HUSKY Health Program Medical ASO Transition Provider Questions and Answers

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1 What is an ASO? ASO stands for Administrative Services Organization. The Department of Social Services (DSS) is moving from a long time system of three at risk contracted Managed Care Organizations (MCOs) to a non-risk consolidated single entity to administer a broad range of member and provider services and healthcare support under the new HUSKY health program. The State has chosen Community Health Network of Connecticut to serve as the ASO. What is the ASO vendor responsible for? The ASO vendor will provide member services support such as referral assistance and appointment scheduling; health education; and intensive care management. It will also be responsible for utilization management, such as prior authorization; quality management, health data analytics and reporting. The ASO vendor will authorize and manage medical services for members. What is the State responsible for? The State will be financially responsible for claims payments which will be processed through Hewlett Packard Enterprises (HP), the vendor that currently processes claims for members enrolled in the State s Medicaid fee-for-service program. What benefit programs are covered under the ASO? HUSKY A, children and qualified adults under 185% federal poverty level (FPL) HUSKY B, children above 185% FPL HUSKY C, single eligible adults in the Aged, Blind and Disabled (ABD) category HUSKY D, eligible Low Income Adults (LIA) Charter Oak, adults ages uninsured for six months Can I continue to see my existing patients if I am not enrolled in the State s Medical Assistance Program network? In order to be reimbursed for any care that you provide to your patients for dates of service on or after January 1, 2012, you must be enrolled in the State s network (CT Medical Assistance Program-CMAP) as of January 1, If you are not enrolled in the State s network, your claims for any dates of service on or after January 1, 2012 will be denied by HP Enterprise services. The MCOs will not be responsible for any claims with dates of services on or after January 1, I only take HUSKY A and B clients today. Under the new program, can I limit my practice to HUSKY members only? Providers have the option of limiting their panel size. Providers will be permitted to notify the ASO if they are not accepting new clients. Where do I submit claims for 2011 dates of service? Where do I submit claims for 2012 dates of service? Doc#: UHC1606c_201110DAY Page 1 of 6

2 For dates of service through December 31, 2011, please submit the claims to the address on the back of the member s ID card. Doc#: UHC1606c_201110DAY Page 2 of 6

3 o o For AmeriChoice members, that address is: AmeriChoice by United Healthcare P.O. Box Salt Lake City, UT For Aetna Better Health that address is: Aetna Better Health 151 Farmington Avenue, MC3N Hartford, CT o For Community Health Network that address is : Community Health Network of CT, Inc. Claim Processing Center P.O. Box Birmingham, AL For dates of service on or after January 1, 2012, please submit claims to HP. Providers are strongly urged to submit claims electronically. Electronic claim submission is a faster, more efficient method of claims processing that creates less paperwork, less claim preparation and no postage or mailing costs. For information on billing electronically (Trading Partner) or on paper (Provider Manual Chapter 8), please visit What do the new health care ID cards look like? How will I be able to identify members covered by the new program? The State is developing new HUSKY health program identification cards for all members as soon as possible, but in the interim, we ask that you accept the member s State issued grey CONNECT card beginning January 1, Providers should always submit an eligibility verification to determine in which program the client is enrolled. If there is no CONNECT card, verification of information on the Automated Eligibility Verification System (AEVS) can be found at under Publications>Proivider Manuals Chapter 10 using any of the following data combinations: 1. a known Client ID# with Date of Birth (DOB), 2. a known Client ID# with a Social Security number, or 3. a Date of Birth (DOB) and a Social Security number If I need to refer a member to a specialist, where can I find a listing of providers who participate in the State s Medical Assistance Program network? You may call HP s Provider Assistance Center at or you may go to the CMAP website at Once on the website click on Provider > Provider Search. How can I verify that I am enrolled in the Connecticut Medical Assistance Program Network? If you are currently paid directly by HP for services to Connecticut Medicaid members who are enrolled with DSS (but not with any of the three existing managed Medicaid plans), then you are Doc#: UHC1606c_201110DAY Page 3 of 6

4 enrolled in the Connecticut Medical Assistance Program Network currently and do not need to take any further action. If you are uncertain whether you currently receive payments directly from HP, you may call HP s Provider Assistance Center at I am not currently enrolled in the State s Medical Assistance Program network. How do I enroll? The self-service provider enrollment application can be found at A step-by-step wizard will guide you through the enrollment process. The application takes on average minutes to complete online. Please read all instructions and assemble relevant documents before beginning the process. Some hard copy documentation (e.g., W-9 form, EFT form, electronic signature addendum) must be submitted What will my reimbursement rates be under the ASO program? Will the contracted rates I have in my current contract with Community Health Network apply? Reimbursement under the ASO will be in accordance with the State s rates and fees for the Medicaid program. These rates are under review. MCO contracted rates will not apply for dates of service on or after January 1, How long do I have to file a claim? For dates of service through December 31, 2011, you have 120 days from the date of service to submit claims for AmeriChoice members. For claims where AmeriChoice is secondary, you have 120 days from the date of the explanation of benefits (EOB) from a primary insurer to submit the claim to AmeriChoice. Please contact Aetna Better Health and Community Health Network of Connecticut for details on their filing limits. For dates of service on or after January 1, 2012, the filing limit will be 365 days; the State Department of Social Services will notify providers if there are any subsequent changes to the filing limits. How long do I have to submit a corrected claim? Corrected claims for 2011 dates of service will need to be submitted within the timeframes identified by the MCOs. For AmeriChoice, that is 365 days. Timely filing requirements for corrected claims have not yet been established by the State Department of Social Services for dates of service on or after January 1, Where do I follow up on claims? For dates of service through December 31, 2011, please contact the applicable managed Medicaid plan. For AmeriChoice, the provider call center number is For dates of service on or after January 1, 2012, contact HP s Provider Assistance Center at (in the Farmington CT area), toll-free at or you may go to the CMAP website at Doc#: UHC1606c_201110DAY Page 4 of 6

5 What about members who are hospitalized through an admission beginning in 2011 and ending in 2012? Do I need to split the claims to bill the 2011 dates of service to the applicable managed Medicaid plan and the 2012 dates of service to HP? For hospital admissions that begin in 2011 and extend into 2012, you will need to split bill. For dates of service through December 31, 2011, please contact the applicable managed Medicaid plan. For AmeriChoice, the provider call center number is For dates of service on or after January 1, 2012, contact HP s Provider Assistance Center at (in the Farmington CT area) or (toll-free), or you may go to the CMAP website at Doc#: UHC1606c_201110DAY Page 5 of 6

6 Can I close my practice to new patients? Providers have the option of limiting their panel size. Providers will be permitted to notify the ASO if they are not accepting new clients. If services have already been authorized for the member but the services have not occurred in 2011, can I still provide the services or will I need to obtain a new authorization? The State will honor authorizations granted by a managed care plan for a service for which the State requires authorization. Any covered services, whether or not they require prior authorization, will only be reimbursed if the provider is enrolled in the State s Connecticut Medical Assistance Program network. Providers should request authorizations for all dates of service from the members Managed Care Organization until January 1, As of January 1, 2012, providers may contact Community Health Network of Connecticut for authorizations for dates of service on or after January 1, Where do I call if I have questions? Eligibility Benefits Claims Prior authorization For dates of service through December 31, 2011, please contact the applicable managed Medicaid plan. For AmeriChoice, the provider call center number is For dates of service on or after January 1, 2012, questions on eligibility, benefits and prior authorization should be directed to Community Health Network at For questions on claims and contracting, contact HP s Provider Assistance Center at (in the Farmington CT area) or toll-free at Providers may also visit the CMAP website at Doc#: UHC1606c_201110DAY Page 6 of 6