Mmai illinois 2021 3200 Highland Ave. MMAI Overview • MLTSS refers to the delivery of long term supports and services through Managed Care Organizations. Findings. For Meridian Medicare-Medicaid Plan plan information on how to submit a prior authorization request, please refer to our new authorization lookup tool. 1, 2022 (Updated November 2021) This information applies to Blue Cross Community MMAI (Medicare-Medicaid) SM and Blue Cross Community Health PlansSM (BCCHPSM) members. May 2021 Updated Process for Urine Drug Testing (UDT) Claims for Illinois Medicaid Members. You pay nothing ($0) when you go to a doctor or health care provider in the plan's network. The MMAI is a groundbreaking joint effort to reform the way care is delivered to clients eligible for both Medicare and Medicaid Services (called “dual eligibles”). The last February 2021 Medicaid Claim Filing Reminder: Don’t Enter a P. This growth is aided by the State of Illinois increasing auto-enrollment of 50% of incoming Medicaid recipients to What are the benefits of MMAI in IL? However, I still very confused on the benefits of getting an MMAI plan vs separate Medicare and Medicaid plans outside of convenience Please help - thank you! reReddit: Top posts of November 30, 2021. It’s a Centers for To see if you are eligible, contact Blue Cross and Blue Shield of Illinois' OTC vendor, Convey Health Solutions *, at 1‑855‑891‑5274. MMAI. A. Our Blue Cross Community Health Plans SM (BCCHP SM) and Blue Cross Community MMAI (Medicare-Medicaid Plan) SM products are aligned with Illinois Department of Healthcare and Family Services (HFS), Health Insurance Portability and Accountability Act (HIPPA) 5010 standards, This means that your care is coordinated with you at the center of it all. See the Additional Information for Government Programs section of our COVID-19 Preparedness FAQs for more details. After that, you cannot change health plans for one year. There are two ways you can enroll: Call Illinois Client Enrollment Services at 1-877-912-8880 (TTY: 1-866-565-8576) Blue Cross Community Health Plans SM. Walla Walla, WA Permit No. Aetna Better Health . Copeland Created Date: 20210607153343Z MMAI Enrollments — September 2021 (continued) HealthChoice Illinois Enrollments — September 2021 (continued) 55 ˆ ˇ 2021 09 MCO Enrollment Report for Website. View product information and commission statements Initiative (MMAI) Plans Aetna Better Health Premier Plan Cook, DuPage, Kane, Kankakee, Will Blue Cross Community MMAI Cook, DuPage, Kane, Kankakee, Lake, Will Humana Health Plan Statewide HealthChoice Illinois Plans-January-1-2021#1 Created Date: 2/23/2021 3:37:29 PM Illinois is set to shift from the MMAI to a Dual Eligible Special Needs Plan (D-SNP) in 2026. 1, 2021 Humana Gold Plus Integrated Illinois Medicare-Medicaid Alignment Initiative (MMAI) Long-Term Services and Supports (LTSS) Provider Billing Guide The tool returns a list of services that may require prior authorization through BCBSIL or eviCore healthcare (eviCore) for BCCHP and MMAI members. or call . on Aging 2021; ICRC 2022; and Medicare Payment Advisory Commission (MedPAC) 2018. 13. You can also call April 2021 Reminder: Hospital Administrative Days May Be Covered for Medicaid Members. Please contact the The MMAI is a groundbreaking joint effort to reform the way care is delivered to clients eligible for both Medicare and Medicaid Services (called “dual eligibles”). Illinois. 1-877-912-8880 (TTY: 1-866-565-8576). In Illinois, Aetna Better Health Premier Plan MMAI coordinates the care for its members. December 16, 2020. Diphenhydramine Antihistamine (Allergy Tablets) 400 ct; 25 mg. Blue Cross and Blue Shield of Illinois (BCBSIL) may provide reimbursement for authorized inpatient stays extended beyond medical necessity, also known as Administrative Days (ADs), for some Blue Cross Community Health Plans SM (BCCHP SM) and Blue Cross CHICAGO, June 11, 2021 /PRNewswire/ -- Aetna ®, a CVS Health ® company (NYSE: CVS), announced it has received approval to expand its existing Illinois Medicare-Medicaid Alignment Initiative The Blue Cross and Blue Shield of Illinois (BCBSIL) Medicaid product also known as Blue Cross Community Health Plans (BCCHP) is available throughout the state of Illinois, servicing 102 counties. (Source: P. This will affect Illinois residents enrolled in Medicare and Medicaid, including those with long-term services and support. Contact Information for Health Plans. Blue Cross and Blue Shield of Illinois, a Division of Health Care To obtain an adequate Statewide network for the MMAI Program of IL, the Plan is using Aetna’s Medicare Statewide Provider Network that is already in place. DME . Illinois MMAI Plan Choices Author: Illinois Department of Healthcare and Family Services Subject: Illinois MMAI Plan Choices Keywords: Illinois Client Enrollment Services; Illinois Department of Healthcare and Family Services; HFS; EnrollHFS, Medicare-Medicaid Alignment Initiative; health plan; Medicare; Medicaid Created Date: 9/22/2023 11:27:57 AM Quality time . Plan Details. Title: 2021 07 MCO Enrollment Report for Website_Revised100421. The General Assembly finds that elderly Illinoisans residing in a nursing home have the right to: Blue Cross Community MMAI (Medicare-Medicaid Plan)prohibits the use of this benefit to order OTC items for family members and friends. The call is free. Stat. The MMAI IMPACT enrollment is required for any provider who renders services to Medicaid members for Medicaid covered services through the MMAI program. This is not a complete list. 01/26/2022 Adaptive Behavioral Support Services Fee Schedule Effective 01/15/2022 (xlsx) (pdf) 09/30/2021 Adaptive Behavioral Support Services Fee Schedule Effective 11/01/2020 (xslx) The Financial Alignment Initiative is designed to provide individuals dually enrolled for Medicare and Medicaid with a better care experience and to better align the financial incentives of the Medicare and Medicaid programs. This reminder applies to all providers that are independently contracted with Blue Cross and Blue Shield of Illinois (BCBSIL) to provide care and services to the following government programs members: Blue Cross Community MMAI (Medicare-Medicaid Plan) SM and/or Blue Cross Community Health Plans SM (BCCHP SM). • MMAI customers (identified in MEDI with exclusion code 8) As of 7/1/2021, our service area You can sign up for Aetna Better Health Premier Plan MMAI by contacting the Illinois Client Enrollment Broker. Call (877) 901-8181, TTY/TDD: 711, Monday – Friday, 8 a. For providers December 16, 2020. 200 et seq. There are two ways you can enroll: Call Illinois Client Enrollment Services at 1-877-912-8880 (TTY: 1-866-565-8576) As of 7/1/2021, our service area includes these counties in Illinois: Region 1 Northwestern counties – Boone, Bureau, Carroll, DeKalb, Fulton, Henderson, If you’d like to find out how to join Aetna Better Health of Illinois or Aetna Better Health Premier Plan MMAI, please call the Illinois Client Enrollment Services at 1-877-912-8880 We would like to show you a description here but the site won’t allow us. Data Collection For this activity, HSAG received the plans’ MY 2021 CAHPS member-level data files and HEDIS data from HFS and the plans. In the meantime, please visit our Health Plan provider website to review the draft Aetna Better Health Premier Plan MMAI Introductory Information, Aetna Better Health® Premier Plan MMAI is a health plan that contracts with both Medicare and Illinois Medicaid to provide benefits of both programs to enrollees. Important . . Most people over age 21 who have Medicare Part A & B as their primary coverage and Medicaid as their secondary coverage will now have one plan. O. Abbreviation. 5 mg / 5 ml. To access the BCCHP and MMAI digital lookup tool, refer to the Prior Authorization Support Materials (Government Programs) page in our Utilization Management section. ) (305 ILCS 5/5F-5) Sec. Contents Page | i Table 1-2—MMAI Health Plans for SFY 2021 . 25 2033 Loratadine (Allergy Tablets) 10 ct 10 mg $7. 75 ; %PDF-1. Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, As of 7/1/2021, the Medicare-Medicaid Alignment Initiative (MMAI) program was expanded statewide. Map of Managed Care as of August 1, 2021. y In 2019, five MMPs operated in the six-county Greater Chicago region, and one MMP operated in the 15-county In 2019, over 60 percent of Illinois MMAI enrollees gave their plans a rating of 9 or 10. Our members must live in one of these counties: Cook, DuPage, Kane, Kankakee and Will. Table 1-2—MMAI Health Plans for SFY 2023 . Once each year, you can change health plans during the time called “open enrollment. In the meantime, please visit our Health Plan provider website to review the draft Aetna Better Health Premier Plan MMAI Introductory Information, Molina Dual Options Medicare-Medicaid Plan is a health plan that contracts with both Medicare and Illinois Medicaid to provide benefits of both programs to enrollees. are not part of the Medicare-Medicaid Alignment Initiative (MMAI). HFS is encouraging all providers to enter into network participation discussion with the MMAI Enrollments — June 2021 . 75 1804 Fexofenadine (Allergy Tablets) 30 ct 180 mg $19. CMS, and health plans, which provides coordinated care to dually eligible beneficiaries in Illinois. 5-5 10 Cumulative demonstration impact on select April 2021 Medicaid Billing Reminders for Home and Community Based Services (HCBS) Waiver Providers . The benefit information is a brief summary, not a complete description of benefits. 06 Subsection: Concurrent Review Effective Date: 12/01/2020 Applies to: Medicaid Health Plans MEDICAL MANAGEMENT: Concurrent Review Effective: 12/01/2020 PURPOSE: As of July 1, 2021, Molina Healthcare of Illinois provides Medicaid HealthChoice, MMAI (MMP Duals), and MLTSS services to all 102 Illinois counties. ilmeridian. 2 LC4302IL1020 (ILHKQZHEN) (CMS) and the Illinois Department of Healthcare and Family Services (HFS), MMAI allows eligible Illinois beneficiaries to receive Medicare Part A, B and D benefits and Medicaid benefits from a single Medicare-Medicaid Plan MMAI reformed the way care is delivered to customers who are eligible for both Medicare and Medicaid services (dually eligible) by providing coordinated care and became a statewide program on July 1, 2021. Box in Field 33. Continued on page 2. If you do not intend to leave our site, please click Close. Through the Initiative, CMS partners with states to test two new models for their effectiveness in accomplishing these goals. The MMAI demonstration has been extended through December 2022. 10 Any reference to Molina Illinois MMAI Plan Choices Author: Illinois Department of Healthcare and Family Services Subject: Illinois MMAI Plan Choices Keywords: Illinois Client Enrollment Services; Illinois Department of Healthcare and Family Services; HFS; EnrollHFS, Medicare-Medicaid Alignment Initiative; health plan; Medicare; Medicaid Created Date: 9/22/2023 11:27:57 AM County for the fourth year in a row. Effective 7/1/2021, the BCBSIL Medicare-Medicaid product also known as Medicare- Medicaid Alignment Initiative (MMAI) is Initiative (MMAI) Plans Aetna Better Health Premier Plan Cook, DuPage, Kane, Kankakee, Will Blue Cross Community MMAI Cook, DuPage, Kane, Kankakee, Lake, Will Humana Health Plan Statewide HealthChoice Illinois Plans-January-1-2021#1 Created Date: 2/23/2021 3:37:29 PM Meridian Medicare-Medicaid Plan (MMP) is a health plan that contracts with both Medicare and Illinois Medicaid to provide benefits of both programs to enrollees. Copeland Created Date: 10/4/2021 3:51:15 PM June 2021 Update: Medicare Medicaid Alignment Initiative Expansion. Frequently Asked Questions. EnrollHFS. Print Update: Medicare Medicaid Alignment Initiative Expansion. As of 7/1/2021, our service area includes these counties in Illinois: MyHumana. Department of Healthcare and Family Services . Illinois Illinois received approval for the MMAI program from CMS in 2013 and the program was implemented in Central Illinois and the Chicagoland area. Last Updated: 10/12/2021. The General Assembly finds that elderly Illinoisans residing in a nursing home have the right to: Welcome. Uses the On April 30, 2021 the Illinois Department of Healthcare and Family Services (IHFS) announced that the Medicare-Medicaid Alignment Initiative (MMAI) would expand statewide. As of December 2021, CountyCare covered more than 422,000 lives. your diabetic blood MMAI Enrollments — October 2021 (continued) HealthChoice Illinois Enrollments — October 2021 (continued) 66 ˆ ˇ 2021 10 MCO Enrollment Report for Website_Revised 110321. 2021 Illinois Comp. Dual Options Provider Manual. PAID. ” This is true for all programs except the Medicare Medicaid Alignment Initiative (MMAI), when you can change your health plan at April 2021 Reminder: Hospital Administrative Days May Be Covered for Medicaid Members. It extends through June 30, 2029, In 2021, according to CMS, Medicaid paid for about 41 percent of all March 11, 2021. You can get this information for free in other formats, such as large print, braille, or audio. HealthChoice Illinois Enrollments — June 2021 (continued) ++ ˆ ˇ 2021 06 MCO Enrollment Report for Website_2. Humana Health Plan, Inc. 82. pub Author: Yoko. HealthChoice Illinois Enrollments — May 2021 (continued) ++ ˆ ˇ 2021 05 MCO Enrollment Report for Website. Membership growth continues on an upward trajectory with 9,400 new enrollees joining CountyCare in December 2021 alone. The Centers for Medicare & Medicaid Services (CMS) and the State of Illinois have contracted with Blue Cross and Blue Shield of Illinois (BCBSIL) along with other Managed Care Organizations (MCO) to implement MMAI. With MMAI, you get all your Medicare and Medicaid Illinois’ Medicare-Medicaid Alignment Initiative (MMAI) demonstration program provides a variety of long-term services and supports for elderly and disabled adults who are “ Illinois and CMS launched the Medicare-Medicaid Alignment Initiative (MMAI) Demonstration in March 2014. Per the Illinois Department of Healthcare and Family Services (HFS), effective July 1, 2021, the Medicare Medicaid Alignment Initiative (MMAI) Program will be expanding. 491 and the HFS Transportation Handbook for further information. 877-774-8592; MMAI – 877-723-7702; BCCHP – 877-860-2837. About The Illinois Medicare-Medicaid Alignment Initiative (MMAI) is a managed care program for individuals who are eligible for both Medicaid and Medicare (referred to as “dual eligibles”). 5 mg / 5 ml $7. Yes, trainings will be offered to Providers starting in Q2 2021. Our Blue Cross Community Health Plans SM (BCCHP SM) and Blue Cross Community MMAI (Medicare-Medicaid Plan) SM products are aligned with Illinois Department of Healthcare and Family Services (HFS), Health Insurance Portability and Accountability Act (HIPPA) 5010 standards, Aetna Better Health® Premier Plan MMAI, a Medicare-Medicaid health plan for people who are dual-eligible. mmp. This group of Medicare-Medicaid enrollees are known as dual-eligible individuals. 7 %âãÏÓ 346 0 obj > endobj 384 0 obj >/Filter/FlateDecode/ID[]/Index[346 84]/Info 345 0 R/Length 164/Prev 1461808/Root 347 0 R/Size 430/Type/XRef/W[1 3 1 As of 7/1/2021, our service area You can sign up for Aetna Better Health Premier Plan MMAI by contacting the Illinois Client Enrollment Broker. If you are enrolled with Aetna . of Healthcare and Family Services 2021; IL Dept. Aetna Better Health In 2021, in accordance with 42 CFR §438. 50 ; 1428. Currently, Blue Cross and Blue Shield of Illinois (BCBSIL) offers its Blue Cross Community MMAI (Medicare-Medicaid Plan) SM plan in the The Blue Cross Community MMAI (Medicare-Medicaid Plan)℠ was created to help you maintain your health and independence. For more information contact the plan or read the Meridian Member Handbook. HFS is encouraging all providers to enter into network participation discussion with the You can view the HFS Medicaid Reimbursement page by selecting the link below: Aetna Better Health® Premier Plan MMAI is a Medicare-Medicaid health plan for people who are dual-eligible. Find care, review your claims, access your digital ID, and more. reReddit: Top posts of November 2021. Illinois Department of Healthcare and Family Services Medicaid Managed Care Program Map January 1, 2021 Medicare-Medicaid Alignment Initiative (MMAI) Plans Aetna Better Health Premier Plan Cook, DuPage, Kane, Kankakee, Will Blue Cross Community MMAI Cook, DuPage, Kane, Kankakee, Lake, Will Humana Health Plan Cook, DuPage, Kane, Kankakee, Lake, Will Illinois Department of Healthcare and Family Services Medicaid Managed Care Program Map January 1, 2021 Medicare-Medicaid Alignment Initiative (MMAI) Plans Aetna Better Health Premier Plan Cook, DuPage, Kane, Kankakee, Will Blue Cross Community MMAI Cook, DuPage, Kane, Kankakee, Lake, Will Humana Health Plan Cook, DuPage, Kane, Kankakee, Lake, Will May 2021 Updated Process for Urine Drug Testing (UDT) Claims for Illinois Medicaid Members. 2/1/2021: Blue Cross Blue Shield of Illinois Quality of Complaints & Occurrences Process Policy: QI 30: 4/1/2023: Blue Cross Blue Shield of Illinois Quality of Complaints & Occurrences Process Procedure: QI 30A: 4/1/2023: Member Communication: RR 5: 1/1/2022: Member Rights and Responsibilities: RR 1: 10/1/2022: Professional Liability Insurance Member transition of care form (English/Spanish) (updated 4/6/2021) Member Care Information registration form; My Care Information member authorization form (English/Spanish) (updated 4/6/2021) You are now leaving Aetna Better Health Premier Plan MMAI. This notice applies only to providers who submit claims for services rendered to our Blue Cross Community Health Plans SM (BCCHP SM) and/or Blue Cross Community MMAI (Medicare-Medicaid Plan) SM members. You are leaving our website and going to a non-Medicare/Medicaid website. Copeland Created Date: 12/29/2021 10:40:46 AM IL-20-12-01 Proprietary . Aetna Better Health. LC8453IL1020_(ILHKYJJEN) Effective: Jan. This reminder applies to all providers that are independently contracted with Blue Cross and Blue Shield of Illinois (BCBSIL) to provide care and services to the following government programs members: Blue Cross Community Health Plans SM (BCCHP) March 2021 Medicaid Providers: Updated Prior Authorization Tips and Peer-to-Peer Discussion Process (One Change Effective May 1, 2021) Blue Cross and Blue Shield of Illinois (BCBSIL) would like to outline some important updates, tips and reminders on prior authorization processes for independently contracted providers treating our Blue Cross Community Health Sources: CMS 2013, 2015, 2018, 2019, 2020, and 2021; IL Dept. 1, 2021, BCBSIL members, whose pharmacy benefits are administrated through Prime, now have (for Medicare Part D plan and MMAI members) or 833-715-0944 (for Medicare Advantage plan members). In general the following require authorization: • CPAP • Hospital beds • Oxygen MMAI Enrollments — December 2021 (continued) HealthChoice Illinois Enrollments — December 2021 (continued) 55 ˆ ˇ 2021 12 MCO Enrollment Report for Website 010522. As of 7/1/2021, our service area includes these counties in Illinois: Illinois SB251 2021-2022 Amends the Illinois Public Aid Code Provides that the Department of Healthcare and Family Services shall provide each managed care organization with the quarterly feeforservice facilityspecific nursing component rather than Illinois SB251 MEDICAID-MMAI-REIMBURSEMENT + − Bill Search Find Similar Bills. As of 7/1/2021, our service area includes these counties in Illinois: Member. Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, Changes are coming soon if you have Medicare and full Medicaid (no spenddown). The effective date for those who are auto assigned to a health plan with passive enrollment will be September 1, CY 2021 MLR Report – Aetna (PDF) CY 2021 MLR Report – BCBS (PDF) CY 2021 MLR Report – CountyCare (PDF) CY 2021 MLR Report – Meridian (PDF) CY 2021 MLR Report – Molina (PDF) 2021 List of Covered Drugs/Formulary Aetna Better Health Premier Plan MMAI Aetna Better Health Premier Plan MMAI (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Illinois Medicaid to provide benefits of both programs to enrollees. Diphenhydramine HCL (Children’s ; Allergy Liquid) 4 oz; 12. generally viewed care coordination as a positive feature. Employer. Their plan selection will be effective July 1, 2021. This program is for seniors and persons with The Illinois Medicare -Medicaid Alignment Initiative (MMAI) is a demonstration designed to improve health care for dually eligible beneficiaries in Illinois. Copeland Created Date: IL FAI Demo Summary of Contract Changes \(10012023\) Keywords "Illinois, IL, Medicare-Medicaid Alignment Initiative, MMAI, Financial Alignment Initiative, FAI, Demonstration, capitated model, Summary of Contract Changes, effective 10012023, three-way contract, demonstration updates, December 31, 2025 end date" Created Date: 11/8/2023 9:14:08 AM CMS, and health plans, which provides coordinated care to dually eligible beneficiaries in Illinois. Standard U. 98-651, eff. A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association . Please see the next page for information about other plans » 1-855-580-1689. , HFS developed a transformative 8 Care coordination staffing at Illinois MMAI MMPs, 2014–2021 . References MMAI reformed the way care is delivered to customers who are eligible for both Medicare and Medicaid services (dually eligible) by providing coordinated care and became a statewide program on July 1, 2021. Private Insurance - Third Party Liability (TPL) - Client Specific Info. CHICAGO, IL — Aetna®, a CVS Health® company (NYSE: CVS), announced it has received approval to expand its existing Illinois Medicare-Medicaid Alignment Initiative (MMAI) demonstration health plan (Aetna Better Health® Premier Plan MMAI) to serve the entire state. gov. Blue Cross and Blue Shield of Illinois (BCBSIL) offers Blue Cross Community Health Plans (BCCHP) which includes a network of independently contracted providers including physicians, hospitals, skilled nursing facilities, ancillary providers, Long-term Services and Support (LTSS) and other health care providers through which Illinois The Medicare-Medicaid Alignment Initiative is one of Illinois' managed care programs. Aetna Better Health Aetna Better Health® Premier Plan MMAI, a Medicare-Medicaid health plan for people who are dual-eligible. Copeland Created Date: 10/4/2021 2:31:29 PM Individual MAPD IL MMAI HM Humana Gold Plus Integrated (Medicare-Medicaid Plan) XXX CHRISTPHER A SAMPLECARDS ember name: ember ID: H Medicaid ID: RI: RxPCN: RxGRP: Member/Provider Service: 1-800-787-3311 If you use a TTY, call 711 2021 IL MMAI Expansion Provider Communication MMAI Enrollments — January 2021 HealthChoice Illinois Enrollments — January 2021 (continued) ++ ˆ ˇ 2021 01 MCO Enrollment Report for Website. ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Posted April 19, 2021 (Updated May 13, 2021). Blue Cross and Blue Shield of Illinois (BCBSIL) will soon begin CY 2019 MMAI MLR Calculations Reports; CY 2021 HealthChoice Illinois MLR Calculations Reports; CY 2021 HealthChoice Illinois MLR Calculations Report Results (PDF) IL 2021-22 Mental Health Parity Summary Report F1 (pdf) Streamlining MSP Enrollment 07/14/2022 (pdf) National Committee for Quality Assurance Aetna Better Health® Premier Plan MMAI, a Medicare-Medicaid health plan for people who are dual-eligible. The calendar year (CY) 2021 Report Card analysis helps support HFS’ public reporting of MCO performance information. Premier Plan MMAI. Review the Illinois Provider Overview and FAQ for additional information. Meridian partners with several external entities to manage prior authorizations for certain services or populations. illinois. Molina Healthcare of Illinois, Inc. The Managed Care map provides more information about the MCOs that are operating in the MMAI program by county. Why is this change taking place? This change is a result of Public Act 102-0661. We work with the Department of Healthcare and Family Services to include medications that treat many conditions and diseases. Blue Cross and Blue Shield of Illinois (BCBSIL) has chosen a new mail order service provider through our pharmacy As of Oct. MMAI reformed the way care is delivered to customers who are eligible for both Medicare and Medicaid services (dually eligible) by providing coordinated care and became a statewide program on July 1, 2021. Reddit . MeridianHealth Provider Information Regarding System Updates Effective July 1, 2021; Meridian Clinical Policy Readmission Review; Meridian of Illinois Announces Provider Relations Team Reorganization; Meridian of Illinois Partners with Jeremiah Development for LOVE Rockford Event; UPDATE PRACTICE INFORMATION USING THE MERIDIAN PROVIDER UPDATES Illinois is set to shift from the MMAI to a Dual Eligible Special Needs Plan (D-SNP) in 2026. Postage. Copeland Created Date: April 2021 BCCHP SM and MMAI Provider Alert: 2020 Mandatory Annual Training Must Be Completed by May 1, 2021 . Manage your company's benefits. State of Illinois . Health Plan Name. Beginning July 1, 2021, the program will be available to all dually eligible individuals statewide. Some medically administered Part B drugs, like injectables or biologics, may have additional requirements or coverage limits. If you provide care and services to any of our Blue Cross Community Health Plans SM (BCCHP) or Blue Cross Community MMAI (Medicare-Medicaid Plan) SM members, it’s time to switch to electronic claim filing, if you haven’t done so already. We’ll help you find the information you need. As of 7/1/2021, our service area includes these counties in Illinois: CMS Accepted: 09/21/2021. Blue Cross and Blue Shield of Illinois (BCBSIL) may provide reimbursement for authorized inpatient stays extended beyond medical necessity, also known as Administrative Days (ADs), for some Blue Cross Community Health Plans SM (BCCHP SM) and Blue Cross To obtain an adequate Statewide network for the MMAI Program of IL, the Plan is using Aetna’s Medicare Yes, trainings will be offered to Providers starting in Q2 2021. and 2021, is hereby amended and restated October 1, 2023, between the (MMAI) pursuant to a written contract or agreement, including, but not limited to, a contracted Provider and network Provider, Prior Authorization Instructions. 50 1428 Diphenhydramine HCL (Children’s Allergy Liquid) 4 oz 12. It was designed to expand home and community-based services, provide better care coordination and ensure quality Blue Cross Community MMAI (Medicare-Medicaid Plan)℠ covers many of your health care needs. This plan becomes effective for some individuals as early as July 1,2021 2/1/2021: Blue Cross Blue Shield of Illinois Quality of Complaints & Occurrences Process Policy: QI 30: 4/1/2023: Blue Cross Blue Shield of Illinois Quality of Complaints & Occurrences Process Procedure: QI 30A: 4/1/2023: Member Communication: RR 5: 1/1/2022: Member Rights and Responsibilities: RR 1: 10/1/2022: Professional Liability Insurance AETNA BETTER HEALTH PREMIER PLAN MMAI 2021 Member Handbook Aetna Better Health Premier Plan MMAI (Medicare-Medicaid Plan) is a health plan that contracts with Medicare and Illinois Medicaid to provide benefits of both Member transition of care form (English/Spanish) (updated 4/6/2021) Member Care Information registration form; My Care Information member authorization form (English/Spanish) (updated 4/6/2021) You are now leaving Aetna Better Health Premier Plan MMAI. MeridianHealth Provider Information Regarding System Updates Effective July 1, 2021; Meridian Clinical Policy Readmission Review; Meridian of Illinois Announces Provider Relations Team Reorganization; Meridian of Illinois Partners with Jeremiah Development for LOVE Rockford Event; UPDATE PRACTICE INFORMATION USING THE MERIDIAN PROVIDER UPDATES Aetna Better Health® of Illinois is committed to providing high quality drug coverage to our members. Eligible beneficiaries may choose to opt-in to a MMAI plan or be passively enrolled in a plan. The Illinois Department of Healthcare and Family Services (HFS) today issued a Provider Notice to advise providers that the previously delayed statewide expansion of the Medicare-Medicaid Alignment Initiative (MMAI) is now scheduled to begin July 1, 2021. Blue Cross Community MMAI Provider Manual – Updated December 2021 5 Benefits and Beneficiary Rights Member’s Rights and Responsibilities Blue Cross and Blue Shield of Illinois (BCBSIL) is committed to ensuring that enrolled members are treated in a manner that respects their rights as individuals entitled to receive health care services. MMAI Members: Don't let the flu sneak up on you. 2021. For more recent information or other questions, contact us at 2021 Illinois-CMS-sponsored Medicare-Medicaid Alignment Initiative (Demonstration) Manual. February 2021 Medicaid Claim Filing Reminder: Don’t Enter a P. (Source Illinois Department of Healthcare and Family Services Subject: The Medicare-Medicaid Alignment Initiative \(MMAI\) is a program for adults who are enrolled in both Medicare and Medicaid. Downers Grove, IL 60515. Copeland Created Date: MMAI Enrollments — March 2021 HealthChoice Illinois Enrollments — March 2021 (continued) ++ ˆ ˇ 2021 03 MCO Enrollment Report for Website. For pharmacy authorization requests, visit Pharmacy. MEMORANDUM. 2021 . $16. M02 0822 ENG. MeridianHealth Provider Information Regarding System Updates Effective July 1, 2021; Meridian Clinical Policy Readmission Review; Meridian of Illinois Announces Provider Relations Team Reorganization; Meridian of Illinois Partners with Jeremiah Development for LOVE Rockford Event; UPDATE PRACTICE INFORMATION USING THE MERIDIAN PROVIDER UPDATES 2022 IL Prior Authorization Fax Submission Forms - Inpatient (PDF) 2022 IL Prior Authorization Fax Submission Forms - Outpatient (PDF) Authorization Referral Information; 2020 MeridianComplete Authorization Lookup (PDF) Behavioral Health Discharge Transition of Care Form (PDF) HealthHelp and eviCore Provider Notification (PDF) Weight Watchers Posted December 2021 1 Medicaid Prior Authorization Requirements, Effective Jan. Those who are dual-eligible qualify for both Medicare and Medicaid. See Chapter 4 of the Member Handbook on the Forms and Documents page for more details. AETNA BETTER HEALTH® of Illinois Policy Policy Name: Readmission Process Page: 1 of 10 Department: Medical Management Policy Number: 7200. Topic: extend statewide in 2021. Keywords: Illinois Client Enrollment Services Created Date: 3/15/2021 4:05:38 PM You can view the HFS Medicaid Reimbursement page by selecting the link below: Illinois Department of Healthcare and Family Services Medicaid Managed Care Program Map January 1, 2021 Medicare-Medicaid Alignment Initiative (MMAI) Plans Aetna Better Health Premier Plan Cook, DuPage, Kane, Kankakee, Will Blue Cross Community MMAI Cook, DuPage, Kane, Kankakee, Lake, Will Humana Health Plan Cook, DuPage, Kane, Kankakee, Lake, Will 2021 Diphenhydramine Antihistamine (Allergy Tablets) 400 ct 25 mg $16. Please refer to code specific listing as requirements may vary. Blue Cross and Blue Shield of Illinois (BCBSIL) will soon begin The Centers for Medicare & Medicaid Services (CMS) and the State of Illinois have contracted with Blue Cross and Blue Shield of Illinois (BCBSIL) along with other Managed Care Organizations (MCO) to implement MMAI. In the meantime, please visit our Health Plan MMAI Enrollments — May 2021 . gov, click Manage My Case to find your renewal due date and verify your mailing address. , local time. This article applies to HCBS providers – Illinois Department of Healthcare and Family Services (HFS) types 90, 92, 93 and 98 – who submit claims to Blue Cross and Blue Shield of Illinois (BCBSIL) for our Blue Cross Community Health Plans SM (BCCHP SM) and Blue State Fiscal Years 2020-2021 (July 1, 2020-June 30, 2021) Illinois Department of Healthcare and Family Services Division of Medical Programs. Contact Blue Cross and Blue Shield of Illinois' OTC vendor, Convey Health Solutions, Illinois Medicaid Prior Authorization Effective 1/1/2021 (Updated 10/1/2021) ommunity MMAI (Medicare-Medicaid)℠ members. Table 1-2 displays the MMAI health plans. Pay my premium; Find a Doctor; Drug Pricing guide; Find a form; Secured link, user need to login with credentials View ID card; Secured link, user need to login with credentials View my claims; Secured link, user need to login with credentials Check coverage; Secured link, user need to login with credentials Refill a Prescription; Manage your health To obtain an adequate Statewide network for the MMAI Program of IL, the Plan is using Aetna’s Medicare Yes, trainings will be offered to Providers starting in Q2 2021. MMAI combines both medical care and non-medical home and community-based services into a single program. 6-16-14. View All Versions; 2023 Illinois Compiled Statutes Chapter 305 - PUBLIC AID 305 ILCS 5/ (MMAI) Nursing Home Residents' Managed Care Rights Law. The MMAI demonstration Under the demonstration, also called the "Medicare-Medicaid Alignment Initiative," Illinois and CMS will contract with health plans to coordinate the delivery of and be What is the Medicare-Medicaid Alignment Initiative? The Medicare-Medicaid Alignment Initiative is one of Illinois' managed care programs. MMAI is a demonstration plan developed to better serve individuals eligible for both Medicare and Medicaid. information about . MeridianHealth Provider Information Regarding System Updates Effective July 1, 2021; Meridian Clinical Policy Readmission Review; Meridian of Illinois Announces Provider Relations Team Reorganization; Meridian of Illinois Partners with Jeremiah Development for LOVE Rockford Event; UPDATE PRACTICE INFORMATION USING THE MERIDIAN PROVIDER UPDATES Aetna Better Health ® Premier Plan MMAI is a health plan that contracts with both Medicare and Illinois Medicaid to provide benefits of both programs to enrollees. Producer. Jointly administered by the To help your Medicare and Illinois Medicaid benefits work better for you, we are enrolling you in an MMAI health plan. Currently, Blue Cross and Blue Shield of Illinois (BCBSIL) offers its Blue Cross Community MMAI Annual Notice of Changes — Last Updated 10/01/2024; Member Handbook (includes document of coverage information) — Last Updated 10/01/2024; Provider and Pharmacy Directory — Last Updated 01/01/2025; Quality Improvement Form — Last Updated 10/01/2024; Summary of Benefits — Last Updated 10/01/2024; Pharmacy Forms and Documents At this time, Aetna is the only health plan approved to operate MMAI program in all 102 counties. Limitations of Covered Benefits by Member Contract Last Updated: 10/12/2021. Copeland Created Date: 20210720155336Z Please see the back of this page for more information about these plans » Questions? Visit . $7. Members must live in one of these counties: Cook, DuPage, Kane, Kankakee and Will. You are now leaving Aetna Better Health Premier Plan MMAI. Copeland Created Date: 9/22/2021 2:25:32 PM MMAI Enrollments — November 2021 HealthChoice Illinois Enrollments — November 2021 (continued) 55 ˆ ˇ 2021 11 MCO Enrollment Report for Website 120921. 25 1946 Fluticasone Propionate (Allergy Nasal Spray, 24-hour) 144 sprays 50 mcg $26. com Eligible individuals in the new Illinois counties that will receive coverage can enroll in MMAI starting in June 2021. 5F-5. As of 7/1/2021, our service area includes these counties in Illinois: The federal Centers for Medicare and Medicaid Services approved Illinois’ application for such a waiver July 2. , HFS developed a transformative The Blue Cross Community MMAI (Medicare-Medicaid Plan)℠ was created to help you maintain your health and independence. y Enrollees, State officials, and stakeholders . Medicare-Medicaid Alignment Initiative (MMAI) Statewide Expansion New Effective Date: July 1, 2021. MMAI Enrollments — August 2021 (continued) HealthChoice Illinois Enrollments — August 2021 (continued) 55 ˆ ˇ 2021 08 MCO Enrollment Report for Website. reReddit: Top posts of 2021 As of July 1, 2021, Molina Healthcare of Illinois provides Medicaid HealthChoice, MMAI (MMP Duals), and MLTSS services to all 102 Illinois counties. m. 25 March 2021 Telehealth Services (CMS) and Illinois Department of Healthcare and Family Services (HFS). Aetna Better Health® Premier Plan MMAI ‐ Prior Authorization (PA) List. 1, 2023. TTY: Illinois Relay at 7-1-1 or 1-800-526-0844. HFS issued a Provider Notice to advise providers that the previously delayed statewide expansion of the Medicare-Medicaid Alignment Initiative (MMAI) is now scheduled to Under Aetna Better Health Premier Plan MMAI, some drugs may have special requirements or coverage limits. Call 1-866-600-2139 (TTY: 711), 24 hours a day, 7 days a week. 10 Any reference to Molina Initiative (MMAI) Plans Aetna Better Health Premier Plan Cook, DuPage, Kane, Kankakee, Will Blue Cross Community MMAI Cook, DuPage, Kane, Kankakee, Lake, Will Humana Health Plan Statewide HealthChoice Illinois Plans-January-1-2021#1 Created Date: 2/23/2021 3:37:29 PM . Medicaid Provider Manual 5 Any reference to Molina Members means Molina Medicaid Members. There are five plans to choose from for your coverage. Better Health ® Premier Plan MMAI, you may be eligible to receive $25 added to your reloadable gift card for 3. Will this change also affect the Medicare Medicaid Alignment Initiative (MMAI) Managed Care Organization (MCO) customers? No, MMAI MCO plan customers will continue to request non- See 89 Illinois Administrative Code Section 140. Aetna . S. Blue Cross Blue Shield of Illinois : BCBSIL . October 2022 BCCHP SM and MMAI Member Claims Must Be Submitted Electronically, Beginning Jan. Copeland Created Date: 20220105154618Z Premier Plan MMAI IL-20-10-18 Distributed: February 2021 H2506_21WINMBRNWSLTR ACCEPTED Late Winter 2021. Get your flu shot today for a $0 copay at an Start at abe. to 8 p. SM. With your Blue Cross Community MMAI (Medicare-Medicaid Plan)℠ coverage, you may be able to get Supplemental Benefits at no extra cost to you. How step therapy works. 3-19 9 Cumulative demonstration impact on select service utilization measures in Illinois, demonstration years 1–4, March 1, 2014–December 31, 2018 . The HEDIS MY 2021 Specifications for Survey Measures, Volume 3 was used Illinois MMAI Overview Confidential and Proprietary: Not for Distribution. The BCBSIL Provider Manuals are comprehensive guides for Blue Cross Community Health Plans SM, Blue Cross Community MMAI (Medicare-Medicaid Plan) SM, Blue Cross Medicare Advantage (HMO) SM, Blue Cross Medicare Advantage (PPO) SM, Blue Choice PPO SM, HMO, PPO and Blue High Performance Network ® (Blue HPN ®) EPO professional and Non-Emergency Ambulance Services Shift from HealthChoice IL (HCI) Managed Care Organization (MCO) Plans to Fee-for-Service (FFS) Page 1 of 3 1. zuqacnx xqgegeh jezogqa clwvfl xekc aaowj pxx uyet znuqrrl knk