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ü Be sure the enrollee is eligible for transportation. ü Status must be Active. ü Eligibility Status must read Eligible. ü Submission Status must be processed. ü Eligibility starts/ends needs to be within the current calendar month. If all of this is correct, proceed as usual, verifying all other information before moving on to Set Up Trip. If ANY of this is incorrect, the Medicaid number will need to be checked. (See below for Eligibility info) If it is determined the enrollee is eligible, select set eligible to move on to the next screen. Select the current month for eligibility which will return you to this screen. If enrollee is ineligible, then Decline Trip using the appropriate reason in the drop down. 2 - Ask caller to verify home address and contact number on every call. 3 - View all comments to check the history of this enrollee. Checking the comment history can provide useful information on modes of transportation and restricted locations. There also may be special instructions left by a supervisor stating to confirm all appointments or not to transport to a certain location or not to use a certain mode. SPECIAL HANDLING OVERRIDES ALL OTHER COMMENTS 4 -If there is no Transportation Type, first run the Medicaid number to confirm eligibility. Then, if eligible, set eligible before asking a supervisor for a trans. type. (If caller can provide appropriate medical conditions, trans. type can be set as Mileage Reimbursement, public transportation or taxi. Anyone needing ambulatory or above will need to submit a verification form.) § First time enrollees need to be asked if they own a vehicle, have access to public transportation and if they are medically able to use public transportation. Document the enrollee's medical condition and set up transportation accordingly. § Enrollees set as Mileage Reimbursement, Bus or Taxi will not need a verification form. Only enrollees using ambulatory or above will need to have a verification form filled out by their doctor. 5 - If a Verification Form is needed, forms can be faxed directly from any MAS desktop using the Fax Maker program. Forms can also be mailed to enrollees by selecting Mail New Form at the top of an enrollees account. Forms will be mailed to enrollee’s home address. If the home address is not the mailing address, enter the information as the mailing address to have the form sent to the correct location. 6 - Enrollees can be blocked from transportation for various reasons. Refer to Blocked Status field and View All Comments to see what restrictions are on the enrollee's account.
Eligibility Information MEVS- eligibility info Dial 2345 then press 1. Convert the Medicaid number using the key below then press #. A-21, B-22, C-23, D-31, E-32, F-33, G-41, H-42, I-43, J-51, K-52, L-53, M-61, N-62, O-63, P-71, Q-11, R-72, S-73, T-81, U-82, V-83, W-91, X-92, Y-93, Z-12 Once the Medicaid number is converted, Press 2 then #. When prompt for provider ID enter 1255424800 then ###. Always listen to Eligibility status and County Code. (Listen on for Managed Care Plan Name when eligibility states Eligible PCP)
The following statuses are ELIGIBLE for transportation: · Medicaid Eligible · Community Coverage with Community Based LTC · Community Coverage with No LTC · Eligible Only Outpatient Care · Eligible Except Nursing Facility Services · EP - Family Planning and Non Emerg Trans Only · Outpatient Coverage with Community Based LTC · Outpatient Coverage without LTC · Outpatient Coverage No NFS · Presumptive Prenatal Eligibility A · Presumptive Prenatal Eligibility B · Prenatal Care The following statuses are NOT ELIGIBLE for transportation: · Enrollee Not on File · Eligible Only Inpatient Services · Eligible Capitation Guarantee · Eligible Family Planning Services-No Transportation · Eligible Only Family Planning Services · Family Health Plus (eligible only if 19/20 years of age and enrolled in C/THP, Child and Teen Health Program. Enrollee becomes ineligible on 21st birthday.) · Family Health Plus Guarantee · Medicare Co-Insurance and Deductible Only · Not Medicaid Eligible · No Coverage-Pending FHP · Perinatal Family · Senior Whole Health
The following statuses require additional steps/information to determine if transportation should be authorized: v Restricted Recipient, No Authorization-Enrollee is eligible for transportation. Trips must be scheduled by the doctor or facility that the enrollee is restricted to. (Refer to Restricted Med. Provider on main page) If caller requests to know why they are restricted they can call 518-474-6866 for details. v No Coverage, Excess Income (Spend Down)-Enrollee has not met spend down for the month. Vendor has the option to transport, notify the vendor of the enrollee’s status and if the trip is accepted status will be “Ineligible/Proceed” v Emergency Services Only-Enrollee is only eligible for non-emergent transportation to dialysis or other life sustaining services (i.e. dialysis, chemotherapy) and hospital discharges. Counties currently not served by MAS. Direct callers to the following contact numbers
County Codes 97 and 98-OMH and OMR/DD MAS will authorize transportation for OMH and OMR/DD enrollees residing in any of MAS counties. For all other counties give caller the following contact numbers:
Managed Cares The following Managed Care Plans are ACCEPTED IN MAS 55 COUNTIES: § 82 - Affinity Health Plan, Inc § 98, 99, 02, HT - Emblem Health (AKA HIP/GHI) § AF – Affinity HARP § C2 - Health Now NY Inc § CG - Capital District Physicians' Health § CR – Crystal Run Health Plan LLC § EE – Excellus – Blue Options Plus HARP § HW - HIP of Westchester § IE, IN – Independent Health Association § KP - Amerigroup NY LLC § MR – Excellus Health Plan, Inc § MO - United Health Care of NY, Inc § MV - MVP Health Plan, Inc § NC – New York State Catholic Health Plan § OZ – YourCare Health Plan, LLC/formally Univera § TO – Molina Healthcare of New York Inc § WC - Wellcare of New York, Inc § WH – Hudson Health Plan Inc The following Managed Care Plans are NOT ACCEPTED IN 55 MAS COUNTIES: § AC - Catholic MLTC - ArchCare Senior Life, 866-263-9083 § AG - Agewell NY LLC, 866-586-8044 § AH – Aetna Better Health, 855-456-9126 § AL - Alphacare of NY Inc, 888-770-7815 § AP - Catholic Managed LTCS MLTC, 800-934-7704 § C7 - Center Light Health Care Pace, 877-226-8500 § CC - Complete Senior Care Inc, 888-303-4333 § CH – Catholic Health Plan Life PACE, 855-671-3341 § CP - Centers Plan for Healthy Living LLC, 855-270-1600 § E7 - Senior Care Connection, 855-376-7888 § EC – Extended MLTC LLC, 866-389-2656 § ED - Elderplan Inc Home First, 866-398-2656 § EG - Erie Niagara MLTCP Inc, 800-894-2464 § EG - Kalos Health, 800-894-2464 § EH – River Spring at Home (Elderserve), 800-370-3600 § FB – Aetna Better Health FIDA Plan, 855-494-9945 § FC – AgeWell New York FIDA, 866-586-8044 § FD – AlphaCare Signature FIDA, 855-632-5742 (Plan closed 12/31/16) § FE – HealthPlus Amerigroup FIDA Plan (Closed 01/01/16) § FF – ArchCare Community Advantage FIDA (Closed 11/30/15) § FG – CenterLight Healthcare FIDA (Plan closed 12/31/16) § FH – FIDA Care Complete, 800-466-2745 § FI – Elderplan FIDA Total Care, 855-462-3167 § FJ – RiverSpring FIDA Plan, 800-950-9000 § FK – Fidelis Care FIDA Plan, 800-247-1447 § FL – Guildnet Gold Plus FIDA Plan, 800-815-0000 § FM – Healthfirst AbsoluteCare FIDA, 855-675-7630 § FN – EmblemHealth Dual Assur, FIDA Plan (Plan closed 01/01/16) § FP – ICS Community Care Plus FIDA, 877-427-2525 § FQ – Integra FIDA Plan (Plan closed 01/01/16) § FR – Metroplus FIDA, 844-288-3432 § FT – North Shore – LIJ FIDA Live Well, 855-776-7545 § FV – VillageCare MAX Full Advantage FIDA Plan, 800-469-6292 § FW – VNSNY Choice FIDA Complete, 866-783-1444 § FX – WellCare Advocate Complete FIDA (Plan closed 12/31/16) § FY – SWH Whole Health FIDA, 844-861-3432 § FZ – Fallon Heath Weinburg PACE, 855-665-1113 § GD – Fidelis Care at Home, 888-343-3547 § GN – Guildnet, 800-932-4703 § H1 - Senior Health Partners Inc, 866-585-9280 § HC - Hamaspik Choice, 855-552-4642 § HP – HIP MLTC Partial (Plan closed 01/01/16) § IC - iCircle Services of the Finger Lake, 844-424-7253 § IL – Elder One (Independent Living), 855-457-4636 § IT - Integra MLTC Inc, 855-661-0002 § IS – Pace CNY, 888-728-7223 § IX – Independent Care Systems, 877-427-2525 § KX – Amerigroup Community Connections, 757-473-2737 § M3 – Evercare Choice Inc (Elant Choice), 877-255-3678 § MF - Montefiore HMO, 855-556-6683 § MH – HealthFirst Complete Care, 888-260-1010 § MP – MetroPlus MLTC, 855-355-6582 § MZ - Senior Network Health, 888-355-4764 § N6 - Total Aging in Place (Fallon Health Weinberg) , 716-250-3100 § NA - Niagara Advantage Health Plan LLC, 866-843-7526 § NS – North Shore – LIJ Health Plan, 855-421-3066 § PC - Prime Health Choice, 855-777-4630 § PO – Partners Health Plan FIDA IDD, 855-747-5483 § SW – Senior Whole Health, 877-353-0185 § TF - Center Light HealthCare Select (Plan closed 05/01/17), 877-226-8500 § TS - Total Senior Care Inc, 866-939-8613 § UH - United Health Care of NY, Inc. MLTCPC, 877-512-9354 § VA - VNA Homecare Options, 855-877-8868 § VC - VNS Choice, 888-867-6555 § VL – Village Senior Services, 800-469-6292 § VN – VNS, 866-469-7774 § WN - Wellcare of NY Inc, 212-463-6100 § Y2 – Neighborhood Health (Closed) § Y9 – Liberty Health Advantage, 866-542-4269 § YD - Fidelis Dual Advantage, 718-896-6500 § YF - Fidelis Care of NY, 877-533-2404 § YG – GuildNet, Inc MAP M/M, 800-932-4703 § YH - Senior Whole Health, 877-353-0185 § YL – Elderplan MAP, 866-386-9437 § YM – MetroPlus MA Advantage (Closed 01/01/16) § YN – VNS Choice Plus M/M, 866-597-6674 § YO – Empire BCBS HealthPlus (Amerigroup Advantage Plus), 866-805-4589 § YT - Touchstone HLTH Prestige M/M, 914-288-1157 (Eligible only in Westchester) § YU – United Health Care M/M, 866-362-3368 § YY – Affinity, 866-247-5678 § ZH - Health Insurance Plan of Greater NY, 646-447-5180
The following Managed Care Plans are ONLY ACCEPTED IN SOME COUNTIES (Plan name as stated in MEVS (Plan Code)-Contact Number) 1. NYS Catholic Health INC (SP)- Eligible in all MAS counties except Rockland. Have enrollees call 800-749-0820, 718-896-6500
2. Group Health Inc M/M (Y4)- Only eligible in Rockland. All others will call 800-624-2414
3. Wellcare of NY M/M (YW)- Eligible only in ALBANY, DUTCHESS, MONROE, RENSSELAER, ROCKLAND, SCHENECTADY, ULSTER, WAYNE, and WESTCHESTER. All other counties will call 866-491-5746.
The following Managed Care Plans will be authorized for NYC § 82, AF - Affinity Health Plan – Enriched Plan § 92 - Metro Plus (Metropolitan Health Plus) § 98, 99, 02, HT - Emblem Health (AKA HIP/GHI) § 99 - HIP (HLTH INSURANCE PLAN OF GTR NY) § AA – Amerigroup New York LLC § HF – Healthfirst PHSP, Inc. § HI - EmblemHealth Enhanced Care Plus § KP - Health Plus , an Amerigroup Co § MO, UC – United Healthcare of New York, Inc § MT – MetroPlus Enhanced § NC – Fidelis HARP § NP - Neighborhood Health Providers § OD - Amida Care, Inc § OM – MetroPlus § SF - HealthFirst PHSP, Inc § SP - NYS Catholic Health Plan Inc § UC – United Healthcare of New York § VS - VNS Choice § WC - Wellcare of New York
The following Managed Care Plans will not be authorized for NYC § AC - Catholic MLTC - ArchCare Senior Life, 866-263-9083 § AG - AgeWell New York LLC, 866-586-8044 § AH - Aetna Better Health, 855-456-9126 § AL - AlphaCare of New York, 888-770-7815 § AP - Archcare Community Life, 866-467-9351 § C7 - Centerlight (formally CCM), 877-226-8500 § CC - Complete Senior Care, 888-303-4333 § CH - Catholic Health Life PACE, 855-671-3341 § CP - Centers Plan for Healthy Living, 855-270-1600 § Elant Choice (Health Advantage Plan Inc) § E7 - Senior Care Connection (Eddy), 855-376-7888 § EC - Extended MLTC, LLC, 866-389-2656 § ED - Elderplan dba Homefirst, 866-389-2656 § EH – River Spring at Home (Elderserve), 800-370-3600 § FI – Elder Plan FIDA Total Care, 718-921-7979 § GD - Fidelis Care at Home, 888-343-3547 § H1 - Senior Health Partners Inc, 800-633-9717 § IL - Independent Living for Seniors d/b/a ElderOne, 855-457-4636 § IS - Loretto/PACE CNY/Independent Living Services HMO, 888-728-7223 § IT - Integra MLTC Inc, 855-661-0002 § IX - Independent Care Systems, 877-427-2525 § KX - Amerigroup Community Connections (Care Plus Conn), 757-473-2737 § MF - Montefiore HMO, LLC, 855-556-6683 § MH - MHI Healthfirst Complete Care, 888-260-1010 § MP - Metroplus MLTC, 855-355-6582 § MZ - Senior Network Health LLC, 888-355-4764 § N6 - Total Aging in Place, 866-882-8185 § NS – NorthShore, LIJ Health Plan, Inc, 855-421-3066 § PO – Partners Health Plan Inc, 646-844-4020 § SW - Senior Whole Health, 877-353-0185 § TF - Centerlight Select (formally CCM Select), 877-226-8500 § TS - Total Senior Care Inc, 866-939-8613 § UH - UnitedHealth Personal Assist, 855-345-6582 § VA - VNA Homecare Options LLC, 855-877-8868 § VC - VNS Choice, 888-867-6555 § VL – VillageCareMAX, 800-469-6292 § VM – Village Senior Services Corporation, 212-337-5750 § YF - Fidelis Care of NY, 877-533-2404 § YG - GuildNet, Inc, MAP M/M, 800-932-4703 § YH - Senior Whole Health M/M Plus, 877-353-0185 § YL - Elderplan MAP, 866-386-9437 § YN - VNS Choice Plus M/M, 866-597-6674 § YU - United Health Care M/M § YO - Amerigroup Advantage Plus, 866-805-4589 § WN - Wellcare of NY MLTC, 212-463-6100 § ZH - HIP of Greater NY, 866-447-9717
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