medicare managed care appeals

MAXIMUS Federal Services, Inc.. Who We Are and What We DoIndependent Review EntityStaff includes Health Care Attorneys and NursesIndependent Medical Panel More than 20 years direct experience with Medicare managed care appeals. 2. Working with MAXIMUS. Sending CasesCase ProcessingEffectuation Advanced Appeal Issues

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Prevention in Medicare Managed Care Plans

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Medicaid Managed Care Initiatives

STARCapitated, Health Maintenance Organization (HMO) model for non-disabled pregnant women and children.Provides acute care services.STAR PLUSCapitated HMO model for disabled Medicaid clients and dual eligibles (Medicaid and Medicare).Provides acute and long term services and supports (LTSS).

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Statewide Medicaid Managed Care Overview

Statewide Medicaid Managed Care Overview. Presented to Commission for Transportation Disadvantaged April 11, 2012 Beth Kidder Assistant Deputy Secretary for Medicaid Operations. Overview of 2011 Legislation.

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Medicaid Managed Care Regulations

Medicaid Managed Care Regulations. Silvia Rodriguez-S á nchez Erika Cristo. Discussion Overview. Background MMC Regulations Technical Areas DMH Implementation Process DMH Communication with CMS Beneficiary Problem Resolution Processes Title 9, CCR, §1850.205

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Texas Medicaid Managed Care Basics

Texas Medicaid Managed Care Basics. Michelle Apodaca John Berta November 2011 . Topics. Key Features Managed Care Operations Managed Care Contracting Resources Reimbursement and Out-of-Network Issues. STAR Service Areas – March 1, 2012. Rural Service Areas – March 1, 2012.

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Medicaid Managed Care

Medicaid Managed Care. Virginia Premier Health Plan April 17, 2012. Today’s Presentation . Introduction to Medicaid Managed Care Why Virginia Premier? What does this mean for my patients? Member Benefits and Eligibility What does this mean for my practice?

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Medicaid Managed Care Introduction and Update

Medicaid Managed Care Introduction and Update . Medicaid Rural Service Area. What is Medicaid Managed Care?. Establish a medical home for Medicaid clients through a primary care provider Emphasize preventative care Improve access to care Ensure appropriate utilization of services

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Medicare and Medicaid

By: Kevin Tang. Medicare and Medicaid. -Senator Robert Wagner tries to pass National Health Act of 1939. Fails. -On November 19, 1945,President Truman outlined a comprehensive, prepaid medical insurance plan for all people through the Social Security system.

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Medicare and Medicaid $

Medicare and Medicaid $. HSPM 714 J50 Fall 2013. http://theincidentaleconomist.com/medicares-structure-and-payment-systems-part-i-traditional-medicare/. http://theincidentaleconomist.com/medicares-financing-problems-the-basics/.

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Medicaid Reform Managed Care Study

Medicaid Reform Managed Care Study . Interim Update. May 2013. Study Background. SEA0082 passed by Wyoming Legislature (2013) Requires WDH to explore the use of managed care for the Medicaid population

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Upholding Medicaid Managed Care Requirements

Upholding Medicaid Managed Care Requirements. Presentation by Sarah Somers and Wayne Turner Sponsored by the Aging and Disability Partnership for Managed Long Term Services and Supports. Sept. 19, 2013. Upholding Medicaid Managed Care Requirements. Overview of Medicaid Managed Care

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Managed Care and Medicare Expenditures

Managed Care and Medicare Expenditures. Health Economics Interest Group Seattle, WA Michael Chernew Phil DeCicca Robert Town June 24, 2006. Overview. Background Data and Analysis Sample Empirical Strategy Results Tentative Conclusions. Background.

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Medicaid Managed Care Basics

Medicaid Managed Care Basics. Presentation to the Specialized Services Subcommittee September 13, 2010. Overview of Presentation. What is Medicaid Managed Care? Specifically, what is risk-based contracting? How does it compare to existing MaineCare approaches?

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Medicaid Managed Care Key Concerns

Medicaid Managed Care Key Concerns. Input of Stakeholders Enrollment and Marketing Services and Benefits Access to Experienced Providers Reimbursement Quality Management and Monitoring. Ryan White Programs public health mission population driven enabling services

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Government Involvement in Health Care - Medicare and Medicaid

Government Involvement in Health Care - Medicare and Medicaid. Craig A. Pedersen, R.Ph., Ph.D. School of Pharmacy Ohio State University and Mary Haven. Objectives Medicare and Medicaid. After viewing and listening to the Internet lectures, the student will be able to:

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Medicaid Managed Care Initiatives

Medicaid Managed Care Initiatives. December 2011. Medicaid Service Delivery Models. STAR Capitated, Health Maintenance Organization (HMO) model for non-disabled pregnant women and children. Provides acute care services. STAR+PLUS

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Medicare and Medicaid

Medicare and Medicaid. “Unlocking the Gate to Funding Assistive Technology”. Who’s Who?. CMS (Centers for Medicare and Medicaid Services) Medicare Part A: Hospital Insurance Part B: Medical premiums cover DME, outpatient care Divided into 4 regions (DMERCs) Medicaid

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Statewide Medicaid Managed Care (SMMC)

Statewide Medicaid Managed Care (SMMC). Managed Medical Assistance (MMA) Program State Consumer Health Information and Policy Advisory Council June 18, 2014. Why are changes being made to Florida’s Medicaid program ?.

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Medicaid Managed Care Initiatives

Medicaid Managed Care Initiatives. December 2011. Medicaid Service Delivery Models. STAR Capitated, Health Maintenance Organization (HMO) model for non-disabled pregnant women and children. Provides acute care services. STAR+PLUS

234 views • 21 slides

Medicare and Medicaid Integrated Care

Medicare and Medicaid Integrated Care. Gale Arden Centers for Medicare & Medicaid Services June 5, 2006. Key Features. Section 231 of the MMA created new type of Medicare Advantage Plan focused on individuals with special needs Individuals identified as –

285 views • 25 slides