MEDICAID MANAGED CARE ORGANIZATION (MCO) TRAINING CONDUCTED BY : THE DEPARTMENT FOR PUBLIC HEALTH & CUSTOM DATA PROCESSING October 18 th, 2011.

MCO CARD OR LETTER

Identified with #6

Log on to www.directprovider.com

Call CoventryCares IVR line @ 1-855-300-5528

http://chcmedicaid-kentucky.coventryhealthcare.com/

Identified with #7

Log on to www.KentuckySpiritHealth.com

Search by date of service and Medicaid ID # or KY Spirit ID #

Call automated system(IVR) at 1-866-643-3153 from a touch tone phone

Call Ky Spirit Health Plan Provider Services @ 1-866-643-3153

Identified with #8

Log on to www.kentucky.wellcare.com

Call WellCare’s IVR @ 1-877-389-9457

Call WellCare’s Customer Service @1-877-389-9457

VERIFY PATIENT ELIGIBILITY

•Verify Medicaid # and MCO member #.

•Print both initially and place in patient chart.

•This will provide proof for billing/inquiries in case there are any problems.

•If no card or letter use KY Health Net & call the MCO listed there.

•Key into Registration.

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Medicaid MCO – drop down of available MCO’s. Previously shown as:“Managed Care Region”

MCO Member # - up to 20 characters availablePreviously shown as:“Managed Care Member #”

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PEF label will show MCO/REGN#

Registration label will show MCO Member #

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MCO COV

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1234567890 MCO

CODING IS THE SAME AT THIS TIME

Anything currently covered by Preventive.

ENTER PEF

VERIFY

Appropriate Medicaid status is in MDCD Field on Encounter Entry Screen

Put Y in bill screen field

On Bill Screena). If not payor code 2, re-verify system informationb). If not working properly call LHO Help Desk at 502-564-6663, option [email protected]

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CDP is working with each MCO to program their specific requirements. IE: VFC modifiers.

New E-reports must be created.

Testing of billing files-live during first week.