Medicare

Inpatient/Hospital Care
Outpatient/not admitted to hospital

Medicare Part D= Prescreiption Drugs
Medicare Part C= Medicare Part C/ HMO Health Maintenance Organization

Healthfirst Medicare Advantage
Plan Name			Plan Abbreviation		Part A& B		Part D		Dual Eligible
.			/			/		/

For Dual Eligible Plan no payment needed
. Life Improvement Plan = Healthfirst Handled only Medicare. Medicaid should be handled by other Insurance   Services or State
  Medicare Will cover 80% and Medicaid will handle 20%
  100% will be billed by Healthfirst
. Completecare Plan= We both Handle Medicare and Medicaid
. Connection Plan= HARP Health And Recovery Program = Members with Mental Health eligibility

Company Code 30
Healthfirst Medicare Advantage Member IDs Will start With 11,12,13



Knowlegde 

Dual Eligibility Renewall Plan= for Life Improvement Plan/ Medicaid can Renew Every Year, Medicare is not renewable

Dual Eligible Plans- Renewal Responsobilities

		LOB					Agency Contact Information
					Provide the Direct phone number 1-844-500-9820 Mon-Fri 8:30AM- 8:00PM
					snd Transfer the number to retention Scheduling Department
LIP with On-Exchange Medicaid		using the FF extension:
					. English

. Signature PPO= can see both in and out of network 
. Signature (HMO)= can only see in network providers
. PPO =preferred provider organization

HARP= Health And Recovery Program

OOP Assistance for PArt D

New YOrk State EPIC Program= New York State (NYS) Supplemental prescription coverage that works with Medicare Part D Plans

Elderly Pharmaceutical Insurance Coverage (EPIC) / Low Income Subsidy (Extra Help)

5 Status of Enrollment
. Enrolled
. Dis Enrolled
. Feature Enrolled
. Pre Enrolled
. Null Enrolled


Healthfirst Plan
Sinature PPO 
Sinature HMO
65 plan = not eligible for OTC
Increased benefits plan
life improvement plan
Complete care plan / handled by Medicaid and Medicare
connection plan / handled only by Medicaid and HARP 


MarketPlace Plan
- on exchange medicaiad 
- CHP 
- essential plan 
- on exchange QHP

Siganture PPO care or Flex Card

Complete care can recive monthly allowance

Medicaid is not eligible for OTC card

OTC card is eligible only for Medicare plan members only

For caller's RP and un authorized Caller
HH - for RP 18 above check case history then view more it must be Valid RP
Minor- Biztalk 

Senior Health Partners don't Have PCP only long term services and Dual services, They may have PCP but handled by the State.

Dual eligibility
. Life Improvement Plan
. Completecare Plan
. Connection Plan


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