Provider FAQ: AmeriHealth Caritas Iowa, Inc. Withdraw and Suspension of MCO Choice



IMPORTANT UPDATE--TEMPORARY SUSPENSION OF MCO CHOICE

AmeriHealth Caritas Iowa, Inc. withdrew from the IA Health Link managed care program effective November 30, 2017. AmeriHealth Caritas members have been assigned to UnitedHealthcare. The department has put in place a temporary suspension of Managed Care Organization (MCO) choice.
 
Previously the Department notified members they would be able to choose Amerigroup Iowa. Due to concerns with capacity, Amerigroup Iowa is not accepting any additional members at this time. This also includes all new IA Health Link members. In the future members will be able to choose from multiple MCOs. Members will be notified when that choice is available. 
 
AmeriHealth Caritas’ members transitioned to UnitedHealthcare effective December 1, 2017. Learn more by reading the sample member letter, the Press Release and the FAQs below.   
 

FAQ for Members

FAQ for Providers

Updated information will be posted as it is available. Please check back regularly.

This Questions and Answers web page will be updated regularly to reflect the latest questions from providers. Check this webpage regularly for the most up-to-date information. 

How will providers know which MCO their clients are assigned to?

Providers will continue to use the DHS eligibility tools to determine a member's MCO enrollment. Providers should also be in regular contact with their members to assist with completing timely MCO choice. Tentative assignment letters were sent to all AmeriHealth Caritas members, assigning them to UnitedHealthcare. 
 
This letter also said members could change their MCO to Amerigroup Iowa until March 1, 2018. This has changed. Amerigroup Iowa has informed the Department they do not currently have the capacity to take any new members. The Department has put in place a suspension of MCO choice.
 
Amerigroup Iowa will continue to serve IA Health Link members who were enrolled with Amerigroup Iowa prior to the announcement of AmeriHealth Caritas' withdrawal. This includes members who may have lost and regained eligibility, who were previously enrolled with Amerigroup Iowa.
 
Members who actively chose Amerigroup Iowa by November 16, 2017, will have coverage through Iowa Medicaid Fee-for-Service (FFS) until Amerigroup Iowa has capacity. 
 
In the future members will be able to choose from multiple MCOs. They will be notified when the choice is available. Until then, they must have a 'good cause' reason to change their MCO. 
 

It has been reported that there are several issues related to Amerigroup telephone support for provider enrollment. What process is Amerigroup following to facilitate enrollment of providers?

If Amerigroup's call center cannot answer the individual CDAC questions, the call is transferred to a voicemail within the Provider Relations department. These calls are logged and forwarded to Provider Relations. Due to an increase in calls, the delay in returning calls was longer than normal, but as of November 8, 2017, all voicemails left in this mailbox have been returned.
 

How will split billing for hospitalization be handled during the transition?

Please refer to IL 1864.
 

How will global billing for pregnancy and delivery be handled during the transition?

Please refer to IL 1864.
 

How will Community-Based Case Management (CBCM) be handled with the transition?

The MCOs will continue to be responsible for administration of CBCM services for their enrolled members. How each MCO decides to facilitate the provision of CBCM services for their HCBS members is that MCO's decision. Members should call their new MCO which they have coverage with effective December 1, 2017, for more information.
 

Please confirm that HCBS authorizations are good for 30 days, we assume this means until December 31, 2017.

The member's new MCO will honor continuity of care for the month of December 2017. The member's new MCO will be responsible for authorizations or extensions of the authorization past that date. Each MCO will use their own policies and processes to authorize servie plans in the future. FFS will follow the same process.
 

Will authorizations that currently go past 90 days be honored until their end date? In other words, if a current authorization does not end until next May, how long will it be valid?

The IA Health Link contract requires the member's new MCO to honor continuity of care for a 30-day transition period (this includes the full month of December 2017). The member's new MCO will be responsible for authorizations or extensions of the authorization past that date. Each MCO will use their own policies and process to authorize service plans in the future.
 

How will MCO's handle members CCO budgets which require prior authorization?

MCOs are actively working with Veridian to review the current authorizations under CCO budget.
 

How will current providers not enrolled with Amerigroup and UnitedHealthcare have their enrollment be expedited?

Informational letters 1585 and 1857 have been posted to the DHS website. These letters describe the provider deeming process for December 2017; and the need for each provider to work through the enrollment and credentialing processes for each MCO for services provided effective January 2018. 
 

Will there be a grace period that extends the HCBS programs level of care assessment deadlines?

AmeriHealth Caritas was directed to complete all new level of care, continue stay reviews and needs based assessments, and service/care planning activities that are due prior to the effective date of the termination of the contract. The IME will be working with the remaining MCOs regarding deadlines for completion of new and annual assessments. Waiver members will not lose their waiver eligibility or services due to overdue assessments.
 

How will the HH incentive withholding be handled by ACIA for the covered time periods?

ACIA is developing a plan which will be submitted to DHS on the payment of the incentive withholdings.
 

Will IHH enrollment automatically transfer to the new MCO or do providers need to disenroll/reenroll?

Member level IHH enrollment data will be provided to IME. Then the IME will provide IHH enrollment information to the MCOs. The MCOs will follow their processes for IHH enrollment. Contact Amerigroup or UnitedHealthcare for specific questions.
 

What documentation is needed for the 30 day period of IHH intensive case management authorizations?

Member level IHH enrollment data will be provided to IME. Then the IME will provide IHH enrollment information to the MCOs. The MCOs will follow their processes for IHH enrollment. Contact Amerigroup or UnitedHealthcare for specific questions.
 

Will prior authorizations be waived for the month of December?

The IA Health Link contract requires the member's new MCO to honor continuity of care for a 30-day transition period, this includes the full month of December 2017. The member's new MCO will be responsible for authorizations or extensions of the authorizatio past that date. Each MCO will use their own policies and process to authorize service plans in the future.
 

How will prior authorizations be handled for members that just changed MCO plans effective December 1, 2017?

The IA Health Link contract requires the member's new MCO to honor continuity of care for a 30-day transition period, this includes the full month of December 2017. The member's new MCO will be responsible for authorizations or extensions of the authorizatio past that date. Each MCO will use their own policies and process to authorize service plans in the future.
 

How will AmeriHealth Caritas approvals be shared with the member's new MCO?

As is currently the practice when a member switches MCOs, AmeriHealth Caritas has sent all authorizations for members who transitioned from AmeriHealth Caritas.
 

How will prior authorizations with a pending status on November 30, 2017, be handled?

AmeriHealth Caritas rendered a decision on all service requests for service dates through November 30, 2017, within their contractual timeframes.
 

How will MCOs address urgent needs of new members not yet loaded into the MCO's system?

The provider can check the state eligibility system to show which MCO the member is in. The MCO will work with providers if eligibiltiy is in the state system and not yet loaded in the MCO system.
 

When will members be loaded in UnitedHealthcare or Amerigroup portals for eligibility and prior authorization submissions for services scheduled in December 2017?

The IME provides member files to each MCO, MCOs will upload the eligibility into the MCO systems.
 

Members who were Medicaid ineligible at the time of service, retroactively reinstated to AmeriHealth Caritas. There is concern for processing the appeals for retro prior authorizations. Will AmeriHealth Caritas have staff to process these timely?

AmeriHealth Caritas will be responsible for any activity related to members enrolled through November 30, 2017, regardless of when the enrollment was received. AmeriHealth Caritas will also be responsible for member grievances and appeals (including state fair hearings), including those filed on or after the effective date of the termination of the contract but for dates of service through November 30, 2017.
 

Will utilized service benefit units be transferred to the new MCO to track the annual maximums?

The MCOs will administer benefit accumulators as defined by the state benefits.
 

What happens if a provider is out of network with Amerigroup or UnitedHealthcare but is contracted with AmeriHealth Caritas? Will current authorizations continue to be honored and how will reimbursement be handled?

Members will be enrolled with a new MCO beginning December 1, 2017. Any changes in MCO enrollment would follow the current policy that requires the new MCO to honor any existing PA for 30 days. Rates of reimbursement are per the MCO contract with the provider. Providers should follow the prior authorization requirements for the member's new MCO for dates of service starting December 1, 2017. 
 

What is the claim run-out period? Is this claim submission only or does this apply to any and all activity, ex: reconsiderations, disputes, appeals?

Providers have 180 days from the date of service, or the decision date from the member's primary carrier, to bill AmeriHealth Caritas. AmeriHealth Caritas will continue all activities related to claims in accordance to contractual timeframes. AmeriHealth Caritas will maintain claims processing functions for a minimum of 12 months after their termination date. They will also be financially responsible for all claims with dates of service through termination date.
 

Will the AmeriHealth Caritas NEMT contractor continue to book trips for December? How will AmeriHealth Caritas approved NEMT trips for December be communicated to the member's new MCO? Will that new MCO honor the AmeriHealth Caritas approved trips for December?

Please refer to IL 1861
 

How will Pharmacy PA be handled during the transition?

The process is the same as when members currently switch from FFS to MCO or MCO to MCO. Claims requiring a PA will not be processed if there is not an approved PA in place for an enrolled prescriber and a covered drug. PA files when available are provided to the MCOs and FFS for their enrolled members. 
 
Webpage Last Updated: December 7, 2017