1. Community Care Network of Virginia Medicaid Medallion II Expansion April 17 & 18, 2012

2. BILLING SYSTEM SET UP Diane N. Harris Director, Central Business Office Community Care Network of Virginia dharris@ccnva.com www.ccnva.com 804-234-7690 x1126

3. INSURANCE PLANS Amerigroup Famis Plus Amerigroup Famis Anthem Healthkeepers Plus Anthem Helathkeepers Plus Famis Optima Family Care Majesta Care Majesta Care Famis Optima Family Care Famis Southern Health Carenet Southern Health Carenet Famis Virginia Premier Virginia Premier Famis

4. INSURANCE FILE SET UP CREATE NEW INSURANCE FILES PRIOR TO JULY 1, 2012 ADD EACH MEDICAID HMO AND FAMIS PRODUCT AS AN INDIVIDUAL FILE ENTER THE STANDARD INFORMATION IN THE INSURANCE FILE TO INCLUDE YOUR CLEARINGHOUSE PAYER ID NUMBER

5. INSURANCE FILE SET UP ll CREATE NEW INSURANCE GROUPS IN YOUR INSURANCE GROUP FILE ASSOCIATE EACH NEW PRODUCT TO THE CORRECT INSURANCE GROUP CONFIGURE UDS MAPPING FOR NEW INSURANCE GROUPS IN TABLE 4 AND TABLE 9D

6. VERIFY-VERIFY-VERIFY-VERIFY APPOINTMENTS SCHEDULED FOR DATES OF SERVICE ON OR AFTER JULY 1, 2012 MUST BE VERIFIED ON LINE PRINT OUT THE PATIENT VERIFICATION FROM EACH WEBSITE SCAN INTO PATIENT DOCUMENTS OR INSERT INTO PATIENT CHART UPDATE PATIENT REGISTRATION- DO NOT DELETE MEDICAID –EXPIRE PLAN

7. EDUCATE STAFF EACH PLAN HAS INDIVIDUAL POLICIES IN REGARD TO PCP EFFECTIVE DATE CHANGE INSURANCE PLAN CARD WILL HAVE THE FAMIS ICON TO ASSIST STAFF IN DIFFERENTIATING BETWEEN THE MEDICAID HMO AND THE MEDICAID FAMIS PRODUCTS

8. EDUCATE STAFF ll REMIND STAFF NOT TO USE THE MEDICAID NUMBER AS THE SUBSCRIBER NUMBER WHEN REGISTERING PATIENTS WITH NEW PLAN HAVE PCP CHANGE FORMS ON HAND TO ASSIST PATIENT WITH PCP CHANGE

9. MEDICAID MCO BEHAVIORAL HEALTH PRE- AUTHORIZATION REQUIREMENTS AMERIGROUP-1-800-454-3730-NO AUTH IN NETWORK ANTHEM HEALTHKEEPERS PLUS- 1-800-991-6045- NO AUTH IN NETWORK CARENET-1-800-235-2206-NO AUTH IN NETWORK FOR 90801 AND 90862. CPT CODES 90804 AND 90806 REQUIRE PRE-AUTHORIZATION-FILE CLAIMS TO MH NET-1-800-975- 8919 MAJESTACARE-1-866-996-9140-NO AUTH IN NETWORK OPTIMA FAMILY CARE- 1-800-648-8420-NO AUTH IN NETWORK VIRGINIA PREMIER-1-800-727-7536-NO AUTH FOR IN NETWORK FOR THE FIRST 26 VISITS PER PROVIDER PER ROLLING YEAR

10. QUESTIONS????