FAQs for PMP Assignment
As previously announced in bulletin BT201038, the Office of
Medicaid Policy and Planning (OMPP) consolidated the contracts for
the managed care entities (MCEs) that manage the Hoosier Healthwise
(HHW) and Healthy Indiana Plan (HIP) programs. With this
consolidation, effective January 1, 2011, the scope of the MCE's
role changed to include responsibility for assigning its members to
primary medical providers (PMPs) within their plan. This change in
responsibility for PMP assignment has elicited several recurring
questions from providers. This article addresses those frequently
asked questions with consistent guidance. Providers should continue
to contact members' assigned MCEs for questions regarding obtaining
PA and claims processing.
FAQs
Q: Who is responsible for MCE assignments and PMP
assignments?
A: The Indiana Health Coverage Programs (IHCP) enrollment broker
continues to be responsible for assisting members with MCE
selections and making member MCE assignments. Members with
questions regarding which MCE is right for them should be referred
to the enrollment broker for assistance. Beginning January 1, 2011,
the MCEs are responsible for assisting members with PMP selection
and assigning members to PMPs. Members with questions concerning
their PMPs should be referred to the MCE to which they belong. No
longer will the IHCP enrollment broker or the IHCP Call Center make
PMP assignments for members.
If a member does not select a PMP within the first 30 days of
assignment to an MCE, he or she will be auto-assigned to a PMP by
the MCE, in accordance with the auto-assignment logic described in
BT201038.
Q: What should a PMP do if a member shows an MCE assignment,
but no PMP assignment on Web interChange?
A: Because MCEs are now responsible for assigning members to
PMPs, there may be a lag time between when the member becomes
enrolled with an MCE and when the MCE makes a member's PMP
assignment. Until the MCE transmits the PMP assignment, Web
interChange shows "PMP not available."
PMPs seeing a member for whom Web interChange shows "PMP not
available" should inform the member to contact his or her MCE and
request a PMP assignment if he or she has not already done so. As
long as the PMP is a participating provider under with the member's
MCE, the provider can provide care to that member regardless of the
"PMP not available" status in Web interChange.
Q: What happens to a PMP's panel if the PMP disenrolls from an
MCE and re-enrolls with another MCE?
A: Prior to January 1, 2011, when a PMP disenrolled from one MCE
and re-enrolled with another MCE, that PMP's panel automatically
followed the PMP to the new MCE.
Effective January 1, 2011, however, members do not automatically
follow their PMP if their PMP disenrolls from one MCE and
re-enrolls with another MCE.
Under this scenario, a member has the choice to follow his or
her PMP to the new MCE or remain enrolled in his or her current
MCE. To follow their PMPs, members need to contact the IHCP
enrollment broker and request a change in assignment to the new
MCE. The enrollment broker verifies that the PMP has been
disenrolled from one MCE and has re-enrolled in the new MCE, and
makes the member's change regardless of open-enrollment or
redetermination status. The new MCE is then responsible for
assigning that member to the correct PMP.
Q: How should PMPs process full-panel add requests?
A: Because the MCEs are the only entities responsible for making
member PMP assignments, MCEs are also responsible for processing
full-panel add requests. Full-panel add requests do not override a
member's MCE assignment.
If an MCE receives a full-panel add request from a PMP for a
member who is not the MCE's member, the MCE will deny the
full-panel add request with a letter to the PMP informing the PMP
that if he or she wishes to have the member added to his or her
panel within that MCE, the member must request an MCE change before
the full-panel add can be processed. The member may request an MCE
change with the IHCP enrollment broker.
Full-panel add requests that the MCEs receive for their members
are processed and the member is added to the PMP's panel with that
MCE. Neither the IHCP enrollment broker nor the IHCP Call Center
processes full-panel add requests.
Q: How are members enrolled in the Right Choices Program (RCP)
affected by the MCE contract changes?
A: MCEs remain responsible for administering the unified RCP
that encourages responsible utilization of services. The MCEs'
responsibilities include assigning RCP members to locked-in PMPs,
hospitals, and pharmacies. In instances in which an RCP member's
PMP disenrolls from one MCE and re-enrolls with another MCE, the
member remains locked-in with the PMP and follows his or her PMP to
the new MCE.