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Below are some frequently
asked questions of CommunityCARE RECIPIENTS. CommunityCARE PROVIDERS CLICK HERE.
CommunityCARE
Recipient FAQs
• What
will change with CommunityCARE?
• How will
CommunityCARE help me?
• When will
CommunityCARE be in the parish I live in?
• How will I
know when to enroll in CommunityCARE?
• Can I choose a
PCP, or will one be assigned to me?
• How will I
know who my PCP is?
• What if I
don’t want the PCP who is assigned to me?
• My doctor
wasn’t on the CommunityCARE list last month, but she is now.
Can I change my PCP to her?
• How long will
it take for my new PCP to be effective?
Q. What will change
with CommunityCARE?
A. You will keep the same Medicaid benefits, but you will
have a CommunityCARE Primary Care Provider (PCP). You must go to your
CommunityCARE Primary Care Provider (PCP) first except for true medical
emergencies and exempt services. You will need a referral for most care
not provided by your PCP.
Q. How will
CommunityCARE help me?
A. Your CommunityCARE PCP will provide you with a medical
home. He/she will see you for basic medical care and will follow your
care if you are referred for specialty care. CommunityCARE focuses on
the relationship between the patient and his/her PCP.
Q. When will
CommunityCARE be in the parish I live in?
A. You can look at the effective date by going to the
Statewide Implementation tab on this website.
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Q. How will I know
when to enroll in CommunityCARE?
A. You will receive a letter and a brochure in the mail
explaining the CommunityCARE program and how to choose a PCP. You can
also call the CommunityCARE hotline toll free at 1-800-359-2122 for
assistance.
Q. Can I choose a
PCP, or will one be assigned to me?
A. You will receive a list of providers that you may choose
from and a deadline for making your selection. If you do not call the
hotline number and choose a PCP by the deadline, one will be assigned
to you.
Q. How will I know
who my PCP is?
A. You will receive a letter in the mail telling you who your
PCP is.
Q. What if I
don’t want the PCP who is assigned to me?
A. You may change your PCP at any time during the first 90
days you are enrolled in CommunityCARE by calling the hotline number.
You also have a chance to change your PCP at least once a year.
Q. My doctor
wasn’t on the CommunityCARE list last month, but she is now.
Can I change my PCP to her?
A. Yes. You can change your PCP at any time within the first
90 days that you are enrolled in CommunityCARE and then at least once
every 12 months after this time.
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Q. How long will it
take for my new PCP to be effective?
A. It may take up to 60 days for the new PCP to be
effective, depending upon when you call the hotline to make the change.
Continue to see your current PCP until the new one becomes effective,
or ask your current PCP to give you a referral to the new PCP until the
change is effective.
CommunityCARE Recipient FAQs
• If I am already a Medicaid
provider and want to be a CommunityCARE Primary Care Provider (PCP), do
I have to enroll in CommunityCARE?
• How will CommunityCARE affect
providers who are not PCPs?
• Do all services require a
CommunityCARE referral?
• Which Medicaid recipients will
be in CommunityCARE? Is the program voluntary?
• So how do I determine which
recipients are CommunityCARE and which are not?
• What is the schedule for
statewide CommunityCARE implementation?
• I have a large family practice
and am not a CommunityCARE PCP. If I don’t enroll in the
program when my parish becomes effective with CommunityCARE, will I
lose all my Medicaid patients?
• If I am enrolled as a
CommunityCARE Primary Care Provider (PCP), do I have to provide KIDMED
screenings?
• How can a
recipient who has used their twelve annual visits obtain additional
visits?
• What happens when
a recipient moves from a CommunityCARE parish to a non-communityCARE
parish?
• How can
recipients who have Medicare or HMO coverage become exempt from
participation in the CommunityCARE program?
• What should I do
if I check eligibility for a recipient who lives in a CommunityCARE
parish, but no information is given about a CommunityCARE linkage?
Q. If I am already a
Medicaid provider and want to be a CommunityCARE Primary Care Provider
(PCP), do I have to enroll in CommunityCARE?
A. Yes. The following provider types may become
CommunityCARE PCPs: family practice, general practice, internal
medicine, pediatrician, and obstetrician (if willing to provide primary
care services for CommunityCARE patients). To request a CommunityCARE
enrollment packet, call toll free 1-800-473-2783.
Q. How will
CommunityCARE affect providers who are not PCPs?
A. Unless the service provided is an exempt service, the
provider must obtain a referral from the PCP in order for Medicaid to
pay for the services. This is true even if the provider is in a
non-CommunityCARE parish but the recipient is in the CommunityCARE
program.
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Providers FAQs
Q. Do all services
require a CommunityCARE referral?
A. Most services do require a CommunityCARE referral unless
provided by the patient’s PCP. However, there are exempt
services that do not require a PCP referral. These are listed in the
CommunityCARE manual so that you can become familiar with them.
Q. Which Medicaid
recipients will be in CommunityCARE? Is the program voluntary?
A. The program is mandatory for most recipients living in
CommunityCARE parishes. There are some recipients that are exempt from
the program, including recipients who have Medicare, recipients age 65
or older, and residents of nursing homes. A complete list of exempt
categories of recipients can be found in the CommunityCARE manual.
Q. So how do I
determine which recipients are CommunityCARE and which are not?
A. You should check each patient’s eligibility
using the REVS or MEVS system. If you check eligibility with the swipe
card and use MEVS, the resulting paper tape will indicate if the
patient has a CommunityCARE PCP by listing the PCP’s name and
phone number. If you verify eligibility using REVS, the response will
indicate the same information. With REVS you must listen carefully and
allow the full voice response to be given so that you obtain all
pertinent information. If you are a PCP, you will receive a monthly
list (the CP-0-92) that lists your CommunityCARE patients.
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Providers FAQs
Q. What is the
schedule for statewide CommunityCARE implementation?
A. You can access the schedule by going to the Statewide
Implementation tab on this website.
Q. I have a large
family practice and am not a CommunityCARE PCP. If I don’t
enroll in the program when my parish becomes effective with
CommunityCARE, will I lose all my Medicaid patients?
A. Your CommunityCARE patients will need a referral from
their PCP to see you if Medicaid is to pay for the services.
Q. If I am enrolled
as a CommunityCARE Primary Care Provider (PCP), do I have to provide
KIDMED screenings?
A. You are responsible for KIDMED services for your
CommunityCARE patients under age 21. However, you may subcontract the
actual screening services to a KIDMED provider(s).
Q. How can a
recipient who has used their twelve annual visits obtain additional
visits?
A. The doctor must see the patient and submit
the Form 158A AFTER THE VISIT to request approval for payment for the
additional visit. The request for extension is reviewed at Unisys, and
either approved or disapproved.
Q. What happens when a recipient moves
from a CommunityCARE parish to a non-communityCARE parish?
A. When a recipient moves from one parish to
another, the recipient must notify staff in the parish Medicaid office,
and the parish code on the recipient file will be updated. Once the
parish code is updated, the CommunityCARE linkage will automatically
close out at the end of the month if the code is changed before the
twenty-third of the month. If the recipient moves from a
non-CommunityCARE parish to a CommunityCARE parish, they will be placed
on a list of recipients who will recieve letters asking them to choose
a CommunityCARE provider. If a recipient moves from one CommunityCARE
parish to another CommunityCARE parish, the system does not take any
action to change their linkage or notify the recipient to make a choice
of a doctor in the new parish. The linkage will not change until the
recipient calls the hotline to make a change.
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Q. How can
recipients who have Medicare or HMO coverage become exempt from
participation in the CommunityCARE program?
A. Recipients who have Medicare or HMO
coverage are automatically exempted from the CommunityCARE program if
this coverage information is correctly entered on their Medicaid file.
If a recipient who has Medicare or HMO coverage has been enrolled in
CommunityCARE, they should submit a copy of their Medicaid card, as
well as their Medicare or insurance card, to their parish office so
that the insurance information can be correctly entered. The
CommunityCARE linkage will close automatically at the end of the month.
Q. What should I do if I check
eligibility for a recipient who lives in a CommunityCARE parish, but no
information is given about a CommunityCARE linkage?
A. You should consider information given to
you by REVS or MEVS to be correct. There are a number of situations in
which a recipient living in a CommunityCARE parish may be exempt from
the program, or may not yet have gotten linked to a provider. Both REVS
and MEVS will give a name and phone number if there is a CommunityCARE
provider.
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