The Academy of Senior Health Sciences, Inc: Managed Care

---SELECT-- MyCare Ohio General Information Education Opportunities Managed Care Complaints

Information and Resources on Managed Care for LTC Providers

• Instructions for Bulk Patient Liability Claims Reconciliation Worksheet
  Please read instructions prior to downloading the worksheet.
  The worksheet can be downloaded here in Excel format.

• Medicare Passive Enrollment Sample Letter: New MyCare Enrollee
• Medicare Passive Enrollment Sample Letter: Current MyCare Enrollee
• ASHS/LTC Collaborative MyCare Ohio FAQ
• MyCare Ohio General Information
• Ohio Medicaid MyCare Ohio Transition and Provider Payment Information
• Ohio Medicaid MyCare Ohio FAQ

MyCare Ohio Rules

• MyCare Ohio plans: definitions
• MyCare Ohio plans: application of general managed carerules
• My Care Ohio plans: eligibility, membership, and automatic renewal of membership
• MyCare Ohio Plans: termination of membership
• MyCare Ohio waiver: eligibility and enrollment
• MyCare Ohio plans: covered services
• MyCare Ohio HCBS Waiver Program: Member Choice, Control, Responsibilities, and Participant Direction
• MyCare Ohio HCBS Waiver Program Covered Services and Providers
• MyCare Ohio waiver: incident management system
• Appeals and grievances for MyCare Ohio (Updated 12/01/2014)

Enrollment Update

• MyCare Timeline
  Updated enrollment timeline, including map of the different regions

MyCare Ohio Plan Resources

	Buckeye	Caresource	UnitedHealthcare	Aetna	Molina
MyCare Website	Buckeye	CareSource	UnitedHealthcare	Aetna	Molina
Provider Manual	Provider Manual	Provider Manual	Provider Manual	Provider Manual	Provider Manual LTSS Provider Manual
Training Materials	Training Slides	Claims Training	Training Slides	Provider Training	Nursing Facility Orientation Presentation
Key Contacts		See pages 2 and 3 of provider manual Provider Relations	UHC key contacts		Important Phone Numbers Provider Relations by County
Reference Guides	Buckeye Quick Reference Guide	CareSource Quick Reference Guide
Additional Resources	Fact Sheet	Transportation Guide	MyCare Billing Codes	Fact Sheet	WebConnect Enrollment Process SNF FAQs

Care Management and Patient Liability Information Table

The Care Management and Patient Liability Information Table provides information for each plan in relation to specific care management and billing procedures related to patient liability. For Care Management, the table covers how to acquire a prior authorization for a skilled service without a 3-day hospital stay and care management practices for the assisted living setting. The Patient Liability table covers the PL source of data, placement on SNF and AL claims, and how to bill lump sum. We believe this information to be accurate as of November 7, 2014.

Managed Care Complaints

Providers:

Although we like to think everything will go smoothly as LTC services are provided to more individuals with a managed care plan, we know there can be bumps in the road. Should a problem arise, the first step should be to contact the plan directly at their provider relations or provider ombudsman number. We will be listing contact information on this website soon for each plan.

If the issue is not readily resolved by the plan or keeps reoccurring, we want to know about it. Not just any problem, but one that the plan is not resolving or keeps happening over and over again. This can include delays in getting prior authorizations for hospital admissions, repeated claim denials, or early discharges from the SNF with negative consequences to the consumer. By letting us know, we can monitor the plans' behaviors and look for trends in the data. And we may be able to help find a resolution to your problem if you would like us to do so. So please fill out the provider unresolved complaint form, send us an email, or giving us a call at 614/461-1922.

Unresolved MCP Complaints – Providers