15
California’s Coordinated Care Initiative Provider Tutorial: Using AEVS to Determine Patient Plan Participation June 2014 DRAFT
California’s Coordinated Care InitiativeProvider Tutorial: Using AEVS to Determine Patient Plan ParticipationJune 2014
DRAFT
Tutorial: AEVS System & Plan Information
• Coordinated Care Initiative: Plan Options
• What to Look for in Automated Eligibility Verification System (AEVS)
• AVES Samples
2
DRAFT
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.3DRAFT
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
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
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, we’ve put together a table of corresponding plan product names.
DRAFT
Plan Names – Active CCI Counties
7
Cal MediConnect Plans Medi-Cal Plans
L.A. Care Cal MediConnect Health Plan L.A. Care Health PlanSub-Plans: • Anthem Blue Cross• Care1st• Kaiser Permanente
CareMore Cal MediConnect Plan No Medi-Cal Only Plan
Care1st Cal MediConnect Plan Care1st
Health Net Cal MediConnect Health Net Community Solutions
Molina Dual Options Molina Healthcare
IEHP Dual Choice Inland Empire Health Plan
CommuniCare Advantage Community Health Group
Care Advantage CMC Health Plan of San Mateo
DRAFT
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
Sample: Cal MediConnect
9DRAFT
Sample: Medi-Cal Plan/ Medicare FFS
10DRAFT
Sample POS: FFS Medi-Cal/FFS Medicare
11DRAFT
12
Sample POS: FFS Medi-Cal &
Medicare Advantage
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. Care’s 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
14
Sample POS: Medi-Cal Plan Sub
to LA Care
DRAFT
