Mmai illinois 2021
Mmai illinois 2021. Each of our members is on their own personal health care journey. Overview. To learn more about dental benefits, see the Member Handbook on the Forms Participate in our quarterly Blue Cross Community Member Advisory Board meetings. Jun 10, 2021 · The Medicare-Medicaid Alignment Initiative (MMAI) is an insurance program run by the state of Illinois that replaces Medicare Parts A, B & D primary insurance coverage AND Medicaid secondary insurance coverage. Machine Readable Formulary File. Please refer to code specific listing as requirements may MMAI Enrollments — December 2021 HealthChoice Illinois Enrollments — December 2021 (continued) 2021 12 MCO Enrollment Report for Website 010522. . Medicare Part B Step Therapy. Medical Criteria. Title: 2021 07 MCO Enrollment Report for Website_Revised100421. We hope these manuals make your interaction with us as efficient as possible by clarifying administrative requirements that support health care services provided to our members and your patients . The Financial Alignment Initiative seeks to increase access to high quality, seamless systems of care that better coordinate benefits and services for the dually eligible enrollee population. Rather than viewing all codes on a running list in a static document, you can use our interactive digital lookup tool to perform a faster, more targeted search. You may also find the Member Handbook on our We would like to show you a description here but the site won’t allow us. Once you have picked a health plan and a PCP, you are ready to enroll! Call Illinois Client Enrollment Services at 1-877-912-8880. Public: Important: You are being enrolled in the Medicare-Medicaid Alignment Initiative (MMAI)! To help your Medicare and Illinois Medicaid benefits work better for you, we are enrolling you in an MMAI health plan. to 6 p. MMAI reformed the way care is delivered to customers who are eligible for both Medicare and Medicaid services (dually eligible) by providing coordinated care and became a statewide program on July 1, 2021. DME . pub Jul 1, 2021 · HCI, YouthCare, and MMAI MCO Assigned Tracking Number Example: • Prior to 7/1/2021: Example - 07-210427-52852 • After 7/1/2021: Example - U327I2W00046 HCI, YouthCare, and MMAI MCO Assigned Tracking Number Instructions: • The tracking number instructions are provided at the links above. indd 1 12/20/23 9:28 AM Jan 11, 2021 · The following summary and related prior authorization lists were posted on the Support Materials (Commercial) page the Utilization Management section of our Provider website as of Jan. Jul 1, 2021 · Aetna Better Health® Premier Plan MMAI is a Medicare-Medicaid health plan for people who are dual-eligible. It outlines general care categories with These manuals set forth the detailed policies, procedures and requirements necessary for participation in the BCBSIL contracting provider networks. Illinois SB251 2021-2022 Amends the Illinois Public Aid Code Provides that the Department of Healthcare and Family Services shall provide each managed care organization with the quarterly feeforservice facilityspecific nursing component rather than facilityspecific RUGIV nursing component per diem along with any addons for enhanced care services support component per diem and capital component Jun 11, 2021 · CHICAGO, June 11, 2021 /PRNewswire/ -- Aetna ®, a CVS Health ® company (NYSE: CVS ), announced it has received approval to expand its existing Illinois Medicare-Medicaid Alignment Initiative HealthChoice Illinois Enrollments — September 2021 (continued) 6,503 7,985 We would like to show you a description here but the site won’t allow us. Title: HFS-MMAI Transition Plan_093022. Copeland Created Date: 3/5/2021 3:11:31 PM Jul 1, 2022 · Practitioner Fee Schedule Updated 12/31/2021 (xls) Practitioner Fee Schedule Key Updated 01/21/2022 (pdf) Practitioner Fee Schedule Key Updated 01/03/2022 (pdf) Title: 2021 05 MCO Enrollment Report for Website. Provider and Pharmacy Search. How to Apply. 2021 . Aetna Better Health Premier Plan MMAI works with certain subcontractors to coordinate services that are provided by entities other than the health plan, such as transportation, vision or dental services. If you submit claims to LC8453IL1020_(ILHKYJJEN) Effective: Jan. Click the link below to view or save a copy. If you think a doctor, hospital or other pharmacy is doing something wrong, please contact us. MMAI combines both medical care and non-medical home and community-based services into a single program. , Central time, for information on joining or leaving Humana Gold Plus Integrated (Medicare-Medicaid plan). With Virtual Visits, your appointment will be with an independently contracted, board-certified MDLIVE doctor or therapist for minor, non-emergency medical issues and behavioral health conditions by phone, mobile app or online video anytime The Illinois Dept. • Aetna Better Health Premier Plan MMAI PO Box 66545 Phoenix, AZ 85082. The Managed Care map provides more information about the MCOs that are operating in the MMAI program by county. State of Illinois . Illinois Client Enrollment Select “For Providers” then the “Claims” tab and finally, click the link to “WebConnect” Paper Claims. It explains health care services, behavioral health coverage, prescription drug coverage, and long-term services and supports. October 1, 2023 - CMS, Illinois, & participating plans execute an updated three-way contract. illinois. MMAI, medicare We would like to show you a description here but the site won’t allow us. 2018, and amended on September 1, 2019, and re-executed July 1, 2021 provided however, that any duties, (MMAI) pursuant to a written Jul 1, 2021 · Aetna Better Health® Premier Plan MMAI, a Medicare-Medicaid health plan for people who are dual-eligible. This is known as the Medicare-Medicaid Alignment Initiative (MMAI) in Illinois. Meridian Medicare -Medicaid Plan's Provider and Pharmacy MMAI Enrollments — November 2021 HealthChoice Illinois Enrollments — November 2021 (continued) 2021 11 MCO Enrollment Report for Website 120921. Feb 28, 2023 · The Aetna Better Health Premier Plan MMAI formulary can be found below. Glucose Meters. Financial Criteria. 5 days ago · The Illinois Medicare-Medicaid Alignment Initiative (MMAI) is a managed care program for individuals who are eligible for both Medicaid and Medicare (referred to as “dual eligibles”). MMAI Model Your case manager will meet with you by phone or where you live as often as needed. July 1, 2021 - CMS, Illinois, & participating plans execute an updated three-way contract. Note: Existing counties will NOT be included in the Illinois Department of Healthcare and Family Services Medicaid Managed Care Program Map January 1, 2021 Medicare-Medicaid Alignment Initiative (MMAI) Plans Aetna Better Health Premier Plan Cook, DuPage, Kane, Kankakee, Will Blue Cross Community MMAI Cook, DuPage, Kane, Kankakee, Lake, Will Humana Health Plan Cook, DuPage, Kane, Kankakee, Lake, Will We would like to show you a description here but the site won’t allow us. com 2nd Quarter 2024 2068606_237727. Illinois Medicaid Prior Authorization ommunity MMAI (Medicare-Medicaid)℠ members. Blue Cross Community MMAI Provider Manual – Updated December 2021 5 Benefits and Beneficiary Rights Member’s Rights and Responsibilities Blue Cross and Blue Shield of Illinois (BCBSIL) is committed to ensuring that enrolled members are treated in a manner that respects their rights as individuals entitled to receive health care services. You also can go to the Illinois Client Enrollment Services website. gov, click Manage My Case to find your renewal due date and verify your mailing address. CY 2020 MMAI MLR Report – Aetna Illinois Department of Healthcare and Family Services Dental Program. The Provider Manual has everything you need to know about member benefits, coverage, and provider guidelines. Our members must live in one of these counties: Cook, DuPage, Kane, Kankakee and Will. Blue Cross and Blue Shield of Illinois (BCBSIL) conducts readmission review of hospital services provided to our Blue Cross Community Health Plans SM (BCCHP) and Blue Cross Community MMAI (Medicare-Medicaid Plan) SM members. com. End Date: 05/09/2022 City - State - Zip: CHICAGO, IL 60601 MCO Program Code (Exclusion Cd) MCO Program Code Description 3 DCFS 6 HealthChoice, IL (MMCP) 8 Medicare Medicaid Alignment Initiative (MMAI). What is MMAI? joint initiative of the Federal and State governments to improve quality of care for individuals eligible for both Medicare and Medicaid. Long-term services and supports include long-term care and home and IL FAI Demo Summary of Contract Changes \(10012023\) Keywords "Illinois, IL, Medicare-Medicaid Alignment Initiative, MMAI, Financial Alignment Initiative, FAI, Demonstration, capitated model, Summary of Contract Changes, effective 10012023, three-way contract, demonstration updates, December 31, 2025 end date" Created Date: 11/8/2023 9:14:08 AM Jan 12, 2023 · Call Illinois Client Enrollment Services at 877-912-8880 (TTY: 866-565-8576), Monday – Friday, 8 a. This plan is also known as the Medicare - Medicaid Alignment Initiative in Illinois. 22. Qualifying When Over the Limits. 2022 Illinois-CMS-sponsored MMAI (Demonstration) provider manual – effective October 10, 2022, PDF. Claim Dispute/Complaint Process: MMAI Plans by County Region 2-Central Region 3-Southern. Unless you opt-out of the deeming, you will automatically be added to the MMAI Statewide Network. This program will benefit our Members Title: 2021 02 MCO Enrollment Report for Website. Formulary. Who is Eligible to Enroll. Jun 16, 2021 · June 16, 2021 - Aetna is expanding its existing Medicare-Medicaid Alignment Initiative (MMAI) plan to provide coverage for all dual eligibles in Illinois. MMAI combines Medicare and Medicaid funding under a blended payment agreement to provide integrated, comprehensive care to benefit dual-eligible enrollees. You may be assigned care coordination services based on your health assessment needs. The call is free! All Medicare-Medicaid Alignment Initiative (MMAI) plans have the same services that you get now, such as: 24/7 nurse line Behavioral health services Doctor services Eye care services Hearing services. Aetna Better Health® Premier Plan MMAI ‐ Prior Authorization (PA) List. to 7 p. ACA Enrollment 2021. Home health care Hospice care Hospital services Lab tests and X-rays Medical supplies. If you do not use the $30, it does not roll over into the next three months. Illinois Department of Healthcare and Family Services Medicaid Managed Care Program Map August 1, 2021 Medicare-Medicaid Alignment Initiative (MMAI) Plans Aetna Serving all counties statewide Blue Cross Serving all counties except: Champaign, E˜ngham, and Massac Humana Serving all counties except: Jo Daviess, Macon, Massac and Rock Island Meridian In addition to your dental coverage, you may be able to get a supplemental dental benefit as a Blue Cross Community MMAI plan member. See if you qualify, and explore the HealthChoice Illinois The plan will pay up to $30 (plus $5 for shipping) for each order. As of 7/1/2021, our service area includes these counties in Illinois: Molina Healthcare of Illinois is participating in a multi-year demonstration program between the Centers for Medicare & Medicaid Services (CMS) and the Illinois Department of Healthcare and Family Services (HFS). Through Humana Gold Plus Integrated, your Medicare and Medicaid coverage and benefits are combined into one plan—PLUS you get prescription drug coverage. MMAI is a demonstration plan developed to better serve individuals eligible for both Medicare and Medicaid. This is only a summary. Approval Process & Timing. If you live in a long term care facility or get home and community based waiver services, you must enroll in a health plan for these Medicaid benefits if you are not enrolled in an MMAI plan. To join our MMAI network, follow the process for Contracting. Copeland Created Date: 20210309100054Z Recently, we added a digital lookup tool that gives you a different way to view prior authorization requirements that may apply to our BCCHP and MMAI members. MMAI is a demonstration program, taking place in Illinois and several other states. B Illinois MMAI MMP Performance on Select HEDIS Quality Measures, 2014–2021. To see if you are eligible, Contact: Blue Cross and Blue Shield of Illinois' OTC vendor, Convey Health Solutions†, at: 1-855-891-5274. The Medicare Medicaid Alignment Initiative (MMAI) is a demonstration plan of the Illinois Department of Healthcare and Family Services (HFS) and the Centers for Medicare & Medicaid Services (CMS) designed to improve healthcare for seniors and person with disabilities. Instead, their coverage will be under one plan and one card. Illinois Department of Healthcare and Family Services Medicaid Managed Care Program Map January 1, 2021 Medicare-Medicaid Alignment Initiative (MMAI) Plans Aetna Better Health Premier Plan Cook, DuPage, Kane, Kankakee, Will Blue Cross Community MMAI Cook, DuPage, Kane, Kankakee, Lake, Will Humana Health Plan Cook, DuPage, Kane, Kankakee, Lake, Will Jan 1, 2021 · Illinois joint CMS-State sponsored Medicare-Medicaid Alignment Initiative (MMAI) MMAI Provider Resource Guide, PDF. 1-877-912-8880 (TTY: 1-866-565-8576). Please read the Member Handbook for the full list of benefits. CMS is working with states to test two integrated care delivery models: a capitated model and a managed fee-for-service (MFFS) model. ©2021 Aetna Inc. As of 7/1/2021, our service area includes these counties in Illinois: Blue Cross Community Health Plans SM. Read More About HFS Notices Issued May-June 2019 Read More About HFS Notices Issued May-June 2019 May 1, 2024 · For information on Meridian and other options for your health care, call the Illinois Client Enrollment Services at 1-877-912-8880 (TTY: 1-866-565-8576) or visit IL_BCCHP_BEN_OTCBenefits22 Approved 12212021 237727. pub This change aligns with the Illinois Department of Healthcare and Family Services (HFS) transition toward paperless claim filing last year, as outlined in this HFS provider notice from November 2021. With added benefits like support making smart health choices, personal care coordination, 24-hour nursing help line, and more. CMS overview of the Medicare-Medicaid Alignment Initiative (MMAI) Program At this time, Aetna is the only health plan approved to operate MMAI program in all 102 counties. 1, 2021 Humana Gold Plus Integrated Illinois Medicare-Medicaid Alignment Initiative (MMAI) Long-Term Services and Supports (LTSS) Provider Billing Guide We would like to show you a description here but the site won’t allow us. How to enroll in the Medicare-Medicaid Alignment (MMAI) program. You can also call 1-800-843-6154. 0124 Over-the-Counter Benefits Blue Cross Community Health Plans Customer Service 1-877-860-2837 TTY/TDD: 711 www. Benefits. This benefit—a $800 allowance—would help pay for dental services that would NOT otherwise be covered by Medicare or Medicaid. CHICAGO, IL — Aetna®, a CVS Health® company (NYSE: CVS), announced it has received approval to expand its existing Illinois Medicare-Medicaid Alignment Initiative (MMAI) demonstration health plan (Aetna Better Health® Premier Plan MMAI) to serve the entire state. FOR PROVIDERS: Please notify Meridian Provider Services with any updates or changes to the information listed by calling 1-855-323-4578, emailing providerupdates@mhplan. Mar 1, 2014 · The MMAI demonstration project will be available to provide coordinated care to more than 135,000 Medicare-Medicaid enrollees in the Greater Chicago area and throughout central Illinois. HFS and CMS are jointly reviewing readiness for implementation of the MMAI, which had been scheduled to begin opt-in enrollment in February 2014. m. Help set up care with your doctor and other If you choose not to enroll in the MMAI program, you must enroll in HealthChoice Illinois. Title: 2058682_242129. Blue Cross and Blue Shield of Illinois (BCBSIL) offers Blue Cross Community Health Plans (BCCHP) which includes a network of independently contracted providers including physicians, hospitals, skilled nursing facilities, ancillary providers, Long-term Services and Support (LTSS) and other health care providers through which Illinois Medicaid members may The Illinois Department of Healthcare and Family Services (HFS), authorized by the Affordable Care Act, will enroll people who receive Medicare and full Medicaid benefits in managed fee- for-service or capitated managed care plans that seek to integrate benefits and align financial You can enroll in Meridian by contacting Client Enrollment Services for the Illinois Department of Healthcare and Family Services at 1-877-912-8880 (TTY 1-866-565-8576), Monday through Friday from 8 a. roberts Created Date: 11/28/2022 1:04:22 PM a better care experience and better align the financial incentives of the Medicare and Medicaid programs. ABC. 2023 Illinois Compiled Statutes Chapter 305 - PUBLIC AID 305 ILCS 5/ (MMAI) Nursing Home Residents' Managed Care Rights Law. The MMAI demonstration has been extended through Apr 6, 2021 · My Care Information member authorization form ( English / Spanish) (updated 4/6/2021) forms that providers may need Apr 25, 2024 · Provider Manual. Updated 10/1/2021 Green highlighted codes are managed by eviCore. Electronic claim filing offers greater security and accuracy of data, with faster processing and payment. Copeland Created Date: 10/4/2021 3:51:15 PM Jan 1, 2021 · ANYTOWN. 3-12 5 Illinois MMAI MMP members with care plans completed within 90 days of Feb 22, 2013 · September 1, 2019 - CMS, Illinois, & participating plans execute three-way contract amendment. These are also known as case management services. MMAI program, you can choose not to enroll (opt out) by calling us at 1-877-912-8880 (TTY 1-866-565-8576). In Illinois, eight health plans have been contracted by the State and the Centers for Medicare & Medicaid Title: 2021 01 MCO Enrollment Report for Website. Call Monday to Friday, 8 a. The call is free. – 6 p. MMAI plans will be available to Illinois residents who: • Are residents of the Greater Chicago or Central Illinois regions and; • Are at least age 21, entitled to Medicare Part A, and enrolled in Medicare Parts B and D; • Are eligible for full Medicaid benefits; MMAI reformed the way care is delivered to customers who are eligible for both Medicare and Medicaid services (dually eligible) by providing coordinated care and became a statewide program on July 1, 2021, In FY2022, a total of five (5) MCOs contracted to provide services under MMAI. Treating COVID-19 This handbook tells you about your coverage for the time you are enrolled with Aetna Better Health Premier Plan MMAI through December 31, 2021. Services include: Help transitioning your care when you leave the hospital for physical or behavioral health needs. You can get one shipment every three months. MMAI Enrollments — August 2021 HealthChoice Illinois Enrollments — August 2021 (continued) 2021 08 MCO Enrollment Report for Website. Effective 1/1/2021, Aetna Better . June 2021 Reminder: Hospital 30-day Readmission Review Process for BCCHP SM and MMAI Members. We would like to show you a description here but the site won’t allow us. However, I still very confused on the benefits of getting an MMAI plan vs separate Medicare and Medicaid plans outside of convenience Please help - thank you! With HealthChoice Illinois, you have a health plan partner to turn to for help. 1, 2021: 2021 Commercial Prior Authorization Requirements Summary This one-page overview has been streamlined for 2021. 2021 2020 2019 Other previous versions. Call us at Aetna Better Health Premier Plan MMAI Member Services at 1-866-600-2139 (TTY: 711), 24 hours a day, 7 days a week. 0124_IL_Medicaid_BCCHP OTC Catalog_2024 Q1_Member_Directory. Before You Apply. January 1, 2021 . Or, call Medicare at 1-800-MEDICARE (1-800-633-4227). of Healthcare and Family Services released notices on numerous issues, including ABE, NPI requirements, APR-DRG and EAPG, and MMAI. Mar 14, 2024 · Last updated: March 14, 2024. Eligibility Requirements. Overview of the Medicare-Medicaid Alignment Program. Illinois and CMS launched the Medicare-Medicaid Alignment Initiative (MMAI) Demonstration in March 2014. Copeland Created Date: 20210607153343Z If you have questions, please call Aetna Better Health Premier Plan MMAI at . Molina Dual Options is a health plan that contracts with both Medicare and Illinois Medicaid to provide benefits of both programs to enrollees. Call if you need us 24/7 Nurse Line BCCHP 888 343-2697 MMAI 877-213-2568 Care Coordination BCCHP 855-334-4780 MMAI 877-723-7702 Government Programs Reference Guide Medicaid and MMAI Compliance Reporting Fraud, Waste, and Abuse Reporting 800-543-0867 Department of Public Health 800-252-4343 Illinois Office of Inspector General 800-368-1463 Elder Abuse Hotline 866 Illinois Department of Healthcare and Family Services . Dec 31, 2017 · Background Today there are over 12 million Americans enrolled in both the Medicare and Medicaid programs. Table of Contents. Jul 21, 2021 · Posted July 21, 2021. Page with formulary, formulary updates, PA criteria, step therapy criteria. pdf Author: amy. Health Premier Plan MMAI . 1-866-600-2139 (TTY: 711), 24 hours a day, 7 days a week. If you have a member who needs one or more of these services, please contact Member Services at 1‑866‑600-2139 for more information. Illinois residents who are eligible for Medicare and Medicaid coverage and benefits can get it all through Humana Gold Plus® Integrated Medicare-Medicaid in Illinois. More on the back » IPM 0421 ENG . pub Author: Yoko. Coming soon, MMAI members will no longer carry two separate insurance cards. To verify telehealth coverage for our government programs members, call the appropriate Provider Services number to speak to a Customer Advocate: Medicare Advantage – 877-774-8592; MMAI – 877-723-7702; BCCHP – 877-860-2837. We can guide you in managing and improving your health. 00003. Key: MMAI Plan status by county Green indicates plan is eligible for passive and opt-in enrollment Yellow indicates plan is eligible to receive opt-in enrollment only Red indicates that the plan is not currently active in this county. Page 3 The Illinois Department of Healthcare and Family Services (HFS) is seeking a five-year extension of the Behavioral Health Transformation Section 1115 Demonstration (Project Number 11-W-00316/5) approved by the Centers for Medicare & Medicaid Services Blue Cross Community MMAI may offer coverage for Virtual Visits benefits, provided by Blue Cross and Blue Shield of Illinois and powered by MDLIVE. Formulary Updates. Oct 1, 2021 · Medicare Prescription Drug Coverage and Your Rights (PDF) - last updated Sep 8, 2021. MMAI Members: Get ready to renew your Medicaid! Start at abe. IL 60601-0001 . May 13, 2021 · Per the Illinois Department of Healthcare and Family Services (HFS), effective July 1, 2021, the Medicare Medicaid Alignment Initiative (MMAI) Program will be expanding. IL-20-12-01 Proprietary . Therefore, traditional health care services such as adding the Aetna Better Health Premier Plan MMAI (Duals MMP Plan) for Illinois to your existing Medicare contract that will begin on 7/1/21. If you are providing service to our Blue Cross Community Health Plans SM (BCCHP SM) and/or Blue Cross Community MMAI (Medicare-Medicaid Plan) SM members, review the updated information regarding how to submit claim disputes to Blue Cross and Blue Shield of Illinois (BCBSIL). 0121_IL_Medicaid_BCCHP MMAI BCCHP Prior Authorization Request Form_Provider Form. 1234. 2021 Illinois-CMS-sponsored MMAI (Demonstration) provider manual – effective Jan. Since March 2014, the MMAI has been This is a summary of health services covered by Aetna Better Health Premier Plan MMAI for 2021. Premier Plan MMAI IL-20-10-18 Distributed: February 2021 H2506_21WINMBRNWSLTR ACCEPTED Late Winter 2021. pub They are here to help you meet your health goals. To learn more about how we can help you with your health care, call Member Services at 1-866-600-2139 (TTY: 711), 24 hours a day, 7 days a week. 1, 2021, PDF. Step Therapy Criteria. Application Process. Transparency Law Data-manualnav. To request a Member Handbook, please call Member Services at 1-866-600-2139 (TTY: 711), 24 hours a day, 7 days a week. Prior Authorization Criteria. S02-ICESGD1S-7 IAD . bcchpil. Dear Jane Q. indd Created Date: 1/27/2021 3:25:49 PM Jan 1, 2021 · ANYTOWN. HealthChoice Illinois is the smart way most Medicaid members get quality care. (TTY 1-866-565-8576). Those who are dual-eligible qualify for both Medicare and Medicaid. wa hl oj sr tb oy ng tc xz av