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Slide 1
Californias Coordinated Care Initiative Provider Tutorial:
Using AEVS to Determine Patient Plan Participation June 2014
DRAFT
Slide 2
Tutorial: AEVS System & Plan Information Coordinated Care
Initiative: Plan Options What to Look for in Automated Eligibility
Verification System (AEVS) AVES Samples 2 DRAFT
Slide 3
Coordinated Care Initiative: Health Plan Options Under the
Coordinated Care Initiative, your patients have new healthcare plan
options: Cal MediConnect Plan: Combines Medicare & Medi-Cal
benefits in one plan. Medi-Cal Plan: Patients can keep their
Medicare as it is now, but must pick a Medi-Cal plan for their
Medi-Cal benefits, including long-term services & supports such
as IHSS, CBAS, MSSP and nursing facilities. You can use AEVS to
determine which plans your patients are enrolled in. 3 DRAFT
Slide 4
Plan Options: What This Means for Billing 4 If the beneficiary
is enrolled in a: Cal MediConnect Plan: You bill the plan, or their
delegate, for both Medicare and Medi-Cal services. Medi-Cal Plan
for MLTSS: You continue to bill Medicare or the Medicare Advantage
plan the way you do today. Send the crossover claim for the 20%
copay to the Medi-Cal plan, which will pay was is required under
state law. DRAFT
Slide 5
AEVS: What to Look For 5 Health plan information in the
Eligibility Message section of the AEVS screen. If the beneficiary
is in a health plan, that plan name will be listed with contact
phone number. This will be listed in the top portion of the
eligibility message. There may be a Medicare Part C or D plan
listed in the bottom section of the eligibility message. The plan
name matters! DRAFT
Slide 6
AEVS: Plan Names Matter 6 Plans can offer both Cal MediConnect
and Medi- Cal plan products, so you need to know the specific
product name to determine your patients enrollment. Not all Cal
MediConnect plans have Cal MediConnect in their name. Below, weve
put together a table of corresponding plan product names.
DRAFT
Slide 7
Plan Names Active CCI Counties 7 Cal MediConnect PlansMedi-Cal
Plans L.A. Care Cal MediConnect Health PlanL.A. Care Health Plan
Sub-Plans: Anthem Blue Cross Care1st Kaiser Permanente CareMore Cal
MediConnect PlanNo Medi-Cal Only Plan Care1st Cal MediConnect
PlanCare1st Health Net Cal MediConnect Health Net Community
Solutions Molina Dual OptionsMolina Healthcare IEHP Dual
ChoiceInland Empire Health Plan CommuniCare AdvantageCommunity
Health Group Care Advantage CMCHealth Plan of San Mateo DRAFT
Slide 8
AEVS: Sample Screen Shots 8 What follows are sample AEVS screen
shots of enrollment in: Cal MediConnect Plan Medi-Cal Plan &
Medicare FFS Medi-Cal Fee-For-Service & Medicare FFS Medi-Cal
Fee-For Service & Medicare Advantage Plan Medi-Cal Plan Sub or
Delegate & Medicare FFS DRAFT
13 Sample POS: Plan Sub or Delegate In LA County, three plans
operate Medi-Cal plans (subs) under L.A. Care (prime Medi-Cal
plan). The sub Medi-Cal plan will be listed after L.A. Cares
Medi-Cal plan. Other plans, including Cal MediConnect plans, may
delegate to an physician group. This will be listed under the prime
plan name. You can always call the plan for more information about
contracts, billing and authorizations. DRAFT