Californias Coordinated Care Initiative Provider Tutorial Using AEVS

California’s Coordinated Care Initiative Provider Tutorial: Using AEVS to Determine Patient Plan Participation June 2014 DRAFT

Tutorial: AEVS System & Plan Information • Coordinated Care Initiative: Plan Options • What to Look for in Automated Eligibility Verification System (AEVS) • AVES Samples DRAFT 2

Coordinated Care Initiative: Health Plan Options Under the Coordinated Care Initiative, your patients have new healthcare plan options: • Cal Medi. Connect Plan: Combines Medicare & Medi-Cal benefits in one plan. • Medi-Cal Plan: Patients can keep their Medicare as it is now, but must pick a Medi-Cal plan for their Medi-Cal benefits, including long-term services & supports such as IHSS, CBAS, MSSP and nursing facilities. You can use AEVS to determine which plans your patients are enrolled in. 3 DRAFT

Plan Options: What This Means for Billing If the beneficiary is enrolled in a: • Cal Medi. Connect Plan: You bill the plan, or their delegate, for both Medicare and Medi-Cal services. • Medi-Cal Plan for MLTSS: • You continue to bill Medicare or the Medicare Advantage plan the way you do today. • Send the “crossover” claim for the 20% copay to the Medi-Cal plan, which will pay was is required under state law. DRAFT 4

AEVS: What to Look For • Health plan information in the “Eligibility Message” section of the AEVS screen. • If the beneficiary is in a health plan, that plan name will be listed with contact phone number. • This will be listed in the top portion of the eligibility message. • There may be a Medicare Part C or D plan listed in the bottom section of the eligibility message. • The plan name matters! DRAFT 5

AEVS: Plan Names Matter • Plans can offer both Cal Medi. Connect and Medi. Cal plan products, so you need to know the specific product name to determine your patients’ enrollment. • Not all Cal Medi. Connect plans have “Cal Medi. Connect” in their name. • Below, we’ve put together a table of corresponding plan product names. DRAFT 6

Plan Names – Active CCI Counties Cal Medi. Connect Plans Medi-Cal Plans L. A. Care Cal Medi. Connect Health Plan L. A. Care Health Plan Sub-Plans: • Anthem Blue Cross • Care 1 st • Kaiser Permanente Care. More Cal Medi. Connect Plan No Medi-Cal Only Plan Care 1 st Cal Medi. Connect Plan Care 1 st Health Net Cal Medi. Connect Health Net Community Solutions Molina Dual Options Molina Healthcare IEHP Dual Choice Inland Empire Health Plan Communi. Care Advantage Community Health Group Care Advantage CMC Health Plan of San Mateo DRAFT 7

AEVS: Sample Screen Shots • What follows are sample AEVS screen shots of enrollment in: • • Cal Medi. Connect Plan Medi-Cal Plan & Medicare FFS Medi-Cal Fee-For-Service & Medicare FFS Medi-Cal Fee-For Service & Medicare Advantage Plan • Medi-Cal Plan Sub or Delegate & Medicare FFS DRAFT 8

Sample: Cal Medi. Connect DRAFT 9

Sample: Medi-Cal Plan/ Medicare FFS DRAFT 10

Sample POS: FFS Medi-Cal/ FFS Medicare DRAFT 11

Sample POS: FFS Medi-Cal & Medicare Advantage DRAFT 12

Sample POS: Plan Sub or Delegate In LA County, three plans operate Medi-Cal plans (subs) under L. A. Care (prime Medi-Cal plan). The sub Medi-Cal plan will be listed after L. A. Care’s Medi-Cal plan. Other plans, including Cal Medi. Connect plans, may delegate to an physician group. This will be listed under the prime plan name. You can always call the plan for more information about contracts, billing and authorizations. DRAFT 13

Sample POS: Medi-Cal Plan Sub to LA Care DRAFT 14

More Information www. Cal. Duals. org info@calduals. org DRAFT 15