CountyCare - Provider Network Notice & FAQ Health Plan Transitions Effective April 1, 2016

March, 2016

Beginning April 1st, CountyCare will be working with a new third party administrator, Valance Health, as well as new benefits managers for pharmacy and vision services. Current benefits managers for dental and non-emergency transportation services are not changing.

It is our intent to make the transition as seamless as possible and are working hard to prevent any service disruptions.

We have assembled this notice and Frequently Asked Questions to communicate our plans and to help you during this time of change.

On behalf of all of us at CountyCare, thank you for your continued support and care of our members. We look forward to working with you.

Sincerely,

Steven Glass
Executive Director, Managed Care/CountyCare
Cook County Health & Hospitals System


Who will CountyCare be working with as of April 1?

The table below outlines the roles and responsibilities for the CountyCare health plan beginning April 1. CountyCare retains overall health plan management and oversight, including management of all vendors and contracted partners.

Overall health plan oversight and management, delegated vendor oversight, quality management, provider incentive program, value-added benefits.

www.countycare.com

312-864-8200

Back office operations (third-party administrator services), utilization management, member and provider services, grievances and appeals, fraud, waste and abuse oversight.

www.countycare.com

312-864-8200

CCHHS Complex Care Management (CCC) unit provides care coordination and care management for CountyCare members not assigned to a MHN ACO medical home

www.cookcountyhhs.org

312-864-0200

Care coordination and care management for CountyCare members assigned to a MHN ACO medical home

www.mhnaco.org

312-883-8380

Care coordination and care management for members identified as children with special needs (CSNs).

www.larabida.org/cce-la-rabida-care-coordination

773-363-6700

 

Pharmacy benefits management

www.optumrx.com

877-235-1981

 

Vision (optometric) benefits management

 

www.eye-quest.com

888-696-9551

Dental benefits management

www.dentaquest.com

888-278-7310

Transportation benefits management

www.firsttransit.com

630-403-1210

Do I need to contract with all of CountyCare’s partners?

It depends. Each of the benefits managers contracts their own provider network. If you provide any of these services directly, you will need to contract with the benefit management company to serve CountyCare members. If you were previously contracted with CountyCare directly, you do not need to re-contract.

What about behavioral health? I don’t see a benefits manager for that.

With this transition, CountyCare will no longer have a separate benefits manager for mental health and substance abuse services. Providers of these services will have one place for utilization management, one place to submit a claim and one place for provider credentialing. If you are directly contracted with CountyCare for medical and/or behavioral health services you do not need to do anything. If you are directly contracted only with Cenpatico for behavioral health services, you need to contact Provider Services to get information on how to join our network.

What about credentialing?

Each of the benefits managers contracts for their own provider network. If you provide any of these services directly, you should contact them to become part of their network.

Where do I submit a claim after April 1?

Where you submit a claim depends on the date of service.

For dates of service PRIOR to April 1, continue to submit your claims to our former through Emdeon using payor ID 42139 for medical claims, and 42138 for behavioral health claims. Claims may also be sent through US Mail to:

Medical claims

CountyCare
Attn: Claims Department
PO Box 5020
Farmington, MO 63640-4420

Behavioral health claims

CountyCare
Attn: Claims
PO Box 7700
Farmington, MO 63640-3828

For dates of service ON OR AFTER April 1, you will submit medical and behavioral health claims to our new TPA. This can be done several ways as outlined in the table below.

Electronic Claims Submission through our Clearinghouse

Clearinghouse: Emdeon

Medical Payer ID: 06541

Individual/Batch Electronic Claims Submission

Available 24/7 through our Provider Portal. You need a user name and password to log into the Provider Portal. See your organization’s site administrator for this information.

Paper Claims

Mail medical claims to:

CountyCare Health Plan

P.O. Box 211592

Eagan, MN 55121-2892

Fax

CountyCare does not accept faxed claims.

Questions

Contact Provider Services, 312-864-8200

Any episode of care spanning the April 1st date (e.g. inpatient stay, physical therapy, long term care, etc.) should be split billed to the correct payer ID based on the date of service.

What tools are available to me once I submit my claim?

Available tools on the CountyCare website and provider portal include:

  • Provider Manual
  • Verification of member benefits and eligibility
  • Claims status review
  • Download, Research, Reprint EOB's & EOPs
  • Request HIPAA compliant secure pre-authorization
  • Analytics relevant to my assigned case load
  • Ability to review codes that require authorization

What else can I expect April 1?

Clinical functions – prior authorization criteria, utilization management criteria, preferred drug list – will not change. Care manager assignment for non-MHN ACO providers will change. Staff from CCHHS’ Complex Care Coordination Unit have been in touch with all medical homes and have established linkages for effective transitions of care.

Contact information – our phone number, our web site – are not changing.

Other administrative functions -- provider portal, prior authorization process, call center staff, claims processing -- will change. These administrative changes will require you to get new portal login and to start using our new payor ID for claims submission to our clearinghouse. To get a login, click here.

CountyCare will suspend all prior authorizations and will not deny claims for non-enrolled providers through June 30, 2016 (90 days), or longer as needed. The suspension of these requirements will allow for smoother transitions of care and provide opportunity to ensure all systems are functioning properly.

How can I enroll to be set up for Electronic Remittance Advice (ERA)?

Beginning April 1st, providers can self-register on the Emdeon website to receive ERA payments. Please be sure to select CountyCare when you sign up. You can find the form at: www.emdeon.com/enrollnow

What is the timely filing period for claims?

CountyCare’s timely filing limit remains unchanged at 180 days. This will be the timely filing period beginning April 1 for behavioral health claims as well. Please refer to your Provider Manual for information on how to resolve claims issues and how to file an appeal.

Will members have a new ID card?

Yes, members are being mailed their new ID cards in March. The new ID cards (see below) include information needed to obtain pharmaceuticals through our new PBM. They also include the new mailing address for claims, and the benefits managers’ hotlines.

Front
Back

Providers are reminded to verify eligibility and benefits at every visit by checking our website or by calling Provider Services. Providers may also confirm enrollment through the State of Illinois’ MEDI System at www.myhfs.illinois.gov

What if I have an appeal?

For all dates of service prior to April 1st, please continue working with the vendors where you submitted your claim. For claims with dates of service on or after April 1st, please refer to the CountyCare website or Provider Manual for details.

Are the members' benefits changing?

No. A member's covered services are not impacted by this change.

Do I need to do anything with my current CountyCare Provider Participation agreement?

No. CountyCare will continue to honor your current agreement with us. In the near future, we will issue an amendment to reflect changes made by the Illinois Department of Healthcare and Family Services (HFS). Providers can expect these amendments in the summer.

How do I get into the new provider portal?

With the transition to a new TPA, providers must obtain new logins to the secure provider portal. Access to the portal is TIN driven. An on-site administrator has been identified by CountyCare. Contact your on-site administrator who can issue you a username and passwords.

If you do not have a site administrator, download and complete the Portal Access Form and return it to CountyCare. Once received, a user login name will be emailed to the person identified on the form

Is there anything special behavioral health (mental health and substance use) providers should know?

Yes. As of 4/1/2016 CountyCare will no longer have a separate benefits manager for mental health and substance abuse services. Below is specific information for mental health and substance use providers that should help you in this transition.

Behavioral Health Outpatient Services

All members currently in outpatient treatment can continue with their current provider, regardless of network participation, through 9/30/2016. During this time, CountyCare invites providers to work with our Provider Relations department to join our network. Providers who do not plan to join the network should contact CountyCare to request the support of a care coordinator who will help the member transition to another provider. As of 10/1/2016, non-participating providers in the contracting process may continue treatment of CountyCare members with letter of agreement from CountyCare.

Behavioral Health Inpatient Services

Providers must notify CountyCare of all inpatient admissions. Beginning 5/1/2016, CountyCare’s utilization management and care coordination teams will work with non-participating inpatient providers to transfer members to in-network providers.

Behavioral Health Provider Services

Behavioral health providers will work directly with CountyCare for utilization management, claims and credentialing. If you are directly contracted with CountyCare for medical and/or behavioral health services you do not need to do anything. If you are directly contracted only with Cenpatico for behavioral health services, you need to contact Provider Services to get information on how to join our network.

Is there anything special HCBS and Service Package II providers should know?

Yes. As of 4/1/2016 CountyCare is making important changes to the administration of HCBS and Service Package II covered services. These changes include:

  • Transitioning administration of Service Package II Provider Network covered services to CountyCare Health Plan
  • Transition of Care Management/Care Coordination
  • New Administrative and Benefits Management vendors

The changes do not affect the benefits or care for CountyCare Health Plan Service Package II members. You should continue to provide services to the CountyCare Health Plan members according to their Service Plan.

Questions about obtaining authorizations for waiver services? Click here to learn more.

CountyCare will honor all current authorizations from March 2016 through April 30, 2016.

If you have not already submitted your executed agreement, it is imperative that you do so as soon as possible contract from you by 4/15/2016 to ensure accurate and timely payment. Please see below for more information.

Transition of Provider Network

All CountyCare members currently receiving Service Package II services can continue with their current provider, regardless of network participation, through 6/30/2016. During this time, CountyCare invites providers to work with our Provider Relations department to join our network.

Providers who do not plan to join the network should contact CountyCare to request the support of a care coordinator who will help the member transition to another provider. As of 7/1/2016, non-participating providers working through the contracting process will be allowed to continue treating CountyCare members through a letter of agreement issued by CountyCare.

If you have questions about your participation in the CountyCare Health Plan or would like to request a provider in-service orientation, please contact Jeanne Klein, CountyCare Provider Relations Manager at jklein2@cookcountyhhs.org. If you have not already done so, please submit your signed contract to CountyCare Health Plan as soon as possible to: 627 South Wood Street, 5th Floor Suite 512, Chicago, IL 60612, by fax at 312-864-9240, or call 312-864-0947.

Transition of Care Management/Care Coordination

Members in HCBS waivers will have a new Care Coordination Team beginning April 1, 2016. The new Care Coordinator/Care Manager will be reaching out to you to coordinate the member’s care. The reach the new Care Management/Care Coordination Team please call (312) 864-0200, option 2.

Additional Information

Please be sure to read all of the FAQs posted on this website for additional information specific to the April 1 transitions.

What if I have additional questions?

CountyCare will host several town halls and webinars to update providers on general information regarding the transition. Visit our website for more information, dates and times.

If your inquiry is regarding claims with dates of service prior to April 1st, please work with the current vendor to resolve these matters. 

Or you may feel free to contact Jeanne Klein, CountyCare Provider Relations manager at 312-864-0947 or jklein2@cookcountyhhs.org.  We will do our best to respond to your inquiries promptly.





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