4/5/2023 0 Comments Horizon blueHorizon NJ TotalCare (HMO D-SNP) is an HMO Medicare Advantage Dual Eligible Special Needs plan with a Medicare contract and a contract with the State of New Jersey Medicaid Program. Horizon Insurance Company ("HIC") has a Medicare contract to offer HMO, HMO-POS, PPO and Part D Medicare plans, including group-Medicare Advantage plans and group Part D Prescription Drug plans. Horizon Blue Cross Blue Shield of New Jersey Do not forget to sign and date your enrollment form before mailing it back. Please double– and triple–check that what you write on the form is correct and written clearly.Do not enter any information in "Agent Use Only" section.Horizon BCBSNJ determines which enrollment period is appropriate by the information and answers you provide in this section. In the section titled "Attestation of Eligibility for an Enrollment Period," please read the options and fill in the box that describes your situation.Also, be sure to read the information that is titled "Paying Your Plan Premium" as this contains useful information about how to get help paying for your plan should you need it. If you forget to fill in one of the boxes in this section, Horizon BCBSNJ will send you a bill every month. Clearly mark how you want to pay for your plan.Make sure you accurately copy the information from your Medicare card. If it does not match, your form will be denied. Make sure your birthday matches what is on file with Medicare and Social Security. Clearly and accurately provide all of the requested personal information.Please be sure to clearly indicate which plan you wish to enroll in at the top of the form. Your health insurance card(s) for any other insurance you carry besides Medicare and/or Medicaid.Your Medicaid program number, if you have one.Have this important information available:.Carefully print your answers in the boxes provided. The most common errors are from hard–to–read handwriting. Please complete the form, writing as clearly as you can. If you prefer not to enroll online, download and print the Enrollment Form in the Enrollment Form section for your preferred plan.More information on the CMS BAE policy can be found at Enrollment Instructions This policy requires Horizon to update our internal systems to reflect the correct cost sharing subsidy for the beneficiary when presented with evidence that the information showing the beneficiary to be ineligible is not correct. Horizon will comply with the BAE policy when situations arise that result in incorrect low income subsidy/cost sharing data at the point of sale. The Centers for Medicare & Medicaid Services (CMS) created the Best Available Evidence (BAE) policy to address incorrect low subsidy/extra help cost sharing data in the electronic data systems of CMS. Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center. To be eligible for Medicare Advantage, you must be entitled to Medicare benefits under Part A or enrolled in Part B and reside in New Jersey. Reviews medical, dental and vision claims and address gaps in member's preventative care.Eligibility Information & Enrollment Instructions Triage and distribute referrals from Member Services and incoming faxes from providers. Handle PCP, demographic changes and/or new ID cards as requested by members. Makes outbound calls to in order to engage members in Case Management and to complete the necessary health assessment(s) (IHS/HRA, CNA/CMNA, MLTSS Elig Survey*.)Įducates members regarding preventive health activities and services.Īssists member to make appointments with their PCP, specialists, and/or transportation, etc. Handles initial screening for pre-certification requests from physicians/members via incoming calls or correspondence based on scripts and workflows, and under the oversight of clinical staff.Īssists members with finding providers, resolving problems and answering questions regarding anything from how to obtain services to how to file an appeal. Non Clinical staff members are not responsible for conducting any UM review activities that require interpretation of clinical information. Upon collection of clinical and non-clinical information MCC can authorize services based upon scripts or algorithms used for pre-review screening. Perform other relevant tasks as assigned by Management Reviewing professional medical/claim policy related issues or claims in pending status.Īcts as liaison with providers, members and Care Managers. Upon completion of inquiries initiate call back or correspondence to Physicians/Members to coordinate/clarify case completion. Initiates call backs and correspondence to members and providers to coordinate and clarify benefits. Prepare, document and route cases in appropriate system for clinical review. Performs review of service requests for completeness of information, collection and transfer of non-clinical data, and acquisition of structured clinical data from physicians/patients.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |