ADVANTAGE CARE SELECT PROVIDER INFORMATION

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.

ADVANTAGE Care Select provider responsibilities include, but are not limited to, the following:

• Verifying member eligibility on the date of service
• Referring members to participating network providers and facilities
• Abiding by ADVANTAGE Care Select policies for prior authorization:
     Prior Authorization Bulletin
     Prior Authorization Forms
• Prescribing pharmaceuticals from the Indiana Care Select Preferred Drug List
• Notifying us upon receipt of an NPI
• Notifying us in advance of any changes in address, phone number, etc.
• Notifying us in advance of any provider additions or terminations
• Not balance billing members

ADVANTAGE Care Select Primary Medical Provider incentives include:

• All claims are still submitted to EDS and paid per the current IHCP Provider Fee Schedule.
• $15 PMPM Administrative fee paid by the State (not applicable to FQHC and RHC providers)
• Care Coordination Conferences reimbursed at $40.00 per member (twice in a 12 month rolling period; not applicable to FQHC and RHC providers)
• Quarterly Member and Provider Profile Information
• Pay for Performance Program (coming soon)

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:

• Care Select Addendum
• Managed Care PMP Enrollment Form
• ADVANTAGE Care Select Provider Demographic Form
• Covering Physician Form
• Attestation and Authorization Form

All forms should be returned to:

ADVANTAGE Health Solutions, Inc.
Attn: Care Select, Katie Tucker
9045 River Road, Suite 200
Indianapolis, IN  46240

Eligibility

The following Indiana Health Coverage Program members will be covered by the Indiana/ADVANTAGE Care Select program:

• Aged
• Blind
• Physically and mentally disabled
• Members receiving adoption assistance
• Members in the Waiver Program
• M.E.D. Works participants (Medicaid for Employees with Disabilities)
• Wards of the Court and Foster Children

Care Management

ADVANTAGE Care Select works with providers to ensure that Aged, Blind and Disabled (ABD) 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 provider, to ensure that they have a treatment plan that meets their needs.

Resource Locator

Care 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:

• Social
• Behavioral
• Physical
• Educational

Coordinator of Care

• Coordinate services based on needs, goals and member’s priorities
• Communication across the spectrum of health care providers (physicians, community-based org’s, wavier programs, school-based services)
• Ensure Right Services; Right Time; Right Resource
• Integrate the behavioral, physical, social and educational needs of all members

Integrator Role

Develop consolidated individualized care plans that incorporate the members’ needs, goals and priorities, with input from the:

• Primary Medical Provider treatment plan
• Behavioral Health Provider treatment plan
• Waiver Case Manager care plans
• Individualized Education Plans
• HCBS resources

Advocate Role

• Share the individualized care plan through multiple of media, i.e. face-to-face, fax, email, secure web portal
• Advocate for the member "TO MAKE IT HAPPEN" by:
• Removing barriers to care
• Provide education about conditions, available benefits and services, community resources, and access to care
• Communication portal for sharing information between all health care providers to include:
• PMPs & Physical health specialists
• Behavioral health
• Community and wavier case managers
• Caregivers, Family members, etc.

Referrals

The ADVANTAGE Care Select Program currently operates under an “open referral” network. Care Select Primary Medical Providers (PMPs) can refer to any Indiana Medicaid participating provider by notifying the provider of the referral and documenting in the patients chart. No additional forms or faxes are required.