdfhttps://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and- Medicaid-Coordination/Medicare-Medicaid-Coordination- Office/FinancialAlignmentInitiative/Downloads/NYProviderFAQ.pdf 2. http://www.wnylc.com/health/download/429http://www.wnylc.com/health/download/429

Download ppt "3047 Avenue U, Brooklyn, NY 11229, | 888-WCHEXPERTS |"

Similar presentations

Changes to Medicaid Because of the Affordable Care Act, many more people will be eligible for Medicaid after January 1, 2014. Medicaid will be expanded.

Changes to Medicaid Because of the Affordable Care Act, many more people will be eligible for Medicaid after January 1, Medicaid will be expanded.
It’s All About MME Tasia Sinn September 18, 2014 Understanding Colorado’s New Medicare- Medicaid Enrollee (MME) Program.

It’s All About MME Tasia Sinn September 18, 2014 Understanding Colorado’s New Medicare- Medicaid Enrollee (MME) Program.
Commonwealth Coordinated Care

Commonwealth Coordinated Care
Module 9: Medicare and TRICARE. 2 Module Objectives After this module, you should be able to: Describe the TRICARE for Life benefit Explain how TRICARE.

Module 9: Medicare and TRICARE. 2 Module Objectives After this module, you should be able to: Describe the TRICARE for Life benefit Explain how TRICARE.
In 2011, Governor Andrew M. Cuomo established a Medicaid Redesign Team (MRT), which initiated significant reforms to the state’s Medicaid program. This.

In 2011, Governor Andrew M. Cuomo established a Medicaid Redesign Team (MRT), which initiated significant reforms to the state’s Medicaid program. This.
Cal MediConnect Martha Smith

Cal MediConnect Martha Smith
A personal health care plan that’s centered on you. One plan that brings together the resources of Medicare and Medicaid. A plan that gives you all the.

A personal health care plan that’s centered on you. One plan that brings together the resources of Medicare and Medicaid. A plan that gives you all the.
Joint Informational Hearing The Federal Medicare Prescription Drug Act: State Readiness, Implementation, and Consumer Issues Bonnie Burns, Training and.

Joint Informational Hearing The Federal Medicare Prescription Drug Act: State Readiness, Implementation, and Consumer Issues Bonnie Burns, Training and.
Ramnik Dhaliwal, MD/JD PGY-2 EM/IM Residency Hennepin County Medical Center.

Ramnik Dhaliwal, MD/JD PGY-2 EM/IM Residency Hennepin County Medical Center.
Managed Long Term Care Plans Mandatory Enrollment Linda Gowdy Home Care Association May 31, 2012 1.

Managed Long Term Care Plans Mandatory Enrollment Linda Gowdy Home Care Association May 31,
Sarah Broughton, MSW: Outreach and Education Coordinator Patti Davidson, MSW: Program Analyst Elizabeth Smith, RN: Program Analyst Virginia Department.

Sarah Broughton, MSW: Outreach and Education Coordinator Patti Davidson, MSW: Program Analyst Elizabeth Smith, RN: Program Analyst Virginia Department.
Getting Started Version 12.  This training can help you make important Medicare decisions  Choosing health and prescription drug coverage  Timing your.

Getting Started Version 12.  This training can help you make important Medicare decisions  Choosing health and prescription drug coverage  Timing your.
Medicare 101 Module 1B. Medicare 101 9/18/20152 Medicare 101 Introduction to Medicare Original Medicare Medicare Supplement Insurance (Medigap) Medicare.

Medicare 101 Module 1B. Medicare 101 9/18/20152 Medicare 101 Introduction to Medicare Original Medicare Medicare Supplement Insurance (Medigap) Medicare.
The Moving Parts of Medicaid Reform CDPAANYS Annual Conference October 24, 2012 Presenter: Cathy Roberts, Senior Paralegal Empire Justice Center, Albany,

The Moving Parts of Medicaid Reform CDPAANYS Annual Conference October 24, 2012 Presenter: Cathy Roberts, Senior Paralegal Empire Justice Center, Albany,
 Agreed upon fees paid for coverage of medical benefits for a defined benefit period. Premiums can be paid by employers, unions, employees, or shared.

 Agreed upon fees paid for coverage of medical benefits for a defined benefit period. Premiums can be paid by employers, unions, employees, or shared.
Helping your Patients Understand the Fully Integrated Duals Advantage (FIDA) Program.

Helping your Patients Understand the Fully Integrated Duals Advantage (FIDA) Program.
The Health of the Nation. Judging the Health of a Nation Quality of its doctors and medical institutions Doctors from all over the world come to the U.S.

The Health of the Nation. Judging the Health of a Nation Quality of its doctors and medical institutions Doctors from all over the world come to the U.S.
C ALIFORNIA ’ S C OORDINATED C ARE I NITIATIVE : M ANDATORY M EDI -C AL M ANAGED C ARE E NROLLMENT AND THE D UAL D EMONSTRATION P ROJECT Presented by the.

C ALIFORNIA ’ S C OORDINATED C ARE I NITIATIVE : M ANDATORY M EDI -C AL M ANAGED C ARE E NROLLMENT AND THE D UAL D EMONSTRATION P ROJECT Presented by the.
PHP CARE COMPLETE FIDA-IDD PLAN (Medicare/Medicaid Plan) Partners Health Plan is a managed care plan that contracts with Medicare, the New York State Department.

PHP CARE COMPLETE FIDA-IDD PLAN (Medicare/Medicaid Plan) Partners Health Plan is a managed care plan that contracts with Medicare, the New York State Department.
Medicare Basics Initial Enrollment 1. What is Medicare? Health insurance for people –65 and older, actively working or retired –Under 65 with certain.

Medicare Basics Initial Enrollment 1. What is Medicare? Health insurance for people –65 and older, actively working or retired –Under 65 with certain.

Similar presentations

Ads by Google