Managed Care Organizational Changes. Explanation of the Organizational Changes

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  1. Managed Care Organizational Changes

Effective January 1, 2014, all current Medical Home Networks (MHN) Plans operating within the state will become Managed Care Organizations (MCO) either through acquisition or conversion.

  1. Explanation of Organizational Changes

 

  1. South Carolina Solutions (MHN) has been acquired by Molina Healthcare, Inc. On January 1, 2014 South Carolina Solutions will cease to operate as an MHN, with the exception of its continued participation in the South Carolina Medically Complex Children’s Waiver (MCCW) through June 30, 2014. Molina Healthcare will begin operating as a MCO, effective January 1, 2014.

  1. Palmetto Physician Connections (MHN) has been acquired by Advicare Corp. and on January 1, 2014 will cease to operate as an MHN. Advicare will begin operating as a new MCO, effective January 1, 2014.

  1. Carolina Medical Home (MHN) has been acquired by WellCare of South Carolina and on January 1, 2014 will cease to operate as an MHN. Wellcare will begin operating in six (6) of the seven counties previously serviced by Carolina Medical Home on January 1, 2014.

 

Providers participating with these MHNs will be notified by the individual plans of the next steps necessary to continue providing uninterrupted services to their Medicaid patients.
 

Below are General Rules that apply with these changes:
 

All Medicaid beneficiaries currently enrolled with an MHN will be notified of these changes and will be given the opportunity to choose a different plan between January 1, 2014 and April 1, 2014. Members may select a different plan by going to www.scchoices.com or by calling South Carolina Healthy Connections Choices at 1-877-552-4642.
 

Prior Authorizations for pharmacy and durable medical equipment issued by the MHNs prior to January 1, 2014 will be honored by the acquiring MCO in accordance with the South Carolina Department of Health and Human Services MCO Policy and Procedure Manual.
 

The new MCOs will be issuing all transferred members a new health plan benefits card. Providers are reminded to confirm Healthy Connections eligibility and health plan enrollment prior to rendering services. Eligibility and enrollment confirmation can be determined at https://portal.scmedicaid.com .
 

All claims for services rendered to MHN members prior to January 1, 2014 should be filed with SCDHHS. This would include inpatient hospitalizations that overlap the transition date (admissions prior to 1/1/2014 and discharges after that date). All claims for covered services rendered on or after January 1, 2014 should be filed with the Medicaid member’s new MCO.
 

The five (5) day Emergency Pharmacy supply rule applies to all members transferring into a new MCO.
 

Women who are pregnant and seeing OB providers that are not in the MCO provider network may continue with these providers throughout their entire pregnancy and for one postpartum visit after the baby is born. They do not need to choose another OB provider or hospital.
 

Contact Information for the three new MCOs are as follows:

 

WellCare of South Carolina

Website: www.southcarolina.wellcare.com

Toll Free Telephone 1-888-588-9842

 

Advicare

Website: www.advicarehealth.com

Toll Free Telephone 1-888-781-4371 (Provider Services) 1-888-781-4371 (Member Services)

 

Molina Healthcare, Inc.

Website: www.molinahealthcare.com

Toll Free Telephone 1-855-237-6178 (Provider Services)

1-855-882-3901 (Member Services)

 

Thank you for your continued support of the South Carolina Healthy Connections Medicaid Program. Please refer any questions or concerns regarding this bulletin to the Managed care staff at (803) 898-4614. 

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