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