The Office of Medicaid Policy and Planning (OMPP) has determined that auto-assigning wards of the court and foster children into the Indiana Care Select program will begin statewide in January 2009 with an effective date of January 15, 2009. Wards and foster children who have not selected primary medical providers (PMPs) prior to January 5, 2009, will be auto-assigned to Care Select PMPs.
During the transition, these members may already be receiving specialty care from an Indiana Health Coverage Programs (IHCP)-enrolled specialist, hospital, or ancillary provider. The physicians who ordered the services PRIOR to the January 15, 2009, auto-assignment effective date may not be the same physicians the members are assigned to AFTER January 15, 2009. The Care Select Program asks the new PMPs to work with specialists, hospitals, or ancillary providers that have already initiated care for these members by reviewing members’ care plans and authorizing the continuation of that care until the new providers can see members for initial primary care visits. Authorize care by releasing your quarterly two-character certification code and National Provider Identifier (NPI) number to these providers, so they may receive reimbursement for their services.
Specialists, hospitals, and ancillary providers who provide services that require prior authorization (PA) in the Traditional Medicaid and Care Select Programs are reminded they must contact the member’s care management organization (CMO) to request PA. ADVANTAGESM Health Solutions, Inc. processes PA requests for Traditional Medicaid members and members in the ADVANTAGESM Care Select network. MDwise processes all PA requests for members in the MDwise Care Select network.
There is an exception to this rule if the member switches CMO networks. If the member’s previous CMO has suspended a provider’s PA request, the provider must submit the requested additional information to the member’s original CMO, even if the member has selected a new PMP and a new CMO.
Note: Additional information submitted to the member’s new CMO – instead of to the member’s previous CMO where the original PA request was sent – will be rejected, and you will need to submit that information to the member’s previous CMO.
If the provider has received PA from a Hoosier Healthwise managed care organization (MCO), a copy of the MCO’s written authorization must be submitted to the member’s CMO. Authorizations are valid for 30 days from the date of eligibility in Care Select or for the remainder of the PA dates of service, whichever comes first. Providers are always encouraged to fax PA requests to the member’s assigned CMO for more efficient processing of PA.
We encourage you to visit each CMO’s Web site for additional Care Select information. Also, see the following bulletins at http://www.indianamedicaid.com/ihcp/index.asp:
BT200723 – Indiana Care Select, dated September 13, 2007
BT200804 – Updated Indiana Care Select and Prior Authorization and Restricted Card Changes, dated January 15, 2008