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ADVANTAGE Care Select is committed to the provision of high quality, cost-effective,
outcomes-oriented care to our members. We realize that the successful pursuit of
these goals requires the active participation of a committed provider network.
Member Eligibility
The Indiana Care Select program covers the following populations statewide:
- The aged, if not eligible for Medicare, or
- Blind members, or
- Physically and/or mentally disabled members (collectively known as "the ABD population"),
or
- Wards of the court and foster children, or
- Children on adoption assistance
However, to be eligible for the program, the populations mentioned above have to
be diagnosed with at least one of the following disease states:
- Asthma
- Diabetes
- Congestive heart failure (CHF) or coronary artery disease (CAD)
- Hypertension
- Chronic kidney disease without dialysis
- Severe mental illness (SMI)
- Serious emotional disturbance (SED)
- Depression
The member must also be selected by Medicaid and choose to enroll.
Provider Responsibilities
ADVANTAGE Care Select provider responsibilities include, but are not limited
to, the following:
- » Verifying member eligibility on the date of service
- » Referring members to Indiana Health Coverage Program (IHCP) participating
network providers and facilities
- » Abiding by ADVANTAGE Care Select policies for prior authorization:
- » Prescribing pharmaceuticals from the Indiana Care Select
Preferred Drug List
- » Notifying us upon receipt of an NPI
- » Notifying us at least thirty (30) days in advance of any changes
in address, phone number, etc.
- » Notifying us at least thirty (30) days in advance of any provider
additions or terminations
- » Not balance billing members
- » Working with the member's Disease Manager and/or Care Manager
and the member to create and implement the member's care plan
ADVANTAGE Care Select Primary Medical Provider (PMP) incentives include:
- » All claims are still submitted to HP and paid per the current
IHCP Provider Fee Schedule.
- » $6 PMPM Administrative fee paid by the State (not applicable to
FQHC and RHC providers)
- » Care Coordination Conferences reimbursed at $20.00 per member
(once in a 12 month rolling period; not applicable to FQHC and RHC providers)
- » Pay for Performance/Provider Reinvestment
Program
- » Assistance from the Disease Management team to meet the needs
of Care Select patients
ADVANTAGE Care Select welcomes your participation in the Care Select
Program. In order to enroll as an ADVANTAGE Care Select Provider please complete
the following forms:
All forms should be returned to:
ADVANTAGE Health Solutions, Inc.
Attn: Care Select, Katie Tucker
9045 River Road, Suite 200
Indianapolis, IN 46240
Care Select claims are processed by HP. Providers should refer to the
IHCP Provider Quick Reference Guide
for contact information.
What does ADVANTAGE Care Select Offer?
Primary Medical Provider (PMP) Network
The ADVANTAGE Care Select Program currently operates under a “closed
referral” network. Care Select Primary Medical Providers (PMPs) can
refer to any Indiana Medicaid participating provider. No additional forms or faxes
are required.
Disease Management
ADVANTAGE Care Select works with providers to assist members in understanding
their chronic conditions, set goals, and achieve self-selected outcomes through
education, counseling, and on-going support. Members with multiple chronic conditions
might have unique health needs which are incorporated into their Disease Management
plan.
Members will receive monthly phone calls from ADVANTAGE Disease Management staff
reinforcing key elements of chronic Disease Management and treatment. These conversations
shall encourage members to follow the Disease Management plan by addressing any
indetified barriers and referring members to additional community resources when
appropriate.
Member education materials are also provided by mail or electronically.
Care Management
ADVANTAGE Care Select works with providers to ensure members receive additional
support to manage their health. Through care management, patients have an advocate
that will help them access the resources they need. We work with them, as well as
you, their PMP, to ensure that they have a treatment plan that meets their needs.
Resource Locating
Disease Management identifies and connects with the benefits and services that meet
the needs, goals and priorities for the member, caregivers and family members, to
include:
- » Clinical
- » Social
- » Behavioral
- » Functional
- » Educational
Coordination and Integration of Care
Care Coordination services include direct member contacts in order to assist members
with:
- » scheduling,
- » locating specialist and specialty services,
- » transportation needs,
- » reminders about the ADVANTAGE 24-hour nurse hotline,
- » general preventive services (e.g. mammography),
- » disease specific reminders (e.g. Hgb A1C),
- » pharmacy review,
- » referral to the Indiana QuitLine for tobacco cessation and intervention,
- » education regarding use of primary care and emergency services.
The ADVANTAGE Care Select program also works to integrate the behavioral,
physical, social and educational needs of all members by removing barriers to care
and providing education about conditions, available benefits and services, community
resources and access to care
Care Planning
For highly chronic and complex members, an individualized care plan will be developed
that is more comprehensive than the disease management plan described above. Care
plans are prepared with members (and their families, if appropriate) based on clinical
guidelines endorsed by the Office of Medicaid Policy and Planning (OMPP) that address
the member’s clinical, social, psychological, and functional needs, appropriate
to the member’s chronic disease condition(s).
Those members receiving care management will have direct access to a clinical dedicated
care manager. The care manager will outreach to the member’s PMP (electronically,
through the mail, or by telephone) and offer to share the member’s care plan with
the PMP.
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