AmeriHealth Transition –
What You Should Know
Date of Publication December 1, 2017
Friday marked the official transfer date for more than 200,000 Medicaid patients who previously had coverage administered by AmeriHealth Caritas. Rapidly shifting developments over the past several weeks have resulted in significant confusion for both patients and the practices attempting to guide them through this transition. IMS has assembled a brief synopsis of the latest information your practice should know.
Determining Patient Coverage After December 1
All former AmeriHealth patients were tentatively assigned to UnitedHealthcare for coverage to begin December 1, 2017. Following Amerigroup notifying the State that it lacked the capacity to assume responsibility for administering coverage for more Medicaid patients, the State has temporarily suspended patients’ ability to opt out of UnitedHealthcare coverage. Approximately 10,000 patients who had opted to change to Amerigroup coverage between their tentative assignment to UnitedHealthcare and the State suspending patient choice, will now revert to Medicaid fee-for-service (FFS) until patient choice can be restored at a future, yet-to-be-determined date. All other former AmeriHealth patients will be locked into UnitedHealthcare coverage until patient choice is restored.
Many of the patients now covered by State FFS were initially issued Amerigroup ID cards and may present these at your clinic. It is imperative that you verify all of your former AmeriHealth patients’ new coverage via the state Eligibility and Verification Information System.
Billing for Services Provided to Former AmeriHealth Patients
Services Provided Before December 1, 2017
AmeriHealth continues to be responsible for all services provided to their former patients prior to the transition. Claims for these services should be submitted to AmeriHealth as you have done previously. AmeriHealth will continue to operate a provider call center until at least December 1, 2018, to aid in the wind down of their Iowa business and adjudication of all outstanding claims.
Services Provided After December 1, 2017
Services provided for former AmeriHealth patients now assigned to State FFS, should be billed directly to Iowa Medicaid Enterprise (IME) in the same manner as prior to the implementation of managed care. Informational Letter 1662
contains additional information about submitted FFS claims.
Services provided for former AmeriHealth patients now assigned to UnitedHealthcare, should be billed to that MCO in compliance with their claims submission guidelines. While Amerigroup did suspend accepting additional Medicaid patients, they continue to be responsible for the approximately 168,000 Medicaid patients already assigned to that MCO, as well as previous Amerigroup Medicaid members who may have lost and regained eligibility. Claims for services provided to these patients should continue to be submitted to Amerigroup.
Authorizations for Services Provided to Former AmeriHealth Patients
The State’s contracts with the MCOs require that they honor patients’ existing authorizations for a minimum of 30 days after they transfer to a new MCO. Authorizations for medications and services to former AmeriHealth patients, which were approved prior to December 1, 2017, must be honored by UnitedHealthcare. IMS is aware of some instances in which AmeriHealth voided previously-issued authorizations for services that are scheduled to occur after December 1. These actions were incorrectly taken and should be reversed. Please contact IMS
if this has occurred in your practice.
AmeriHealth authorizations that extend beyond 30 days and authorizations for former patients that will now be covered by the State under fee-for-service, will be subject to the authorization criteria for UnitedHealthcare and IME. More information on UnitedHealthcare prior authorization criteria is available on their website.
Additional information on authorizations, billing, and transition policies affecting former AmeriHealth patients is included in Informational Letter 1864-MC-FFS. For more information or assistance as your practice navigates the transition for former AmeriHealth patients, please contact Dennis Tibben
with the IMS Center for Physician Advocacy.