cshcs - customer support section (css) update ….where it all begins…
TRANSCRIPT
CSHCS - Customer
Support Section(CSS) Update….where it all
begins….
Newly eligible Clients who have full Medicaid are not required to complete an Application for enrollment
Enrollment begin date for new clients who are MHP members may be retroactive a maximum of 6 months from the month the approved medical was received
Coverage begins on first day of the month Coverage ends on the last day of the month, except
when client ages out
PROCEDURAL CHANGES
SINCE OCTOBER 2012
April 20132
Backdating initial coverage Payment Agreements Adding Providers
REMINDERS
April 20133
GM Section 10.4 Coverage may be retroactive up to six
months (from the month the Application is received) if, during that time: All CSHCS medical and non-medical eligibility
requirements were met; and Medical services related to the qualifying
diagnosis(es) were rendered; and There is no other responsible payer (e.g.
Medicaid, private insurance, etc.).
BACKDATING INITIAL COVERAGE
April 20134
Retro coverage does not guarantee that providers of services already rendered will accept CSHCS payment
CSHCS does not reimburse families directly for payments made to providers
Questions to ask: Are providers willing to bill CSHCS ? If family paid out of pocket, are providers willing to
reimburse family (e.g. pharmacy copays)?
BACKDATING INITIAL COVERAGE
April 20135
CSHCS coverage may be made retroactive up to 90 days for the purpose of covering travel assistance
Requests for travel assistance reimbursement must be submitted to MDCH within 90 days after the date of the travel as indicated on the MSA-0636 form
Retroactive coverage does not extend the 90 day time period for submitting reimbursement requests
Requests received by MDCH more than 90 days after the date of the travel will be denied, regardless of retroactive coverage.
BACKDATING INITIAL COVERAGE
for Travel Assistance
April 20136
MYTH BUSTERS! CSHCS will always backdate initial coverage up
to one year as long as the family sends a letter addressed to Rebecca Start (not true)
If private insurance says it will cover services but then denies, CSHCS will backdate up to one year from month the Application is received (myth)
The three Children’s Hospitals always refer potentially eligible families to CSHCS (local PR activities are critical)
BACKDATING INITIAL COVERAGE
April 20137
When the information required for renewal is submitted within ONE YEAR of the date coverage ended and the client remains eligible for CSHCS, Renewal coverage may be backdated a
maximum of TWO months from the month renewal information was received (if needed)
BACKDATING RENEWAL COVERAGE
April 20138
GM Section 9 Fee to join CSHCS Due upon receipt of payment agreement
notification (i.e. coupon letter) As a convenience, families may pay in 12
installments Payment Agreement revenue is used exclusively
for CYSHCN (not put in State general fund)
PAYMENT AGREEMENT
April 20139
Use the Financial Worksheet (MSA-0742) to project income for the IRPA if there has been a dramatic change in income since last Federal 1040
Use the Payment Agreement Amendment form
(MSA-0927) when there is a change in family size, income, etc. during the contract period Amendment applies to current payment agreement
only
PAYMENT AGREEMENT
April 201310
MYTH BUSTERS! If we don’t use CSHCS coverage, the payment
agreement will be cancelled (untrue) If we don’t pay for the first month, coverage
will automatically terminate and the payment agreement will be cancelled (wrong)
I have time to decide if we should enroll since CSHCS will backdate up to a year from the month they receive my signed IRPA (incorrect)
PAYMENT AGREEMENT
April 201311
Why do we authorize providers on the Client Eligibility Notice (CEN)?1. Identify the client’s ‘system of care’ (sub-
specialists) Applies to all CSHCS clients Assure client has access to appropriate care
2. Claims processing (CHAMPS) Does not apply to clients with full Medicaid
except for CSHCS-only services paid through the CHAMPS system (e.g. orthodontia)
ADDING PROVIDERS
April 201312
Currently CSS is not adding providers to the Client Eligibility Notice (CEN) unless services were provided during the time client was not a MHP member
CONCERNS: If the provider is authorized on the CEN:Client/family may assume the MHP will cover care even if MHP guidelines are not followedProviders may assume they can provide services without coordinating with the MHP
ADDING PROVIDERS FOR MHP MEMBERS
April 201313
The Dilemma: Identify client’s ‘system of care’ (sub-specialists) CHAMPS ready for claims processing should client lose
Medicaid coverage
MHPs do not ‘authorize’ providers Is provider in the MHP network? Do services require prior authorization? Is the provider willing/able to work with the MHP? Member Handbook – MHP Website – MHP Member
Services
ADDING PROVIDERS FOR MHP MEMBERS
April 201314
QUESTIONS ?
April 201315
CHAMPS CLIENT VIEW
April 201316
CHAMPS CLIENT VIEW
April 201317
CHAMPS CLIENT VIEW
April 201318
CHAMPS CLIENT VIEW
April 201319
April 201320
CHAMPS CLIENT VIEW
April 201321
Client NameClient NameClient NameClient Name
QUESTIONS ?
April 201322
April 201323
April 201324
April 201325
CHAMPS CLIENT VIEW
April 201326
April 201327