As of January, the majority of Pennsylvania's home care providers will move from the historical state Medicaid program, PA Promise, to the managed care model. The state has outsourced the management of its Medicaid home care program to three Managed Care Organizations (MCOs) as follows:
- University of Pennsylvania Medical Center (UPMC),
- Pennsylvania Health and Wellness (PAHW / Centene), and
- Amerihealth (referred to as Keystone in Eastern Pennsylvania)
Why is Pennsylvania and Other States Making These Big Changes?
How Must PA Providers Prepare for Managed Care?
- Each consumer needs to be affiliated with one of the MCOs, and you need to know which one so that you can submit claims.
- In addition to knowing the consumer's Medicaid ID, you'll need to know their MCO admission ID because this is how authorizations are referenced and how remittance information (payments from the MCOs) are referenced.
- You need to provide EVV proof of visit completion. This is most commonly done with a GPS enabled mobile app or with IVR Voice telephony. This information needs to be submitted to "The Exchange" in order for you to get paid.
Ankota provides software to improve the delivery of care outside the hospital, focusing on efficiency and care coordination. Ankota's primary focus is on Care Transitions for Readmission avoidance and on management of Private Duty non-medical home care. To learn more, please visit www.ankota.com or contact us.