Why blue cross community MMAI (Medicare-Medicaid plan)?
The Blue Cross Community MMAI (Medicare-Medicaid Plan) SM was created to help you maintain your health and independence. Blue Cross Community MMAI (Medicare-Medicaid Plan) SM includes: Medical benefits such as coverage for preventive care services, emergency and urgent care coverage, diagnostic tests and more
What is MMAI insurance?
MMAI is a health plan that provides benefits to people who are eligible for both Medicare and Medicaid. Are You Eligible? Learn more about MMAI eligibility and enrollment.
What is not covered by the MMAI plan?
The MMAI Plan, consistent with Medicare, will also not cover hospitalizations and other services related to these non- covered procedures as defined in the Medicare Benefit Policy Manual (BPM), chapter 1, sections 10 and 180 and chapter 16, section 120. Blue Cross Community MMAI Provider Manual –May 2021 65
Where do I send Blue Cross community MMAI Appeals?
Blue Cross Community MMAI Appeals & Grievances P.O. Box 27838, Albuquerque, NM 87125-9705 877-723-7702 866-642-7069 Expedited Appeals: 800- 338-2227 Claims submission Blue Cross Community Options P.O. Box 4168 c/o Provider Services Scranton, PA 18505 877-723-7702
What does Mmai mean in insurance?
MEDICARE-MEDICAID ALIGNMENT INITIATIVEMEDICARE-MEDICAID ALIGNMENT INITIATIVE (MMAI)
Is Mmai better than Medicare?
MMAI plans should have more benefits, meaning they cover more services than traditional Medicare/Medicaid. However, they may not cover the same prescriptions that Medicare/Medicaid covered. In order to understand the coverage differences, you may contact any MMAI plan for details.
Is Blue Cross of Illinois Medicaid?
The Centers for Medicare & Medicaid Services (CMS) and the State of Illinois have contracted with Blue Cross and Blue Shield of Illinois (BCBSIL) along with other Managed Care Organizations (MCO) to implement Medicaid to all counties in Illinois.
Who takes Illinois Medicaid?
Medicaid pays for medical assistance for eligible children, parents and caretakers of children, pregnant women, persons who are disabled, blind or 65 years of age or older, those who were formerly in foster care services, and adults aged 19-64 who are not receiving Medicare coverage and who are not the parent or ...
How do I opt out of Mmai Il?
If you do not want to be in the MMAI program, you can opt out (decide not to enroll) by calling us at 1-877-912-8880 (TTY: 1-866-565-8576). If you get long term care or home-based waiver services, you will still need to enroll in a Long Term Services and Supports (LTSS) health plan for those services only.
Does Illinois Medicaid pay Medicare premiums?
Who is eligible to have Medicaid pay their Medicare cost sharing expenses? Your income must be less than Illinois' income limits. If your income is equal to or less than $981 per month for a single person or up to $1,328 per month for a couple, you may qualify for Medicaid to pay all of your Medicare cost sharing.
What type of insurance is Blue Cross Blue Shield of Illinois?
health insurance companyBlue Cross and Blue Shield of Illinois (BCBSIL) is a customer-owned health insurance company serving Illinois residents. The company offers individuals and families healthcare and prescription drug coverage through its Blue Choice Preferred PPO, Blue Precision HMO, and BlueCare Direct HMO plans.
Which Illinois Medicaid plan is best?
NCQA Health Insurance Plan Ratings 2019-2020 - Summary Report (Medicaid)RatingPlan NamePrevention3.5Cook County Health & Hospitals System's CountyCare Health Plan3.53.5Meridian Health Plan of Illinois, Inc.3.03.5Molina Healthcare of Illinois, Inc.3.03.0IlliniCare Health2.03 more rows
What are the Illinois Medicaid plans?
HealthChoice Illinois Health Plan Contact Information:www.ilyouthcare.com |1-844-289-2264.Blue Cross Community Health Plan. www.bcbsil.com/bcchp/ | 1-877-860-2837.CountyCare Health Plan (Cook County only) ... IlliniCare Health. ... Meridian Health Plan (Former Youth in Care Only) ... Molina Healthcare.
What is the monthly income limit for Medicaid in Illinois?
Illinois offers Medicaid coverage for people with disabilities with income up to 100% of the federal poverty level (monthly income of $1,012 for an individual) and non-exempt resources (assets) of no more than $2,000 (for one person).
What is the highest income to qualify for Medicaid?
Federal Poverty Level thresholds to qualify for Medicaid The Federal Poverty Level is determined by the size of a family for the lower 48 states and the District of Columbia. For example, in 2022 it is $13,590 for a single adult person, $27,750 for a family of four and $46,630 for a family of eight.
What is the income limit for Illinois Medicaid?
ACA Adults – under the Affordable Care Act (ACA), adults age 19-64 who were not previously eligible for coverage under Medicaid can now receive medical coverage. Individuals with income up to 138 percent of the federal poverty level (monthly income of $1,366/individual, $1,845/couple) can be covered.
What is health Choice Illinois?
HealthChoice Illinois is the statewide Medicaid managed care program. Most Medicaid customers are required to choose a primary care provider (PCP) and health plan. We can help you understand your plan choices, find providers and enroll.
What is Mltss Illinois?
The Illinois Managed Long Term Services and Supports (MLTSS) Medicaid Waiver provides a variety of home and community-based services (HCBS) for elderly and disabled “dual eligible” residents who are at risk of being institutionalized (being placed in a nursing home).
How do I cancel my Medicaid in Illinois?
To voluntarily disenroll: Call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. If you are hearing or speech impaired, please call 1-877-486-2048.
What is MMAI in health care?
Blue Cross Community MMAI (Medicare-Medicaid Plan) is provided by Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an independent licensee of the Blue Cross and Blue Shield Association. HCSC is a health plan that contracts with both Medicare and Illinois Medicaid to provide benefits of both programs to enrollees. Enrollment in HCSC’s plan depends on contract renewal.
What is a Blue Cross and Blue Shield manual?
This manual is a reference for independently contracted providers to use in working with the Blue Cross and Blue Shield of Illinois. Independently contracted providers who have additional questions can refer to the following chart which includes several important telephone and fax numbers available to your office.
What is BCBSIL training?
BCBSIL will make available cultural competency, cross cultural communication and disability literacy training programs to independently contracted providers. The goals of the training programs include, but are not limited to:
What is HCSC in Illinois?
HCSC is a health plan that contracts with both Medicare and Illinois Medicaid to provide benefits of both programs to enrollees . Enrollment in HCSC’s plan depends on contract renewal. Blue Cross Community MMAI Provider Manual –May 2021 2 . Table of Contents .
What is the confidentiality requirement for independent contracted providers?
Independently contracted providers must comply with all state and federal laws concerning confidentiality of health and other information about members. Independently contracted providers must have policies and procedures in place regarding use and disclosure of health information that comply with applicable laws. BCBSIL members have the right to privacy and confidentiality regarding their health care records and information. Independently contracted providers and each staff member must sign an Employee Confidentiality Statement to be placed in the staff member’s personnel file.
What is the QAC in Blue Cross?
The Quality Assurance Committee (QAC) is responsible for providing oversight and direction to the Blue Cross and Blue Shield of Illinois (BCBSIL) Quality Improvement Program. The QAC brings multidivisional staff together with independently contracted providers and members for the purpose of reflecting customer values.
Is Illinois a CMS state?
The State of Illinois has been designated by the Centers for Medicare & Medicaid Services (CMS) to participate in a demonstration program designed to help better service individuals who are eligible for both Medicare and Medicaid. This partnership will include a three-way contract with CMS, the State of Illinois and Blue Cross and Blue Shield of Illinois (BCBSIL) to provide integrated benefits to Medicare-Medicaid enrollees. The network will consist of independently contracted providers including physicians, hospitals, skilled nursing facilities, ancillary providers, long-term services and support and other health care providers through which members may obtain Covered Services.
When do you have to use in network hospitals?
You must use in-network hospitals when not an emergency.
Do ambulances have to be approved by the plan?
Ambulance services for other cases must be approved by the plan. In cases that are not emergencies, the plan may pay for an ambulance. Prior authorization is not required for services provided by in-network providers. Prior authorization is not required for services provided by in-network providers.
