CMCS Connections

M E M B E R R E S P O N S I B I L I T I E S : W H O T O C A L L : A C T I O N T O TA K E : H O W L O N G W I L L I T TA K E ? The first step is for the member to CHOOSE A HOOSIER HEALTHWISE MANAGED CARE ENTITY (MCE) PLAN. The insurance or MCE plans for the Hoosier Healthwise (HHW) Medicaid program are: Anthem Medicaid / MDwise Medicaid / MHS Medicaid Hoosier Healthwise Hotline (HHW): (800) 889-9949 If the member has a doctor they want to be assigned to, find out which MCE that office accepts and which hospitals they work with. Choosing a health plan which includes their doctor and the hospital where the member would go for a medical emergency keeps the member "In Network" and all their healthcare in one delivery system. It takes about 10-30 days to be assigned to the MCE the member has chosen. (Traditional Medicaid members will not be assigned to a certain health plan; they can go to any provider who accepts Medicaid and will not be assigned a doctor.) Next, the member will need to CHOOSE A DOCTOR IN THE MCE PLAN. If they do not choose a provider, they will be auto-assigned to one within that plan. MDwise Customer Service: (800) 365-1204 Anthem Medicaid Customer Service: (866) 408-6131 MHS Customer Service: (877) 647-4848 All MCE plans have a website to help members choose a doctor. If the member is choosing a MDwise Provider, there are 8 MDwise delivery systems: MDwise St. Vincent (Central Indiana area) MDwise IU Health (Statewide) MDwise Eskenazi (Indianapolis area) MDwise Hoosier Alliance (Statewide) MDwise St. Margaret Mercy MDwise & St. Anthony (NE Indiana) MDwise Select (South Bend) MDwise St. Catherine (NE Indiana) It can take up to 30 days to be assigned to a doctor in the MCE plan. Requests made by the 20th of the current month will be effective by the 1st of the following month. If the member wants to CHANGE MCE PLANS, call the HHW Hotline. If the member has MHS Medicaid, MDwise Medicaid or Anthem Medicaid and wants to change to a different one of these three plans, the member needs to call Hoosier Healthwise. Hoosier Healthwise Hotline (HHW): (800) 889-9949 A member can change MCE plans during the 1st 90 days of enrollment, or during their annual enrollment anniversary. Members can call Hoosier Healthwise Hotline to make a change. Other reasons for changing health plans may be allowed. After requesting a change in MCE plans, repeat the step above. The member will need to call the MCE plan to choose a new doctor - see second row above. It takes 30-45 days to be assigned to a different MCE plan. Requests made by the 20th of the current month will be effective by the 1st of the following month. It is best to allow 30-45 days for MCE Plan changes to be active. A new doctor must also be chosen. The member needs to call the Insurance plan for the doctor choice - see the second row above. If the member wants to CHANGE TO A DIFFERENT DOCTOR WITHIN THEIR ASSIGNED PLAN, they need to call their MCE plan customer service number to make a request. MDwise Customer Service: (800) 365-1204 Anthem Medicaid Customer Service: (866) 408-6131 MHS Customer Service: (877) 647-4848 A member can change providers within their MCE plan any time they wish; however, changing doctors frequently does not help with continuity of care and providing Patient Centered Medical Home care. It can take about 3-10 days for a request to change doctors within an MCE plan to be completed. IF THE DOCTOR'S OFFICE PANEL OF PATIENTS IS FULL, BUT THE DOCTOR AGREES TO ADD THE MEMBER to their panel, the member will need to sign a Full Panel add form at the doctor's office The member can also call the customer service center for their MCE plan at the phone number above, to confirm their request to switch doctors. The provider's office should fax the full panel add request form to the MCE plan the member is assigned to. Full panel add forms will only work within an assigned plan, they cannot be used to switch the member from one MCE plan to another. If the member is not in the correct MCE plan, they first need to call Hoosier Healthwise to switch It takes about 3-10 days for a request to change doctors within an MCE plan to be completed. Members need to call the provider's office if they are unable to keep a scheduled appointment. IF THE PROVIDER REQUESTS A MEMBER REASSIGNMENT TO A NEW PROVIDER FOR A VALID REASON, such as missing too many appointments, the Medical Director will review the request. If the reassignment is approved, the member will be sent a reassignment letter. For questions about member reassignment issues, providers should call: MDwise Customer Service: (800) 365-1204 Anthem Medicaid Customer Service: (866) 408-613 MHS Customer Service: (877) 647-4848 or their provider representative. IF THE DOCTOR'S OFFICE WOULD LIKE TO REQUEST REASSIGNMENT OF A MEMBER FOR A VALID REASON, the office should refer to the MCE plan's website and Policy & Procedure. Member disenrollment or reassignment forms are available on each MCE Plan's website: MDwise. org; MHSIndiana.com; or Anthem.com/inMedicaid. Member reassignments must be reviewed and approved by the MCE Medical Director. If approved, the member will be reassigned to a new doctor within 10 business days. PMPs must demonstrate just cause for the reassignment & submit supporting documentation. PMPs may not dismiss a member from their care until the reassignment has been approved by the respective MCE plan Medical Director and the member has a new PMP assignment. Valid reassignment reasons are listed in the provider manual published by each health plan. Valid reasons include having multiple missed appointments, member fraud, threatening, abusive or hostile behavior, medical needs better met by another PMP, breakdown in physician/ patient relationship and other reasons. m a k i n g m a n a g e d c a r e w o r k f o r y o u • C M C S c o n n e c t i o n s s p e c i a l i n s e r t • 2 n d q u a r t e r 2 0 1 4 How to Help Medicaid Hoosier Healthwise Members with enrollment & changes in health plans, delivery systems or providers BY Rochelle Bailey, Provider Representative for MDWise St. Vincent

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