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California’s Coordinated Care Initiative

California’s Coordinated Care Initiative. Provider Tutorial : Using AEVS to Determine Patient Plan Participation June 2014. DRAFT. Tutorial: AEVS System & Plan Information. Coordinated Care Initiative: Plan Options

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California’s Coordinated Care Initiative

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  1. California’s Coordinated Care Initiative Provider Tutorial: Using AEVS to Determine Patient Plan Participation June 2014 DRAFT

  2. Tutorial: AEVS System & Plan Information • Coordinated Care Initiative: Plan Options • What to Look for in Automated Eligibility Verification System (AEVS) • AVES Samples DRAFT

  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. DRAFT

  4. Plan Options: What This Means for Billing 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

  5. AEVS: What to Look For • 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

  6. AEVS: Plan Names Matter • 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

  7. Plan Names – Active CCI Counties DRAFT

  8. AEVS: Sample Screen Shots • 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

  9. Sample: Cal MediConnect DRAFT

  10. Sample: Medi-Cal Plan/ Medicare FFS DRAFT

  11. Sample POS: FFS Medi-Cal/FFS Medicare DRAFT

  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

  15. More Information www.CalDuals.org info@calduals.org DRAFT

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