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BAYOU HEALTH Newsletter 3.27.2012
Recipients in Capital Area, South Central Louisiana and Acadiana Still Have Until March 28 at 5 PM to Pick a BAYOU HEALTH Plan for April 1 Start Date
Eligible Medicaid recipients who live in the Capital Area, South Central Louisiana and Acadiana regions have until Wednesday, March 28, at 5 p.m. Central Daylight Time to choose a Health Plan and be enrolled in that Plan effective for their April 1 go-live date. These areas comprise Geographic Service Area (GSA) B, which is the second area of the State that will transition to BAYOU HEALTH.
There are several ways that recipients who have not yet chosen a Health Plan for their families can enroll. Recipients can call 1-855-BAYOU-4U and have an enrollment specialist assist them in choosing a Plan, or they can follow the automated phone cues to select a Plan, or they can enroll online at www.bayouhealth.com. Recipients can also complete and mail the forms back in the envelope provided in their Enrollment Kits, but mailed forms are not guaranteed to arrive before the March 28 deadline.
As of this week, nearly 97,000 recipients - about 34 percent of the recipients in GSA B who will be enrolled in BAYOU HEALTH - have selected their own BAYOU HEALTH Plans. The BAYOU HEALTH Enrollment Center has completed auto-assignment of recipients in GSA B who have not yet selected a Plan to one of the five Health Plans to ensure that every eligible recipient is in a Health Plan effective April 1. Auto assignments took into account a recipient's health care history, among other factors.
Recipients should know that even if they were auto-assigned to a Plan, they still have through March 28 to choose their own Health Plans. If a recipient was auto-assigned but makes a different choice by March 28, the recipient will be placed in the Plan he/she chose. Recipients who select a Health Plan after March 28 will have an effective start date of May 1, and will be in the original Plan they selected or were auto assigned to for the month of April.
After recipients are enrolled in a Health Plan, either by choice or through auto-assignment, they will receive a letter from BAYOU HEALTH, including information about the services and benefits available through that Plan. Recipients have 90 days from the date on their letter from BAYOU HEALTH with the name of their Plan to contact the Enrollment Center and select another Health Plan.
After the 90-day enrollment period, recipients can change Plans at any time if they have a good reason for doing so, such as moving to a different area of the state or their doctor leaving their Health Plan's network.
The New Orleans and Northshore areas, GSA A, transitioned to BAYOU HEALTH on Feb. 1. Southwest, Central and North Louisiana, which comprise GSA C, will transition to BAYOU HEALTH on June 1.
For the latest information about BAYOU HEALTH, please visit www.MakingMedicaidBetter.com or the enrollment website, www.bayouhealth.com. To share your comments or ask questions, email bayouhealth@la.gov. Call toll-free 1-855-BAYOU4U (1-855-229-6848) to speak with an enrollment counselor for assistance in picking a Health Plan.
FOR PROVIDERS
Resources Available to Assist Providers During BAYOU HEALTH Transition
DHH is committed to working with providers during the Medicaid program's transition to BAYOU HEALTH, and is offering several resources to assist in answering common questions and provide information.
Medicaid staff hold a daily BAYOU HEALTH call for providers each week day from noon until 1 p.m. The toll-free number to call is 1-888-278-0296, and the Access Code is 729-9088#. It is not necessary to pre-register, and any interested provider can participate.
DHH staff begin each call with announcements related to BAYOU HEALTH implementation and then open the line for questions and comments. The call is open to all provider types, regardless of whether BAYOU HEALTH has already been implemented in their region. If Medicaid staff are unable to answer a question on the call, they will follow up via email. Questions are usually answered within one business day.
In addition, the Medicaid staff members who are implementing BAYOU HEALTH have developed a series of numbered Informational Bulletins for providers and stakeholders, which answer frequently asked questions about the initiative and/or consolidate information from each of the five BAYOU HEALTH Plans into a single document.
These bulletins cover a range of topics, including recent additions on cash flow and provider reimbursement, referrals and prior authorizations and the BAYOU HEALTH auto-enrollment process. The bulletins are available at www.MakingMedicaidBetter.com, through the tab "Informational Bulletins."
Medicaid staff will update the bulletins as needed, and any revisions will include the date of the revision. The staff add new bulletins on a regular basis, based on requests for information and questions received. Providers are advised to check the site frequently to see the latest information.
If you have questions about BAYOU HEALTH, please email bayouhealth@la.gov, and the appropriate Medicaid staff member will respond. Typically, questions are answered within one business day. Providers who have complaints about BAYOU HEALTH can send these to DHH via the form on the Medicaid program website.
DHH's BAYOU HEALTH website, www.MakingMedicaidBetter.com, contains abundant information about the program, including specific information for providers. This site is updated daily to provide the latest details on BAYOU HEALTH implementation.
BAYOU HEALTH Plans Correcting Data in Provider Registry
Each of the five BAYOU HEALTH Plans submits an electronic Provider Registry to DHH with key information for all providers they have contracted with, including specialty, whether the provider is a primary care physician, parish, physical address(es) of all practice locations for that provider and phone numbers. As this information is used for the Provider Search tool on the enrollment website, www.bayouhealth.com, and is also used by enrollment agents to assist recipients in determining the Health Plans with which a provider is "in network," it is important that this information be accurate and up to date. Updates to the electronic Provider Registry are typically made weekly on Mondays, no later than early afternoon.
Several providers have reported to DHH that incorrect information is listed for their practice in a Health Plan's registry. DHH has been working with each of the Health Plans individually to correct problems, and the Plans continue to submit updated registries to the BAYOU HEALTH Enrollment Broker to update the Provider Search.
The BAYOU HEALTH enrollment site, www.bayouhealth.com, has temporarily disabled the electronic provider directory search, and DHH has directed the BAYOU HEALTH Plans to revise their provider registries and make any necessary corrections to ensure providers are correctly listed. While printed copies of each Plan's Provider Registry are available through the Enrollment Broker, the most up-to-date information for the Plan's network providers can be accessed through their individual websites. Links to each BAYOU HEALTH Plan website can be found on the Search for Providers page at www.bayouhealth.com so that recipients can find providers there to make Health Plan choices.
Providers are reminded that they can tell their Medicaid patients which BAYOU HEALTH Plans they will accept so Medicaid recipients can use this information in picking their Plans. The BAYOU HEALTH team has created a one-sheet flier that providers can use to identify the names of all the BAYOU HEALTH plans in which they will participate. Providers can distribute this flier to all their Medicaid patients. Providers can download the flier in color or black and white.
Providers who know there is incorrect information listed for them or their practice in a Health Plan's registry should bring this to that Health Plan's attention immediately. Providers who have trouble getting their information correctly listed with the BAYOU HEALTH Plans should report this to bayouhealth@la.gov so a DHH staff member can follow up with that Plan appropriately. If the Plans fail to make necessary corrections for providers' information in their registries, they are subject to sanctions from the state.
Providers Should Prepare Their Business Processes Before BAYOU HEALTH Goes Live in Their Areas
Providers should begin preparing for BAYOU HEALTH implementation next week by getting enrolled with any necessary login IDs and passwords for Health Plans' provider websites and registering for EFT with those Plans with whom they have contracted under BAYOU HEALTH.
There are five BAYOU HEALTH Plans that will coordinate care for Medicaid recipients: Amerigroup Real Solutions, Community Health Solutions, LaCare, Louisiana Healthcare Connections and United Healthcare Community Plan. As providers consider their Health Plan options, they should familiarize themselves with the contact information, payment processes and provider relations functions for each.
BAYOU HEALTH will go live in GSA B (Capital area, Acadiana and South Central Louisiana) on April 1, and in GSA C (Southwest, Central and North Louisiana) on June 1. Providers will want to have the information for each Plan ready on the day BAYOU HEALTH goes live in their region so they can more easily contact the Health Plans in which their patients are enrolled and can promptly bill for services provided. A list of all Health Plans' contact information is available at www.MakingMedicaidBetter.com.
Once BAYOU HEALTH is implemented in a GSA, the check write dates for each of the five Health Plans will occur as follows:
- Monday and Wednesday: LaCare
- Tuesday and Friday: Amerigroup
- Tuesday night: Louisiana Healthcare Connections
- Tuesday night: Molina for legacy/fee-for-service Medicaid program, Community Health Solutions, United Healthcare Community Plan
Providers should keep in mind that as patients begin transitioning to BAYOU HEALTH, they can access the eligibility website eMEVS to see which Plan that patient is in. The Medicaid eligibility database is the ultimate source of information. A patient may think he is in a different Plan or have a letter from another Plan, but providers should always consider the Medicaid eligibility verification system response to take precedence over information in the possession of the patient or Health Plan. Default to the Plan listed in Medicaid's database.
Contact Us
BAYOU HEALTH is the State's new approach to delivering and financing health care for nearly 900,000 Medicaid and LaCHIP recipients. Under BAYOU HEALTH, DHH has contracted with five private Health Plans responsible for coordinating and managing the care of their members to improve health outcomes while controlling costs in the program.
For the latest information about BAYOU HEALTH, please visit www.MakingMedicaidBetter.com or the enrollment website, www.bayouhealth.com. To share your comments or ask questions, email bayouhealth@la.gov. Call toll-free 1-855-BAYOU4U (1-855-229-6848) to speak with an enrollment counselor for assistance in picking a Health Plan.
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