my care alabama claims address
Listed below are claims payment policies and other information for Qualified Health Plans offered by Blue Cross and Blue Shield of Alabama. The Blue Cross representative will assist you in developing a Plan of Care - a guide in determining the type and frequency of care services you need. This means that they don't get paid until you get paid. need assistance as they transition from inpatient to outpatient care After determining your benefit eligibility, your Lifetime Waiting Period start date will be determined. As a participating provider in the ACHN Program, you will be asked to work with My Care Alabama to review utilization data of your patients to help achieve ACHN goals. Provider Assistance Center. If you use our Care Coordinator services in developing your Plan of Care, and your claim is initiated with Home or Community Services, then your Lifetime Waiting Period will be reduced by half. Care Coordination services are provided in the county where you live. Please email us at: Join_Now@mycarealabama.org, or call us: if you are in the Northwest Region, please call our Provider Help Line: 855-500-9470; if you are in the Central Region, please call our Provider Help Line: 855-288-8361; or if you are in the East Region, please call our Provider Help Line: 855-288-8366. You have the right to pick any Alabama Medicaid doctor or clinic for birth control services. 301 Technacenter Drive, Montgomery, AL 36117. Information on Explanations of Benefits (EOBs). The goal of My Care Alabama is to create a team of community and healthcare partners who are dedicated to providing Medicaid recipients with the highest quality of care possible. Our Behavioral Health Care Managers assist patients in managing their mental health conditions by linking patients with appropriate community mental health services and ensuring appointment follow-up and medication compliance. Reimbursement Policies (PDF) You have the right to pick any Alabama Medicaid doctor to deliver your baby no matter where the doctor is located. N/A: Is Organization Subpart? Northwest counties include: Bibb, Colbert, Fayette, Greene, Hale, Lauderdale, Lamar, Lawrence, Marion, Pickens, Sumter, Tuscaloosa, Winston, Walker For My Care Alabama Northwest. My Care is committed to helping our recipients reach their health goals. You can email the site owner to let them know you were blocked. For My Care Alabama East We service over 300,000 Medicaid recipients, including those that: Cloudflare Ray ID: 7e3d356d9cb0fdb9 You do not need approval or a referral from your personal primary care doctor to get birth control or family planning services. You do not need approval or a referral from your personal primary care doctor to get birth control or family planning services. . My Care Alabama sets the standard for quality administration, and we love nothing more than finding physicians, practices and providers who match our standards for efficiency with even higher standards of care. Additionally, out-of-network providers have not contracted with us or any Blue Cross and/or Blue Shield plan for negotiated discounts and can bill you for amounts in excess of the allowed amounts under the plan. For My Care Alabama East Learn more about how were supporting members and providers. These relationships are focused on a single and important goals. Find out more about us, and see how My Care can help you. More information regarding these notices: For My Care Alabama Central An assessment will be scheduled and performed by a Blue Cross representative to determine if your situation and health needs meet claims benefit eligibility. Recipient Help Line: 855-200-9471 Get an annual flu shot today. Find out more. . Please do not call the Medicaid or ALL KIDS help desks. For My Care Alabama East If the out-of-network services are covered, in most cases, you will have to pay significantly more than what you would pay an in-network provider because of lower benefit levels and higher cost sharing. Caring for our recipients is important to My Care Alabama. Heres a list of the ones we get asked all the time. A secondary plan is one which takes into consideration the benefits of the primary plan before determining benefits available under its plan. For My Care Alabama East You have the right to pick any Alabama Medicaid doctor to deliver your baby no matter where the doctor is located. An EOB is not a bill. Access Claimant Portal We will give you a response within 72 hours of receiving all information we need to make a decision for a standard review. My Care Alabama East There is a grace period of three months for all monthly premium payments after the initial premium payment. LifePlans Claims Services:* 1-800-525-7279 extension 273 LifePlans Provider Pathway:* 1-800-886-7404 or www.lifeplansproviderpathway.com *Please do not contact LifePlans unless you have already contacted Blue Cross and Blue Shield of Alabama to start your claim. If youre a Delivering Health Care Provider (DHCP) or a Primary Care Physician (PCP) in the East region and are interested in becoming part of the My Care provider network, please contact us. Heres all the information you need to get started. Before contacting My Care, you might want to have a look at our FAQsection and see if we have already covered your issue. Precertification also does not mean that we have been paid all monies necessary for coverage to be in force on the date that services or supplies are rendered. Recipient Help Line: 855-288-8360 You do not have to use your personal primary doctor for birth control or family planning services. You have the right to pick any Alabama Medicaid doctor to deliver your baby no matter where the doctor is located. In these cases, you are responsible for payment to the provider. 450 Riverchase Parkway East. A Blue Cross representative from LifePlans will contact you to discuss your initial needs and to clarify any questions you have about your policy. It also tells you how much has been credited toward any required deductible and out-of-pocket maximums. We help you get doctor appointments, transportation to appointments, or anything else you may need to stay healthy. A link to "My Medicaid" is at the bottom of the Medicaid website home page. If we deny your request, you may request an internal appeal and an external review by an impartial third party reviewer, known as an Independent Review Organization (IRO). For My Care Alabama Northwest. Blue Cross and Blue Shield of Alabama Recipient Help Line: 855-288-8364. You do not have to use your personal primary doctor for birth control or family planning services. Auxiliary aids and services are available upon request free of charge. For My Care Alabama Northwest, List of Medicaid-enrolled Delivering Healthcare Providers (DHCPs), List of Medicaid-enrolled Primary Care Physicians (PCPs), My Care Alabama East Disclosure and Grievances, Community Resource Guide East ACHN Region, Scroll down and click on the Recipient Documents link. For a list of Care Coordinators in your region, view the My Care East Care Coordinator List below. Call Preferred Long-Term Care (LTC) Customer Service (1-888-331-4188) to complete the Claims Intake Form over the telephone. Our Transitional Nurse Care Managers help transition patients from inpatient facilities to their home or to a medical home. In some cases, the plan requires that you or your treating provider precertify the medical necessity of your care. It is your responsibility to ensure that you or your provider obtains precertification. The Community Resources Guide provides a list of helpful services available in your area. And if you dont find the answer you need here, fill out a contact form, and well get you an answer as quick as possible. Claims Filing Addresses For care received in the U.S. or U.S. Our Pharmacists work with you to answer questions about medication and assist in medication reconciliation. Integrated Care Networks (ICNs) and other managed care programs. If you are an actively Participating DHCP Medicaid will pay $100.00 for each bonus payment and the following procedure codes must be submitted on a separate claim: Initial Prenatal Visit H1000 (made during the first trimester), Postpartum visit G9357 (between 21 and 56 days of delivery), Actively work with the ACHN entity to review recipient care plans, Participate as needed in ACHN Multi-Disciplinary Care Team (MCT), Participate in ACHN initiatives centered around quality measures, Participate in at least two quarterly Medical Management Meetings and one webinar/facilitation exercise with the regional ACHN medical director over a 12 month period (NPs and PAs may attend for PCP), Review data provided by the ACHN to help achieve regional and state Medicaid goals, New opportunity to earn bonus payments for achieving quality related goals in addition to FFS payments, If you earned bump payments previously, you can earn increased amounts by participating with Medicaid and a regional ACHN entity, You will not have a patient panel to manage, but will work in partnership with licensed social workers and nurses who will help manage your complex or non-compliant patients, You can see patients regardless of where they live, Referrals are not needed for primary care, Referrals will be required only for certain medical specialties, EPSDT referrals will continue to be required. Our Care Managers work with you and a full scope of other service providers to ensure a holistic care approach for your patients. Birmingham, Alabama 35244-2858, Grace periods and claims pending policies during the grace period. >>Learn More; East: TRICARE East Region Alabama, Arkansas, Connecticut, Delaware, the District of Columbia, Florida, . Toll Free: 1-800-874-9426 and TTY: 711. Update Your Address; COVID-19 Information for Recipients; A to Z Index; . 2616 Hough Road, Florence, AL 35630 (Directions) Toll Free: 1-800-874-9426 and TTY: 711. We help you get doctor appointments, transportation to appointments, or anything else you may need to stay healthy. You will work with your Care Coordinator to pick the best doctor for you. 2023 Medicare and PDP Compare Plans and Enroll Now. Toll Free: 1-800-874-9426 and TTY: 711, Language interpretation and translation services are available upon request free of charge. You have the right to pick any Alabama Medicaid doctor or clinic for birth control services. You have the right to pick any Alabama Medicaid doctor or clinic for birth control services. Find out which region is the right one for you based on your county: Northwest Region Bibb, Colbert, Fayette, Franklin, Greene, Hale, Lauderdale, Lamar, Lawrence, Marion, Pickens, Sumter, Tuscaloosa, Winston, Walker East Region ACHN Quality Strategy - 1/9/20. (800) 688-7989 (Nationwide Toll-Free) Provider Enrollment. For any contract questions or to submit provider agreements, email Join_Now@mycarealabama.org. The allowed amount for such out-of-network benefits will be determined in accordance with the requirements of the applicable Federal law. East counties include: Blount, Calhoun, Cherokee, Clay, Cleburne, Coosa, Dekalb, Etowah, Randolph, St. Clair, Talladega, Tallapoosa, Address: 600 Broad Street, Gadsden, AL 35901 (Directions) You do not have to use your personal primary doctor for birth control or family planning services. Auxiliary aids and services are available upon request free of charge. Auxiliary aids and services are available upon request free of charge. Each of our Regions operate independently to assist the specific needs of those counties. Main Address. You have the right to pick any Alabama Medicaid doctor or clinic for birth control services. A primary plan is one whose benefits for a person's healthcare coverage must be determined first without taking the existence of any other plan into consideration. Travel Benefit Claim. If you believe you believe you have overpaid your premium due to our overbilling, please contact us by calling the Customer Service Department number on the back of your ID card. A pdf document that includes your Care Coordinators number will pop up. Birmingham, Alabama 35244-2858. Learn More. Corporate Office Address 450 Riverchase Parkway East Birmingham, Alabama 35244 2023, BlueCross and BlueShield of Alabama is an independent licensee of the BlueCross and BlueShield Association. More information regarding these notices: For My Care Alabama Central Since this is a new way to provide care in Alabama, were sure youve got questions. If you live in one of the counties listed in the East region, please call our Recipient Help Line or use the Care Coordinator contact list below. Your IP: My Care Alabama Central, My Care Alabama East, and My Care Alabama Northwest complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. You have the right to see any Primary Care doctor no matter where the doctor is located. Care Coordination services are provided in the county where you live. You will participate in our Medical Management Committee, which meets quarterly to develop and implement quality and outcome-based improvements for our patients. Toll Free: 1-800-874-9426 and TTY: 711. They provide consultation services and assist with pharmacy-related initiatives. There are several actions that could trigger this block including submitting a certain word or phrase, a SQL command or malformed data. Also, let us know if you need assistance with transportation to the doctor. For My Care Alabama Northwest, List of Medicaid-enrolled Delivering Healthcare Professionals (DHCPs), List of Medicaid-enrolled Primary Care Physicians (PCPs), My Care Alabama East Medical Management Meeting Schedule Q1 Q4 (Yr. 2022- 2023), My Care Alabama East Medical Management Meeting Schedule Q1to Q4 Yr 2022 2023, Specialist Referral East (Please read the information on My Care East Specialist Referral page before completing this form), My Care Alabama East PCP Agreement Out of State, Claims for maternity services will be reimbursed FFS directly by Medicaid. If you receive out-of-network benefits for a medical emergency in the emergency room of a hospital, those services will be paid at the applicable in-network coinsurance amounts for such benefits described in your benefit booklet and subject to the in-network calendar year deductible. The goal of My Care Alabama Central is to create a team of community and healthcare partners who are dedicated to providing Medicaid recipients with the highest quality of care possible in central Alabama. Learn More. You will work with our Care Managers to provide holistic care to our patients. Toll Free: 1-800-874-9426 and TTY: 711, Language interpretation and translation services are available upon request free of charge. Drug exceptions timeframes and enrollee responsibilities. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. And it allows us to be truly innovative in our approaches. You have the right to pick any Alabama Medicaid doctor to deliver your baby no matter where the doctor is located. Keep Healthy with a Flu Shot. Provider Help Line: 855-500-9470, My Care Alabama Central Address: 600 Broad Street, Gadsden, AL 35901 ( Directions) Recipient Help Line: 855-288-8364 Participating Providers for services: List of Medicaid-enrolled Delivering Healthcare Providers (DHCPs) List of Medicaid-enrolled Primary Care Physicians (PCPs) List of Urologists Recipient Documents My Care Alabama provides care coordination services for our Medicaid recipients. We're here for you. We conduct home visits to help patients follow your orders and make sure they understand their care plan. More information regarding these notices: For My Care Alabama Central Click to reveal . Cloudflare Ray ID: 7e3d363aaef9177e More than simply sending nurses on home visits, our experienced, licensed Care Coordinators work with patients to help meet their needs outside of health care alone. Since this is a new way to provide managed care in Alabama, there will undoubtedly be questions and lots of them. You have the right to see any Primary Care doctor no matter where the doctor is located. Contact Us. It is common for contingency amounts to be anywhere from 25% . Blue Cross and Blue Shield of Alabama will send you a Claims Packet to be completed and returned to us. In certain situations, a claim may be reprocessed and denied retroactively, even after it has been paid. Care Coordination services are provided in the county where you live. Wellcare uses cookies. Please include what you were doing when this page came up and the Cloudflare Ray ID found at the bottom of this page. have chronic conditions, including behavioral health or substance use disorder, Chronic conditions may include:Asthma, Diabetes, Cancer, COPD, HIV, Mental Health Conditions, Substance use disorders, Transplants, Sickle Cell, BMI over 25, Heart Disease and Hepatitis C. If you have or are at risk of having any of these chronic conditions and you are a Medicaid recipient, contact us to see if ACHN services can benefit you. For CMS-1500 claims, Pharmacy, Dental & UB 04 claims, Medicare claims and Prior Authorization (including Medical Records . Recipient Help Line: 855-288-8360 We welcome brokers who share our commitment to compliance and member satisfaction. (888) 223-3630 (Nationwide Toll-Free) Claims-Related Mailing Addresses. Jun 30, 2023 - Beginning April 1, 2023, Alabama Medicaid no longer requires PA for the dental procedure codes listed below when provided in an inpatient or outpatient hospital setting . This website is using a security service to protect itself from online attacks. Recipient Help Line: 855-288-8360. You have the right to see any Primary Care doctor no matter where the doctor is located. CMS approved the application on 6/14/19. In that case, you will be responsible for all charges billed to you by the out-of-network provider. are pregnant or thinking about becoming pregnant If you do not see your county listed, click here to find your ACHN region. Refer to. Tell us the type of service or supply for which you wish to file a claim (for example, hospital, physician, dentist or pharmacy), and we will send you the proper type of form. Each time Blue Cross processes a claim submitted by you or your healthcare provider, we send you an Explanation of Benefits (EOB). Toll Free: 1-800-874-9426 and TTY: 711, Language interpretation and translation services are available upon request free of charge. Care Coordination services are provided in the county where you live. Additional details about this and other exception review details can be found in the Claims and Appeals section of your benefit booklet. Our Nurses provide personalized service and care management to the members before discharge, and then again at home within 72 hours of discharge. Performance & security by Cloudflare. Provider Help Line: 855-288-8366. 2010 CLUB DR STE 101 GADSDEN, AL ZIP 35901 Phone: (205) 220-8256 Get Directions Mailing Address 375 RIVERCHASE PKWY E HOOVER, AL ZIP 35244 Location Map Authorized Official The name of the person authorized to submit the NPI application or to officially change data for a health care provider. Provider Help Line: 855-288-8361, My Care Alabama East North Alabama Community Care. Contact My Care If you or your children receive Medicaid benefits and live in the East region, then you may be able to receive care coordination services from My Care. If you fail to pay in full all periodic monthly payments due and payable before the end of the grace period for those coverage periods, your coverage under the plan will be retroactively canceled back to the last day of the first month of the grace period. The good news is that reputable personal injury lawyers work on contingency. Please include what you were doing when this page came up and the Cloudflare Ray ID found at the bottom of this page. Toll Free: 1-800-874-9426 and TTY: 711. Email: infoEast@mycarealabama.org. The annual flu vaccine helps prevent the flu. You do not need approval or a referral from your personal primary care doctor to get birth control or family planning services. Recipient Help Line: 855-200-9471 Your Lifetime Waiting Period begins after you have been deemed Chronically Ill (or to have a significant Cognitive Impairment) and you have incurred one Qualified Long-Term Care expense. Auxiliary aids and services are available upon request free of charge. If you pay a monthly payment later than the first day of the coverage period to which it applies, but before the end of the grace period for the coverage period, any claim you submit for benefits will be placed in a pending status (suspended) on the first day of the second month of the grace period and then processed by the plan only when all periodic monthly payments due during the grace period are received. My Care Alabama Central. When you receive services from an in-network provider, your provider will generally file claims for you. Expenses will be applied against your Plan of Care and reimbursed accordingly. You have the right to pick any Alabama Medicaid doctor or clinic for birth control services. Please email us at: Join_Now@mycarealabama.org, or call us: if you are in the Northwest Region, please call our Provider Help Line: 855-500-9470; if you are in the Central Region, please call our Provider Help Line: 855-288-8361; or if you are in the East Region, please call our Provider Help Line: 855-288-8366. From time to time, Wellcare Health Plans reviews its reimbursement policies to maintain close alignment with industry standards and coding updates released by health care industry sources like the Centers for Medicare and Medicaid Services (CMS), and nationally recognized health and medical societies. Reimbursement will be sent to claimant; no claims are paid directly to provider. Provider Help Line: 855-288-8366 Medical necessity and prior authorization timeframes and enrollee responsibilities. Because, when we combine high quality, compassionate health services with our ability to wrap around other issues for Medicaid recipients, we can get closer to achieving our goal of improving health outcomes in east Alabama. My Care Alabama Central, My Care Alabama East, and My Care Alabama Northwest complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. So before you contact us, please check to see which Region is the right one for your county. Performance & security by Cloudflare. My Care Alabama East. Our Care Coordinators help you schedule doctor appointments, find transportation to appointments, or anything else you need to stay healthy. You do not have to use your personal primary doctor for birth control or family planning services. My Care Alabama Central, My Care Alabama East, and My Care Alabama Northwest complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. You can also file your claims online. You can file your expenses for reimbursement as frequently as you want. An EOB is a statement that describes what medical treatments and/or services we paid on your behalf, what our payment was and your financial responsibility under the terms of the plan. Auxiliary aids and services are available upon request free of charge. The practitioner's primary taxonomy code is 251B00000X. You do not have to use your personal primary doctor for birth control or family planning services. Toll Free: 1-800-874-9426 and TTY: 711, Language interpretation and translation services are available upon request free of charge. My Care provides primary care, family planning, and maternity care coordination services with Medicaid recipients and providers. Care Coordination services are provided in the county where you live. 2023, BlueCross and BlueShield of Alabama is an independent licensee of the BlueCross and BlueShield Association. My Care Alabama East. Recipient Help Line: 855-288-8364. And for all of us at My Care, that starts with building effective relationships with our healthcare providers, healthcare administrators, community leaders, and care coordination experts. If you are unemployed and need to upload identity documents for claim review, provide medical documentation, upload self-employment documents, request a claim status update, and more. Send your claims to the claims address where the care is received. We follow up with members to make sure theyre making appointments and taking their medicine, and we give them community contacts to help with other needs in their lives such as food and housing. More information regarding these notices: For My Care Alabama Central For My Care Alabama East Toll Free: 1-800-874-9426 and TTY: 711. If you or your doctor believe there are exigent circumstances that require an expedited review, an expedited exception request can be submitted, and we will give a response within 24 hours. Find out which region is the right one for you based on your county: You have the right to see any Primary Care doctor no matter where the doctor is located. eFax Line: 205-402-9222 meeting the needs of our recipients. If your drug is not covered and you think it should be, you may ask us to make an exception to the drug coverage rules by calling the Customer Service Department number on the back of your ID card. Your doctor or other prescriber must give us a statement that explains the medical reasons for requesting an exception.
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my care alabama claims address
