2 Health Partners Plans Provider Manual Frequently Asked Questions
2 Health Partners Plans Provider Manual Frequently Asked Questions Purpose: This chapter provides answers to frequently asked questions concerning member, provider and disease management issues Topics: Benefits & Eligibility FAQ Claims FAQ Referral Information FAQ Authorizations FAQ Behavioral Health FAQ Disease Management Services FAQ Perinatal/Baby Partners FAQ Provider Information FAQ Health Partners Plans Provider Manual Frequently Asked Questions - February 2014 Page 2-1 Health Partners Plans Provider Manual Frequently Asked Questions - February 2014 Page 2-2 Module Contents Overview 2-4 Health Partners Plans & KidzPartners Benefits & Eligibility Claims Referral Information Authorizations Behavioral Health Healthier You Disease Management Program Provider Information 2-4 2-5 2-8 2-9 2-10 2-10 2-11 Health Partners Plans Medicare Benefits & Eligibility Claims Referral Information Behavioral Health Disease Management Provider Information Health Partners Plans Provider Manual Frequently Asked Questions - February 2014 2-12 2-12 2-14 2-15 2-15 2-15 Page 2-3 Overview This chapter provides a series of frequently asked questions pertaining to the following broad categories: • Benefits & Eligibility • Claims • Referrals • Authorizations • Behavioral Health • Disease Management • Provider Information Health Partners Plans & KidzPartners Benefits & Eligibility ¾ Do I have to verify member eligibility? Yes, you must verify eligibility whenever a Health Partners Plans or KidzPartners member visits your office. We offer a direct phone number to member eligibility verification. For Health Partners Plans members, simply call 1-800-225-2978 or 215-849-4791, Monday through Friday, from 8:30 a.m. to 5 p.m., to go directly to eligibility verification. Of course, the general Provider Services Helpline is available 24 hours a day, seven days a week at 215991-4350 or 888-991-9023. For KidzPartners members, call 215-967-4540 or 888-888-1211 for eligibility verification. To gain access to HP Connect you will need to first register online for a secured log-on ID and password. Please visit our website at www.HealthPartnersPlans.com. Click Providers and complete the online registration form. Make sure to designate a primary super user. The requesting super user is authorized to set up additional user profiles and reset passwords. Please allow three business days for processing your registration. We will contact you by email or phone to confirm that you have access to HP Connect. Specialists, ancillaries, and hospitals also need to confirm eligibility. Because of the frequent changes in eligibility (especially for Medical Assistance members) and the member's right to change his/her Managed Care Organization (MCO) choice from month to month, all providers must verify member eligibility on the date of service (via the avenues described in the paragraph above) to ensure the patient's eligibility in the plan. ¾ What insurance coverage is primary? Employer group health, worker's compensation, automobile coverage and any other liability insurance or payment is always primary. Absent any of these liable parties, Medicare is primary. Medicaid is always the payer of last resort. For KidzPartners there is no secondary coverage. KidzPartners insurance is the only coverage. Health Partners Plans Provider Manual Frequently Asked Questions - February 2014 Page 2-4 ¾ If a member has another insurance provider, what is Health Partners Plans ‘payment liability? Medicaid is always the payer of last resort. If a member has other coverage, such as Medicare or Blue Cross, the Medicaid liability is limited. Specifically, payment will be made only up to the contracted Medicaid rate. So if a primary insurer has paid more than Health Partners Plans would have paid if its coverage were primary, no additional reimbursement will be made. The one exception to this rule concerns payment of the Medicare inpatient copayments, which are normally payable as a secondary benefit. ¾ If Health Partners Plans is secondary, is it necessary to get authorization from HealthCare Management? Health Partners Plans requires an authorization from our HealthCare Management department regardless of whether Health Partners Plans is the member's primary or secondary insurance. Please refer to Sections IV and V to determine which services require authorization. ¾ Is there a copayment or deductible for doctor visits? Copayments vary according to the member's benefit package under Medical Assistance/General Assistance for Health Partners Plans members and under CHIP for KidzPartners members. For more information, see Copays for Medicaid Members on page 4-21 and Copays for KidzPartners Members on page 6-10 and HP Medicare members at 5-5. Claims ¾ Does Health Partners Plans accept electronic claims submissions? Health Partners Plans offers the speed, convenience and lower administrative costs through Electronic Data Interchange (EDI), also known as electronic claims processing. Health Partners Plans has contracted with Emdeon as our claims transaction clearinghouse. Please use Payer ID number 80142 for Health Partners Plans and KidzPartners claims. For more information, call the EDI Support Line (see Table 1: Service Department Contact Information on page 1-15). Health Partners Plans Transaction Code Set Companion Guides are available through the HIPAA section of our website under Providers. ¾ Where do I mail claims for Health Partners Plans/KidzPartners? Please note the following addresses: Health Partners Plans (Medical Assistance) P.O. Box 1220 Philadelphia, PA 19105-1220 KidzPartners (CHIP) P.O. Box 1230 Philadelphia, PA 19105-1220 Claims Reconsiderations Health Partners Plans 901 Market Street, Suite 500 Philadelphia, PA 19107 ¾ What is the normal payment cycle for releasing claim payments? Health Partners Plans Provider Manual Frequently Asked Questions - February 2014 Page 2-5 Health Partners Plans records the date of receipt of each claim received at our claim processing center and tracks its status through processing and check generation. With few exceptions, claims are processed within 30 days of receipt. Checks are produced on a weekly basis and mailed within two days of generation. ¾ What is Claim Check? Claim Check is a software product that identifies potential unbundling of services. Certain claims are compared against expected norms. In some cases, a service will be denied as being part of another major procedure. Your remittance should indicate the code review message if that situation occurs. ¾ What does the term "pre-paid" mean? When you don't receive payment and your remittance shows an amount in a pre-paid column, it indicates that the service billed has already been reimbursed. This usually occurs when a capitated payment has been made and no additional fee for service reimbursement is available for the procedure code billed. ¾ Why don't I get paid correctly for services that have been authorized? There are a number of possible answers. In some cases, the services authorized are different than the services billed. This can occur because individual CPT or HCPCS codes differ between authorization entry and claim billing. Also, dates of service authorized may vary from the dates of service shown on the form. It is important to make sure that both the persons calling for prior authorization and the billing staff have a common understanding about exactly what services have been authorized. ¾ When, if ever, am I allowed to bill the member for balances due? The general rule to follow for the Health Partners Plans Medicaid line of business is that the member cannot be balance billed. If you disagree with a claim payment decision, you should appeal the claim decision to Health Partners Plans and not attempt to collect monies from the member. The member may be billed only if: 1) the member knows that the service he or she is requesting is not a covered benefit; and 2) the provider obtains written agreement in advance of the service from the member that he or she understands that and will pay for the service. This restriction regarding balance billing does not apply to members enrolled in the KidzPartners (CHIP) program. ¾ When should I resubmit a claim in lieu of appealing a decision? In very few instances does resubmission of a claim lead to monetary reimbursement. If a claim has been returned with a letter indicating the form is being sent back because of incorrect provider number, diagnosis or procedure code, you should resubmit a corrected copy of that claim. In all other cases, the claim decision should be appealed. Simply resubmitting a claim, on which you feel an underpayment was made, will generally lead to an automatic system denial for duplicate billing. ¾ What are the timely filing limitations? Health Partners Plans Provider Manual Frequently Asked Questions - February 2014 Page 2-6 For claim submission, the timely filing limit is 180 days from the date of service. For secondary billings, the 60-day timeframe starts with the primary explanation of payment notification date. Claim appeals must be filed within 180 days of the claim notification date noted on the Health Partners Plans Explanation of Payment notice. ¾ What information do I need to submit my claims electronically to Health Partners Plans? Make sure to include the following items prior to sending claims electronically for Health Partners Plans members: Payer ID Number for Health Partners Plans/KidzPartners is 80142. Individual and billing NPI numbers are required. Failure to include this information will result in a rejection of the claim. Please refer to the Health Partners Plans 837 Institutional and Professional Companion Guide for the required provider number field. ¾ What is my Health Partners Plans Provider ID number? Health Partners Plans providers must use their individual and billing NPI numbers when submitting claims electronically. A Health Partners Plans legacy number may be billed on paper claims. Legacy provider numbers are specific to individual providers or facilities by their practice location/site. If you are unsure of your Health Partners Plans Provider ID number, please contact the Health Partners Plans. ¾ What if my billing company or EDI software vendor uses another clearinghouse such as NDC, Med-E America, ETS, or Equifax instead of Emdeon (WebMD/NEIC/Envoy)? Emdeon is the leading clearinghouse in the country and almost all claims clearinghouses forward claims to them for processing. Check with your software vendor for details. ¾ How can providers obtain copies of Health Partners Plans' Companion Guide? All Companion Guides are available on the Health Partners Plans website: www.HealthPartnersPlans.com, click Providers > Eligibility & Claims > HIPAA Connect > EDI Claims. Please check this site frequently for updates. ¾ Who can we contact at Health Partners Plans if we have Transaction and Code Set or EDI questions? If you have questions regarding electronic billing or Transaction and Code Sets, please contact Health Partners Plans' EDI Support Line (see Table 1: Service Department Contact Information on page 1-15). ¾ Can Health Partners Plans accept HIPAA- and non-HIPAA-compliant formats? No, Health Partners Plans can only accept HIPAA-compliant transactions. Health Partners Plans Provider Manual Frequently Asked Questions - February 2014 Page 2-7 Referral Information Primary care providers should refer Health Partners Plans/KidzPartners members to a participating specialist or facility. ¾ What is Health Partners Plans' referral process? In July 2009, Health Partners Plans introduced an easier referral process: Participating providers are now able to order services using a script. A copy of the script should be kept in the member's medical chart, but it is not necessary to send a copy to Health Partners Plans with your claim. Please keep in mind that prior authorization must be obtained for certain services. For more information, see Health Partners Plans Benefit Summary and see KidzPartners Benefit Summary. ¾ If the script says "consult only," but the specialist believes treatment is warranted for a HealthPartners/KidzPartners member, what is the procedure? The specialist should communicate the clinical situation to the member's primary care provider (PCP) who may authorize additional services by forwarding or faxing a written referral or script to the specialist's office. As with all referrals, the specialist and the referring PCP must keep a copy of this new referral in the member's medical record. ¾ Can the specialist give a verbal report to the PCP, or does it have to be written? Verbal communication is acceptable initially, but it must be followed with a written report. A notation regarding communication between the PCP and specialist should be recorded in the patient's medical record. ¾ Can members go outside of the Health Partners Plans/KidzPartners provider network? Health Partners Plans realizes that PCPs might occasionally refer members to a nonparticipating provider for medical care not available through a participating provider. However, we require that you seek prior authorization before making a referral to a nonparticipating physician. If prior authorization is not obtained for out-of-network services, reimbursement will be denied. Please call the Inpatient and Outpatient Services department for prior authorization of both inpatient and outpatient services (see Table 1: Service Department Contact Information on page 1-15). Please see the Health Partners Plans Primary Care, KidzPartners Primary Care, and/or Specialist Directory for lists of participating plan providers, or consult PROVIDER Plus+, our online provider directory www.HealthPartnersPlans.com which is updated more frequently. You can also call Health Partners Plans for information about participating providers. ¾ How long is a referral valid? A referral is valid for 90 days from the date it is written as long as the member remains an active member in Health Partners Plans/KidzPartners. A PCP is not restricted regarding the specialist referral criteria (i.e. the length of time the member sees the specialist or the number of visits that comprises). If the specialist does not participate with Health Partners Plans/ Health Partners Plans Provider Manual Frequently Asked Questions - February 2014 Page 2-8 KidzPartners, prior authorization is required and these claims are adjudicated accordingly. PCPs are expected to keep a copy of all referrals on file in the patient's record. Members are given a copy of the referral to bring to the specialist office to confirm that the PCP made the referral. If the PCP does not indicate the number of visits on the referral, the specialist will assume only one visit is authorized and may refuse to see the member for follow-up care (without an additional referral). ¾ What services require referrals? Specialist services for Health Partners Plans/KidzPartners members require a referral. A referral is not needed for emergency services (i.e., emergency room visits, emergency inpatient stays, emergency SPUs), family planning, routine dental, vision or OB/GYN services, or initial chiropractic evaluations. Please refer to the benefits grid in chapter IV for details about services requiring referral, script and/or prior authorization. Authorizations ¾ Who should contact HealthCare Management for authorization of an elective hospital admission – the PCP, the specialist or the hospital? Any of the three. The ideal caller is the party who has the best understanding of the patient's medical condition and proposed treatment. Keep in mind, however, that unauthorized elective hospital admissions will be subject to denial. All hospital admissions, including patients admitted through the emergency room, as well as elective admissions, should be called in to Health Partners Plans for notification and authorization within two business days (see Table 1: Service Department Contact Information on page 1-15). If your need for prior authorization occurs on a weekend or holiday, please make your request the next business day. ¾ What should I do if a member requires home care or DME? Call Health Partners Plans' Outpatient Services Unit for DME, outpatient rehabilitation services, and home care (see Table 1: Service Department Contact Information on page 115). Rentals - regardless of reimbursement - and DME/supplies over $500 per claim line require prior authorization. All home care, shift care, and outpatient rehabilitation services also require prior authorization. A prescription request and letter of medical necessity must be faxed to 215-849-4749. ¾ Is authorization needed for radiology services? Yes, Prior authorization is required for all PET scans, CT scans and MRI through Medsolutions, Inc. (MSI). They can be reached by calling 800-575-4594 ¾ Is authorization needed for short procedure unit (SPU) services? Health Partners Plans: No authorization is needed, but a prescription from the PCP or specialist is required. For more information, see Table 1: Short Procedure Unit (SPU)/Ambulatory Procedures on page 7-8. KidzPartners: Prior authorization is required for all SPU services. Health Partners Plans Provider Manual Frequently Asked Questions - February 2014 Page 2-9 Behavioral Health ¾ How do Health Partners Plans/KidzPartners members access behavioral health treatment? Behavioral health services do not require a referral. Providers who identify a Health Partners Plans member in need of behavioral health services should contact the Medical Assistance behavioral health managed care organization (BHMCO) assigned to the county in which the member resides (these are listed below). Our Special Needs Unit is also available to help with coordination of care issues. Behavioral Health Managed Care Organizations in the five county Philadelphia area include: - Philadelphia County - Community Behavioral Health (CBH) [215-413-3100 or 1-888545-2600] Bucks County - Magellan [1-877-769-9784] Chester County - Community Care Behavioral Health (Provider) [1-888-251-2224] (Member) [1-866-622-4228] Delaware County - Magellan [1-888-207-2911] Montgomery County - Magellan [1-877-769-9782] Behavioral health services for Kidzpartners members do not require a referral. Providers who identify a Kidzpartners member in need of behavioral health services should contact Magellan Behavioral Health Inc. Magellan Behavioral Health - Provider Services [1-800-424-3702] Healthier You Disease Management Program ¾ How should I enroll a member in the Healthier You Disease Management program provided by Health Partners Plans? To enroll a member in the Healthier You, Disease Management program, contact the department by calling 215-967-4690 or 866-500-4571 and leaving all the pertinent member information on the confidential line. You may enroll adults and children in our asthma, diabetes and Fit Kids programs. We also have a heart failure program for adult members too. Perinatal/Baby Partners Program ¾ What does the Baby Partners program offer members? Our Baby Partners Case Managers are highly qualified nurses and social workers who will outreach and case manage members throughout their pregnancy and follow up after delivery in coordination with the member's health care provider. We will facilitate members who wish to quit smoking, provide breast feeding counseling, coordinate transportation to appointments and home care, screen for depression and follow up as needed, and ensure that the member understands the importance of all appointments. For more information, see Table 1: Service Department Contact Information on page 1-15. Health Partners Plans Provider Manual Frequently Asked Questions - February 2014 Page 2-10 Provider Information ¾ How do I reorder PCP supplies, such as Health Partners Plans Authorization forms? Simply log on to www.HealthPartnersPlans.com and click Providers. You can order your supplies via our online Supply Request Form. You can even have them shipped to a different location than your main office for easier storage. In addition, supplies can be ordered by calling the Provider Services Helpline (see Table 1: Service Department Contact Information on page 1-15). ¾ Do I have to notify Health Partners Plans when there is a change such as a new physician joining the practice, an office address change, or a change in practice ownership? The Department of Public Welfare (DPW) requires that Medicaid providers have valid licenses in PROMISe or will be terminated. It is crucial to have the most current and up-todate information to ensure proper claims submission, recredentialing and to provide you with important notifications. You are contractually required to let us know when you have had a change in your practice or status. When you need to notify us of a change please send the request in writing to our Credentialing Administration department, or via email at [email protected] Health Partners Plans Provider Manual Frequently Asked Questions - February 2014 Page 2-11 Health Partners Plans Medicare Benefits & Eligibility ¾ Do I have to verify member eligibility? Yes, you must verify eligibility whenever a Health Partners Plans Medicare member visits your office. Simply call to verify the member’s benefit plan coverage by contacting us at 1866-901-8000 Monday through Friday, from 8:30 a.m. to 5:00 p.m. Eligibility verification is available 24 hours a day, seven days a week. To gain access to our provider portal, HP Connect, you will need to first register online for a secured log-on ID and password. Please visit our website at www.HealthPartnersPlans.com. Click Providers and complete the online registration form. Make sure to designate a primary super user. The requesting super user is authorized to set up additional user profiles and reset passwords. Please allow three business days for processing your registration. We will contact you by e-mail or phone to confirm that you have access to HP Connect. ¾ What insurance coverage is primary? In most instances Medicare will be the primary insurance. However, it is dependent on what the other insurance is. ¾ If a member has other insurance, what is Health Partners Plans Medicare payment liability? It depends on what the other insurance is but in most cases Medicare will be the primary payer. ¾ What payments count toward out-of-pocket costs? Co-insurances and/or deductibles count toward out-of-pocket costs. ¾ What is the coverage gap (donut hole) phase of coverage? The coverage gap known as the Medicare donut hole is the gap between the initial coverage limit and the catastrophic-coverage threshold in the Medicare Part D Rx program Once a Medicare beneficiary exhausts the initial coverage of the prescription-drug plan, the beneficiary is financially responsible for a higher cost of prescription drugs until he or she reaches the catastrophic-coverage threshold at which time Medicare will begin. Claims ¾ Does Health Partners Plans Medicare accept electronic claims submissions? Yes. We offer the speed, convenience and lower administrative costs through Electronic Data Interchange (EDI), also known as electronic claims processing. Health Partners Plans has contracted with Emdeon as our claims transaction clearinghouse. Please use Payer ID number 80142 for Health Partners Plans Medicare claims. For more information, call the EDI Support Line (see Table 1: Service Department Contact Information on page 1-15). ¾ Where do I mail claims for HP Medicare? Health Partners Plans Provider Manual Frequently Asked Questions - February 2014 Page 2-12 Please note the following addresses: Health Partners Plans Medicare P.O. Box 1220 Philadelphia, PA 19105-1220 Claims Reconsiderations Health Partners Plans 901 Market Street, Suite 500 Philadelphia, PA 19107 ¾ What is the normal payment cycle for releasing claim payments? Health Partners Plans Medicare records the date of receipt of each claim received at our claim processing center and tracks its status through processing and check generation. With few exceptions, claims are processed within 30 days of receipt. Checks are produced on a weekly basis and mailed within two days of generation. ¾ What is Claim Check? Claim Check is a software product that identifies potential unbundling of services. Certain claims are compared against expected norms. In some cases, a service will be denied as being part of another major procedure. Your remittance should indicate the code review message if that situation occurs. ¾ When, if ever, am I allowed to bill the member for balances due? The general rule to follow for the Health Partners Plans Medicare line of business is that the member cannot be balance billed. If you disagree with a claim payment decision, you should appeal the claim decision to Health Partners Plans and not attempt to collect monies from the member. The member may be billed only if: 1) the member knows that the service he or she is requesting is not a covered benefit; and 2) the provider obtains written agreement in advance of the service from the member that he or she understands that and will pay for the service.. ¾ When should I resubmit a claim in lieu of appealing a decision? In very few instances does resubmission of a claim lead to monetary reimbursement. If a claim has been returned with a letter indicating the form is being sent back because of incorrect provider number, diagnosis or procedure code, you should resubmit a corrected copy of that claim. In all other cases, the claim decision should be appealed. Simply resubmitting a claim, on which you feel an underpayment was made, will generally lead to an automatic system denial for duplicate billing. ¾ What are the timely filing limitations? For claim submission, the timely filing limit is 180 days from the date of service. For secondary billings, the 60-day timeframe starts with the primary explanation of payment notification date. Claim appeals must be filed within 180 days of the claim notification date noted on the Health Partners Plans Explanation of Payment notice. ¾ What information do I need to submit my claims electronically to Health Partners Plans? Health Partners Plans Provider Manual Frequently Asked Questions - February 2014 Page 2-13 Make sure to include the following items prior to sending claims electronically for Health Partners Plans Medicare members: Payer ID Number is 80142. Individual and billing NPI numbers are required. Failure to include this information will result in a rejection of the claim. ¾ What is my Health Partners Plans Provider ID number? Health Partners Plans providers must use their individual and billing NPI numbers when submitting claims electronically. A Health Partners Plans legacy number may be billed on paper claims. Legacy provider numbers are specific to individual providers or facilities by their practice location/site. If you are unsure of your Health Partners Plans Provider ID number, please contact us. ¾ What if my billing company or EDI software vendor uses another clearinghouse such as NDC, Med-E America, ETS, or Equifax instead of Emdeon (WebMD/NEIC/Envoy)? Emdeon is the leading clearinghouse in the country and almost all claims clearinghouses forward claims to them for processing. Check with your software vendor for details. ¾ Who can we contact at Health Partners Plans if we have Transaction and Code Set or EDI questions? If you have questions regarding electronic billing or Transaction and Code Sets, please contact Health Partners Plans' EDI Support Line (see Table 1: Service Department Contact Information on page 1-15). ¾ Can Health Partners Plans accept HIPAA- and non-HIPAA-compliant formats? No, Health Partners Plans can only accept HIPAA-compliant transactions. Referral Information ¾ Why is it important for a member to choose a primary care provider (PCP) when enrolling in Health Partners Plans Medicare? The PCP acts as the gatekeeper and the member’s healthcare is better managed if one provider knows the member’s healthcare history. Primary care providers should refer Health Partners Plans Medicare members to a participating specialist or facility. ¾ Can the specialist give a verbal report to the PCP, or does it have to be written? Verbal communication is acceptable initially, but it must be followed with a written report. A notation regarding communication between the PCP and specialist should be recorded in the patient's medical record. ¾ Can members go outside the network area? A member cannot choose to go outside the network. Services outside of the network are not covered by Medicare or Health Partners Plans Medicare except in limited situation like emergency care. If prior authorization is not obtained for out-of-network services, reimbursement will be denied. Please call the Inpatient or Outpatient Services department for prior authorization of both inpatient and outpatient services (see Table 1: Service Department Contact Information on page 1-15). Please refer to our online provider directory PROVIDER PLUS for a list of participating providers at www.HealthPartnersPlans.com. Health Partners Plans Provider Manual Frequently Asked Questions - February 2014 Page 2-14 ¾ How long is a referral valid? A referral is valid for 90 days from the date it is written as long as the member remains an active member in HP Medicare. A PCP is not restricted regarding the specialist referral criteria (i.e. the length of time the member sees the specialist or the number of visits that comprises). If the specialist does not participate with Health Partners Plans Medicare, prior authorization is required and these claims are adjudicated accordingly. PCPs are expected to keep a copy of all referrals on file in the patient's record. Members are given a copy of the referral to bring to the specialist office to confirm that the PCP made the referral. If the PCP does not indicate the number of visits on the referral, the specialist will assume only one visit is authorized and may refuse to see the member for follow-up care (without an additional referral). ¾ What services require referrals? Specialist services for Health Partners Plans Medicare members require a referral. A referral is not needed for emergency services (i.e., emergency room visits, emergency inpatient stays, emergency SPUs). Please refer to the Health Partners Plans Medicare benefits grid for details about services requiring referral, script and/or prior authorization. Behavioral Health ¾ Are Behavioral health services covered? Health Partners Plans Medicare – Appropriate behavioral health services are coordinated for all members in collaboration with Magellan Behavioral health Service Inc. Health Partners Plans’ Care Managers work closely with the behavioral health MCO to ensure that each member receives the right care, in the right place, at the right time. Our Care Managers will assist with the referral and follow through to support the ongoing needs and progress of the member. Disease Management ¾ What resources do you have for managing health conditions like diabetes? Health Partners Plans has dedicated staff to assist you in our Disease Management and Special Needs Unit departments to ensure support with member healthcare needs. Provider Information ¾ How does Health Partners Plans Medicare compare with a Medicare supplement? Health Partners Plans Medicare Advantage plan takes the place of the traditional Medicare insurance. A Medicare supplement is a plan that is used in conjunction with traditional Medicare. It is used as gap insurances for example, for prescription coverage and other services. ¾ If a member chooses a Medical-Only option, can he/she join a different Medicare Part D drug plan? Health Partners Plans Provider Manual Frequently Asked Questions - February 2014 Page 2-15 If a member chooses a Medicare Advantage plan that offers RX coverage they must choose that plan. If the plan does not offer RX coverage then they can obtain RX coverage thru another carrier. ¾ How does a member qualify for low income subsidy? Qualifying for low income subsidy depends on the member’s household income and will necessitate contacting Medicare directly. ¾ How can I get more information? You can get additional information by calling us at [1-866-901-8000]. Additional information can be also found on our website at www.HealthPartnersPlans.com. Health Partners Plans Provider Manual Frequently Asked Questions - February 2014 Page 2-16
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