- Provider Notice – ARTs Flyer
- Provider Notice – Home Health Claims Q HCPC Update
- Provider Notice – NDC Billing Requirement
- ARTS 101 In-Person Training
- Regulatory Language Updates for Hospitals
- Regulatory Language Updates for Providers
- Provider Notice – VPCC Provider Portal Claims Submission
- Provider Notice – Balance Billing
- TDO provider letter 3-2-2016
- Provider Notice – VPCC Magellan Phone Number 2-10-2016
We’re here for you! CompleteCare is building free online training modules and a library of literature to help give our providers the best possible resources to care for your patients.
If you would like to attend an in-person training, our schedule can be found under the Education Meetings tab.
If you are looking for our “Nuts and Bolts” training, that can be found here.If you have any questions about our training options, please contact us.
Some of the topics we offer training on:
- Cultural Competency
- Practice Accessibility
- Patient Safety
- Disability Literacy
- And many more great topics!
Eligible individuals include those who:
- Are 21 and older
- Are enrolled in full Medicare and full Medicaid
- Live in designated regions of Virginia serviced under the Commonwealth Coordinated Plan
Yes, plan participation is completely voluntary. Members may decide not to join by opting out or withdraw from the program at any time and return to original Medicare and Medicaid coverage.Q: How are members enrolled with a Virginia Premier CompleteCare?
Eligible members received a letter in 2014 which provides a phone number to call to sign up. A trained professional with Maximus, the enrollment broker hired by the State of Virginia, guides beneficiaries through the enrollment process. Individual health plans cannot enroll or dis-enroll beneficiaries directly.Q: Do I need to check member eligibility?
Each new member enrolled with Virginia Premier CompleteCare will receive an individual member identification card. It is important to remember that a member’s eligibility could change on a month-to-month basis. Consequently, you should verify your patient’s eligibility each time they present for services. Providers can check member eligibility through several methods:
- Call Virginia Premier CompleteCare: 855-338-6467
- Check member eligibility with the CompleteCare Provider Portal
No, this type of activity is prohibited by CMS. Providers are expected to remain neutral and should not encourage or sway members towards one plan or another. A provider may assist a beneficiary in an objective assessment of his/her needs and potential options to meet those needs. However providers should encourage members to call the plan’s enrollment broker, Maximus for assistance is selecting a plan.
- One ID card for members
- One toll free phone number for 24 hours/7 days a week assistance
- A unified appeals process
- Person-centered service coordination/case management
Benefits include all Medicare (part A, B and D) benefits and Medicaid benefits, including EDCD waiver services, nursing facility services and transportation.Q: What types of Long Term Support Services are covered for the members enrolled in Virginia Premier CompleteCare?
Members have access to the following Long Term Support services, however all services must be pre-authorized.
- Adult Day services
- Respite Care
- Personal Care services
- Transition Coordination
- Personal Emergency Response services
- Transition Services
Referrals to non-participating specialists are permitted only if the required specialty service is not available through the Virginia Premier Health Plan network and the service is pre-authorized by the Plan. Out-of-plan referrals should be documented in the POC (Plan of Care) and agreed to by all ICT members.Q: What if any benefits are carved out from this plan?
The following services are carved out:
- Case Management Services for participants of auxiliary grants
- Targeted case management for individuals with intellectual disabilities
- Community mental retardation services
Yes, the plan must allow enrollees to maintain their current providers (including out-of-network providers) for 180 days from enrollment for new enrollees or for 30 days if the enrollee is switching from another CCC plan. However, after that period the plan must authorize any request to see an out-of-network provider.
No providers only need to submit claims directly to Virginia Premier. One of the benefits of the Commonwealth Coordinated Care program is that providers receive a blended reimbursement from contracted health plans so there is no need to send claims to a secondary payer. When an individual is enrolled in Virginia Premier CompleteCare, he/or she is no longer enrolled in traditional Medicare or Medicaid fee-for-service.Do members enrolled in Virginia Premier CompleteCare have co-pays or cost sharing?
No, as part of this program, there is no cost-sharing. Providers cannot collect co-payments, coinsurance, deductibles or any other amount for services covered under this plan. The contract you have with Virginia Premier clearly stipulates that you cannot balance bill members enrolled with the dual eligible plan.Are there are special requirements for how I bill services rendered to Virginia Premier CompleteCare members?
No, providers are expected to follow Medicare and Medicaid billing guidelines unless otherwise noted in the Virginia Premier CompleteCare Provider Manual.What is the timely filing period for participating Virginia Premier CompleteCare providers?
Providers should follow the timely filing as indicated on their contract, but in general providers have 180 days to file claims to Virginia Premier CompleteCare.
An enrollee or a provider acting on behalf of an Enrollee and with the Enrollee’s written consent may appeal the plan’s decision to deny, terminate, suspend, or reduce services. An enrollee or provider action on behalf of an enrollee and with the enrollee’s consent may also appeal the plan’s delay in providing or arranging for a Covered Service. Virginia Premier has 30 days from receipt to resolve all initial appeals and seventy-two (72) hours or as expeditiously as the enrollee’s condition requires for appeals qualifying as expedited appeals.
As required by the 3 Way Contract with CMS and DMAS, Virginia Premier must provide initial and annual Model of Care training for our provider network. This requirement keeps everyone informed about the care management structure. Providers must satisfy this requirement by completing the course provided in our learning management system.I am a Virginia Premier CompleteCare PCP, what are my responsibilities?
In addition to managing the members overall health and well-being you will:
- Develop, maintain and monitor Plan of Care (POC) for the member
- Actively participate as a member of the Interdisciplinary Care Team (ICT)
- Provide information to member’s regarding LTSS services
- Perform an initial health assessment for new members assigned to their panel to begin establishing the physician-patient relationship
- Direct provision or coordination of all healthcare services for the member to include 24-hour coverage
- Generate referrals to in-network specialist when services cannot be performed by the PCP
- Contact Virginia Premier CompleteCare to obtain necessary prior authorization for designated services (e.g. out of network referrals, specified diagnostic tests)
- Freely communicate with patients about their treatment, regardless of benefit coverage limitations
Central Virginia:Nicole Williams at 800.727-7536 ext. 55118 or email: nicole.williams@localhost
Taylor Fink at 800.727.7536 ext. 55456 or email: taylor.fink@localhost
A.J. Binga at 800.727.7536 ext. 55263 or email: anthony.binga@localhost
RoanokeContact to Attend:
Tammy English at 888.338.4579 ext. 55817 tammy.english@localhost
Katrina Evans at 888.338.4579 ext. 55883 or email: katrina.evans@localhost
Rebecca Frango at 888.338.4579 ext. 55876 or email: rebecca.frango@localhost
TidewaterContact to Attend:
Dana Wilson at 800-828-7989, ext 55504 or email: Dana.wilson@localhost
Constance Ferguson, 800.828.7989 ext. 55590 or email: Constance.ferguson@localhost
Rashard Grier at 888.828.7989 ext. 55501 or email: Rashard.grier@localhost
Western VaRoger Young at 540.607.7312 or email: roger.young@localhost
South West VirginiaRobin Murray at 888.338.4579 ext. 55626 or email: Robin.murray@localhost
Spencer Huddleston at 888.338.4579 ext. 55667 or email: rhuddleston@localhost