Children s Rehabilitative Services: Eligibility Verification Overview

Transcription

1 Children s Rehabilitative Services: Eligibility Verification Overview This document will provid assistance with how to identify a Children s Rehabilitative Services (CRS) member on Arizona Health Care Cost Containment System () Online. Member List - Sample Plan /Name First Name Last Name DOB Begin DOS DOS CRS FULLY INTEGRATED A CRS FULLY INT 12/05/ CRS PARTIAL ACUTE A CRS PARTIAL ACUTE 06/13/ CRS PARTIAL BH A CRS PARTIAL BH 10/23/ CRS ONLY PLAN A CRS ONLY 06/09/1981 Screen prints containing de-identified data are provided for the following areas for each sample member. Online Eligibility and Enrollment Status 5010 version replaces 4010 version Notes: For Only you will only be able to look up using the member s name and date of birth or the. The system is not yet able to search using the CRS number. The CRS Only Group on the 4010 version (10/1-10/10) is the most difficult to identify as there is no indicator.

2 Online - Eligibility and Enrollment Status 5010 CRS Fully Integrated Example Arizona Health Care Cost Containment System Requested Data: A Last Name First Name DOB 12/05/2000 Begin of Service of Service Returned Data: A Last Name FULLYINT First Name CRS DOB 12/05/2000 DOD Gender F Demographics Mailing Address 1 Mailing Address 2 City State Zip 701 E JEFFERSON PHOENIX AZ Eligibility Renewal : 05/31/2013 Eligibility Renewal Eligibility Eligibility Group Description Insurance Begin Added On ACUTE DISABLED MC MEDICA 04/01/ /29/2013 Medical Enrollment Health Plan /Description Start Rate Code Contract Insurance CRS FULLY INTEGRAT ED SSI DISABLED WITH MEDICARE A ACU/CAP HM HEALTH MAINTENANCE ORGANIZATION (HMO) Service Codes 2

3 30-HEALTH BENEFIT PLAN COVERAGE Third Party Liability NO TPL FOUND CoPayment CoPay Level Start 00 04/12/2013 HMO NO MEDICARE HMO Claim Number Indicator Start Insurance Service A A Y 01/01/ A B Y 01/01/2013 MA MEDICARE PART A MB MEDICARE PART B A D Y 01/01/2013 OT OTHER 30 HEALTH BENEFIT PLAN COVERAGE Part D Enrollment Health Plan/Name Start Service S ENVISIONRXPLUS SILVER 05/01/ PHARMACY Category/Des cription Start C CHILDREN SERVICES 04/11/2013 Behavioral Health Services Site/Description 33 UHCP/CHILDRENS REHAB Service CH MENTAL HEALTH FACILITY - OUTPATIENT Indicator Y Share of Cost NO SOC FOUND Targeted Support Coordination/DDD NO TSC FOUND Children s Rehabilitative Services CRS Indicat or Be gin CRS Service Y 04/11/2013 A9 REHABILITATION 7

4 Arizona Early Intervention Program NO AzEIP FOUND *** This verification does not constitute a guarantee of payment *** 8

5 Online - Eligibility and Enrollment Status 5010 CRS Partially Integrated Acute Example Arizona Health Care Cost Containment System Requested Data: A Last Name First Name DOB 06/13/1992 Begin of Service of Service Returned Data: A Last Name PARTIALACUTE First Name CRS DOB 06/13/1992 DOD Gender F Demographics Mailing Address 1 Mailing Address 2 City State Zip 701 E JEFFERSON PHOENIX AZ Eligibility Renewal : 06/30/2013 Eligibility Renewal Eligibility Eligibility Group Description Insurance Begin Added On ACUTE MC MEDICA 07/01/ /24/2011 Medical Enrollment Health Plan /Description Start Rate Code Contract Insurance CRS PARTIAL ACUTE 07/01/ AHC CARE/MI FEMALE NO MDC A ACU/CAP HM HEALTH MAINTENANCE ORGANIZATION (HMO) 9

6 Service Codes 30-HEALTH BENEFIT PLAN COVERAGE Third Party Liability NO TPL FOUND CoPayment CoPay Level Start 00 07/01/2011 HMO NO MEDICARE HMO NO MEDICARE PART A NO MEDICARE PART B NO MEDICARE PART D Part D Enrollment NO DRUG PLAN Category/Descri ption Start G GENERAL MEN TAL HEALTH SERVICES 04/10/ 2012 Behavioral Health Services Site/Description 14 NAVAJO NATION Service CH MENTAL HEALTH FACILITY - OUTPATIENT Indicator Y Share of Cost NO SOC FOUND Targeted Support Coordination/DDD NO TSC FOUND Children s Rehabilitative Services CRS Indicator Be gin CRS Service Y 07/01/2013 A9 REHABILITATION Arizona Early Intervention Program NO AzEIP FOUND *** This verification does not constitute a guarantee of payment *** 10

7 Online - Eligibility and Enrollment Status 5010 CRS Partially Integrated Behavioral Health Example Arizona Health Care Cost Containment System Requested Data: A Last Name First Name DOB 10/23/1949 Begin of Service of Service Returned Data: A Last Name PARTIALBH First Name CRS DOB 10/23/1949 DOD Gender F Demographics Mailing Address 1 Mailing Address 2 City State Zip 701 E JEFFERSON PHOENIX AZ Eligibility Renewal : 01/31/2014 Eligibility Renewal Eligibility Eligibility Group Description Insurance Begin Added On LTC LC LONG TERM CARE 11/01/ /26/1993 Medical Enrollment Health Plan /Description Start Rate Code Contract Insurance LTC DD DES 10/01/ SSI DISABLED WITH QMB J LTC/CAP HM HEALTH MAINTENANCE ORGANIZATION (HMO) 11

8 Service Codes 30-HEALTH BENEFIT PLAN COVERAGE Third Party Liability NO TPL FOUND CoPayment CoPay Level Start 00 10/01/2003 HMO NO MEDICARE HMO Claim Number Indicator Start Insurance Service A A Y 04/01/ A B Y 04/01/1990 MA MEDICARE PART A MB MEDICARE PART B A D Y 01/01/2006 OT OTHER 30 HEALTH BENEFIT Part D Enrollment Health Plan/Name Start Service S SILVERSCRIPT BASIC 01/01/ PHARMACY Category/Des cription Start Behavioral Health Services Site/Description Service Indicator G GENERAL MEN TAL HEALTH SERVICES 06/19/ UHCP/CHILDRENS REHAB CH MENTAL HEALTH FACILITY - OUTPATIENT Y Share of Cost Please direct any questions regarding share of cost data to the member's program contractor Share of Cost Share of Cost Month.00 09/2013 Targeted Support Coordination/DDD NO TSC FOUND 12

9 Children s Rehabilitative Services CRS Indicat or Be gin CRS Service Y 06/19/2013 A9 REHABILITATION Arizona Early Intervention Program NO AzEIP FOUND *** This verification does not constitute a guarantee of payment *** 13

10 Online - Eligibility and Enrollment Status 5010 CRS Only Example Arizona Health Care Cost Containment System Requested Data: A Last Name First Name DOB 06/09/1981 Begin of Service of Service Returned Data: A Last Name ONLY First Name CRS DOB 06/09/1981 DOD Gender M Demographics Mailing Address 1 Mailing Address 2 City State Zip 701 E JEFFERSON PHOENIX AZ Eligibility Renewal Eligibility Renewal : Eligibility Eligibility Group Description Insurance Begin Added On ACUTE MC MEDICA 04/01/ /19/2013 Medical Enrollment Health Plan /Description Start Rate Code Contract Insurance AMERICAN INDIAN HP 04/19/ TANF MALE NON- MEDICARE E ACU/FFS MC MEDICA 14

11 Service Codes AL-VISION (OPTOMETRY) BY-PHYSICIAN VISIT - OFFICE: SICK BZ-PHYSICIAN VISIT - OFFICE: WELL MH-MENTAL HEALTH PT-PHYSICAL THERAPY UC-URGENT CARE 1-MEDICAL CARE 2-SURGICAL 33-CHIROPRACTIC 35-DENTAL CARE 47-HOSPITAL 82-FAMILY PLANNING 86-EMERGENCY SERVICES 88-PHARMACY 93-PODIATRY 98-PROFESSIONAL (PHYSICIAN) VISIT - OFFICE Third Party Liability NO TPL FOUND CoPayment CoPay Level Start 00 04/20/2013 HMO NO MEDICARE HMO NO MEDICARE PART A NO MEDICARE PART B NO MEDICARE PART D Part D Enrollment NO DRUG PLAN Category/Descri ption Start G GENERAL MENTAL HEALTH SERVICES Behavioral Health Services Site/Description 04/19/ CENPATICO 4 Service CH MENTAL HEALTH FACILITY OUTPATIENT Indicator Y Share of Cost NO SOC FOUND 15

12 Targeted Support Coordination/DDD NO TSC FOUND Children s Rehabilitative Services CRS Indicat or Begi n CRS Service Y 04/19/ /10/2013 A9 REHABILITATION Arizona Early Intervention Program NO AzEIP FOUND *** This verification does not constitute a guarantee of payment *** 16