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| GENERAL |
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| Q: |
Is Passport Advantage a Medicare Replacement
Policy? |
| A: |
No. Passport Advantage does not "replace"
beneficiaries' Medicare coverage. Instead, beneficiaries
receive their Medicare benefits through Passport Advantage
under a contract between the Medicare program and Passport
Advantage. Also, Passport Advantage is not a Medicare supplement
policy (sometimes called a "Medigap" policy). |
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| ELIGIBILITY |
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| Q: |
Who can enroll in Passport Advantage? |
| A: |
Passport Advantage is a Medicare Advantage
Special Needs Plan. Passport Advantage only enrolls members
of Passport Health Plan who have Medicare Parts A and B. |
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| Q: |
Will Passport Advantage serve members in
other counties besides the 16 counties currently served
by Passport Health Plan? |
| A: |
No. The Passport Advantage service area is
the same as Passport Health Plan's. The service area has
not changed. Passport Health Plan and Passport Advantage
serve the following counties: Breckinridge, Bullitt, Carroll,
Grayson, Hardin, Henry, Jefferson, Larue, Marion, Meade,
Nelson, Oldham, Shelby, Spencer, Trimble, and Washington. |
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| Q: |
Have members been educated about Passport
Advantage? |
| A: |
Yes. Passport Advantage conducted a comprehensive
member communication campaign. The campaign included letters,
telephone calls, community meetings, and more. |
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| Q: |
How many ID cards will a Passport Advantage
member have? |
| A: |
Passport Advantage members will have at least
four (4) ID cards: the gold Passport Advantage card; the
Passport Health Plan card; the KYHealth card (issued by
the State); and the traditional red, white and blue Medicare
card. Please refer to Section 2 of the Passport Advantage
Provider Manual for additional information regarding ID
cards. |
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| Q: |
When will members receive ID cards? |
| A: |
ID cards were mailed to members in late December
2005. In the future, new members will generally receive
their ID cards one to two weeks before their effective date.
In some cases, they could receive their cards up to two
weeks after their effective date. |
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| Q: |
Will the Passport Advantage ID Card include
an effective date of coverage? |
| A: |
No. The Passport Advantage ID card will not
include an effective date. Providers must verify eligibility
before providing services. Providers may call (800) 578-0775
or visit our website at www.passporthealthplan.com. |
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| Q: |
What if a patient does not present all
ID cards (Passport Advantage, Passport Health Plan and DMS)? |
| A: |
The best way to verify eligibility is online
through the Provider Center at www.passporthealthplan.com
or via telephone (800) 578-0775. Providers will need to
verify eligibility at each visit as members' enrollment
status can change from month to month. It is not mandatory
that a Medicare beneficiary participate in a Medicare Advantage
plan. |
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| Q: |
Can members disenroll from Passport Advantage? |
| A: |
Yes. Passport Advantage members can disenroll
from the Plan at the end of any month. |
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| Q: |
Can providers verify eligibility for Passport
Advantage members on the Passport Health Plan web site? |
| A: |
Providers can verify eligibility by logging
into the Provider Center of the Passport Health Plan web
site. The provider must enter their provider identification
number and password. Once the information has been confirmed,
providers will be able to verify Medicaid and Medicare eligibility
by using the quick navigation tab. Eligibility can also
be verified by calling the IVR at (800) 578-0775. Provider
Services staff are also available to assist providers with
questions about member eligibility, policies, procedures
and more. Providers should request that members show all
ID cards. |
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| Q: |
What will happen if a patient loses his/her
Passport Health Plan coverage? |
| A: |
In order to be a member of Passport Advantage,
a Medicare beneficiary must be a member of Passport Health
Plan and have Medicare Parts A and B. If a Passport Advantage
member loses Passport Health Plan eligibility, the beneficiary
will continue to be a member of Passport Advantage for up
to 90 days. If the beneficiary does not regain Passport
Health Plan eligibility, he/she will be disenrolled from
Passport Advantage. The beneficiary can choose to return
to traditional Medicare or enroll in another Medicare Advantage
Plan. If the beneficiary regains Passport Health Plan eligibility
within 90 days, the beneficiary will continue coverage with
Passport Advantage. |
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| Q: |
Will the Passport Health Plan web site
indicate that a person has Passport Advantage or will it
state Medicare primary? |
| A: |
The Passport Health Plan web site will continue
to reflect "Medicare primary." |
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| Q: |
If members were not passively enrolled,
how do they enroll with Passport Advantage? |
| A: |
Members not passively enrolled will receive
an application packet from Passport Advantage. The completed
application form must be returned in order for the member
to be enrolled. |
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| Q: |
Will Passport Advantage members have a
Medicare Part B deductible? |
| A: |
No. Passport Advantage members will not have
a deductible for Part B. All other applicable, co-insurance/co-pays
also apply for Part B. |
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| Q: |
Will Passport Advantage members have a
Medicare Part A deductible? |
| A: |
Yes. Passport Advantage members will have
a deductible for Part A services. |
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| Q: |
Will all Medicare beneficiaries have to
select a Medicare Advantage plan? |
| A: |
No. Beneficiaries can elect to remain with
the traditional Medicare plan. |
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| CONTRACTING |
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| Q: |
Are providers automatically contracted
with Passport Advantage? |
| A: |
No. Providers currently contracted with Passport
Health Plan must sign a "Passport Advantage" contract
amendment. Providers may contact their Provider Relations
representative or the Provider Relations department at (502)
585-7943 for additional information. |
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| Q: |
Will Passport Advantage providers have
different provider numbers? |
| A: |
Yes. Providers who participate with both plans
will have both a Passport Health Plan provider number and
a Passport Advantage provider number. The appropriate number's
must be utilized when submitting claims to each plan. |
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| Q: |
Where will the letters regarding the Passport
Advantage provider numbers be mailed? |
| A: |
Letters were mailed to both the remit and
primary addresses. |
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| Q: |
How can a Passport Health Plan provider
find out if he/she is contracted with Passport Advantage? |
| A: |
Passport Advantage provider letters were mailed
to providers in November. If a Passport Health Plan provider
is unsure if he/she is in the Passport Advantage network,
he/she should contact his/her Provider Relations representative
or the Provider Relations department at (502) 585-7943. |
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| Q: |
Will Passport Advantage backdate provider
enrollment during the credentialing period? |
| A: |
No. Providers must complete the credentialing
process before they will be considered participating practitioners
with Passport Advantage. |
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| UTILIZATION MANAGMENT |
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| Q: |
Will Passport Advantage require prior authorization
for services? |
| A: |
Yes. Passport Advantage will require prior
authorization for inpatient admissions and other services
as outlined in Section 5.3 in the Passport Advantage Provider
Manual. |
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| Q: |
Will Passport Advantage providers use the
same prior authorization forms as Passport Health Plan? |
| A: |
Yes. Please refer to Section 13.5 in the Passport
Advantage Provider Manual for prior authorization forms. |
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| Q: |
Will Behavioral Health drugs require prior
authorization? |
| A: |
Yes, some drugs used to treat behavioral health
conditions will require prior authorization from the Plan.
Please refer to the Formulary on the Passport Advantage
web site at www.passporthealthplan.com. |
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| Q: |
What happens on January 1, 2006, if a patient
is receiving services that began on December 15, 2005? |
| A: |
Passport Advantage will assume responsibility
for all services as of January 1, 2006. Any prior authorization
requirements that are needed would be required. Services
rendered on or after January 1, 2006 must be billed to Passport
Advantage. |
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| CLAIMS/REIMBURSEMENT |
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| Q: |
Can corrected claims for Passport Advantage
be sent electronically? |
| A: |
No. Corrected claims must be re-submitted
to Passport Advantage via paper. Please refer to Section
1.6 of the Passport Advantage Provider Manual for additional
information. |
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| Q: |
Will the coding and billing processes be
the same as Medicare? |
| A: |
Yes. Claims should be submitted using Medicare
standards. |
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| Q: |
How will providers be reimbursed? |
| A: |
Contracted providers who have executed a Passport
Advantage contract or amendment will be reimbursed at 103%
of the Medicare allowed amount. Non-contracted providers
will be reimbursed at 100% of the Medicare allowed. Any
necessary deductibles and co-payments would apply. |
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| Q: |
When Medicare (Passport Advantage) denies
a claim, will Passport Health Plan automatically pay? |
| A: |
No. Guidelines for coverage by Passport Health
Plan will remain as they are today. |
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| Q: |
When will providers be able to check claim
status and verify eligibility online? |
| A: |
These functions will be available in January
2006. |
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| Q: |
Will the bundling guidelines be different
for Passport Advantage than Medicare? |
| A: |
Passport Advantage will initially utilize
Claim Check by McKesson for claim editing. Passport Advantage
will implement the CMS developed NCCI edits during 2006. |
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| Q: |
Will providers receive two different remittances? |
| A: |
Yes. Passport Health Plan and Passport Advantage
are two different health plans. A remittance advice will
be received for each. |
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| Q: |
Will claims cross over from Passport Health
Plan to Passport Advantage? |
| A: |
No. Providers must initially file Passport
Advantage claims to Passport Advantage. Claims submitted
to Passport Health Plan in error will receive a denial stating
"other insurance primary." |
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| Q: |
Will claims cross over from Passport Advantage
to Passport Health Plan? |
| A: |
Yes, except for behavioral health and skilled
nursing facility claims. These claims must be sent to DMS
for secondary processing. |
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| Q: |
Will Passport Advantage claims cross over
to commercial carriers? |
| A: |
No. Providers must submit claims with the
explanation of benefits to the commercial carrier. |
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| Q: |
Is it possible for Passport Advantage members
to have a third carrier? |
| A: |
Yes. Members may have additional health care
coverage, e.g. employer sponsored coverage. Standard coordination
of benefit rules apply. |
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| Q: |
Is there a cap on rental items with Passport
Advantage? |
| A: |
Yes. Passport Advantage will rent only to
the purchase price. |
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| Q: |
Will the patient get an option to rent
or purchase? |
| A: |
No. Once Passport Advantage has paid rental
payments totaling the purchase price, the member will own
the item. |
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| Q: |
Will providers be required to file the
Certificate of Medical Necessity (CMN) and other forms with
claims? |
| A: |
No. CMN's and other forms do not require submission.
However, providers should continue to complete these forms
and maintain them on file. |
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| Q: |
Will Passport Advantage use the Medicare
fee schedules? |
| A: |
Yes. Passport Advantage will use the Medicare
fee schedules. |
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| Q: |
Will Passport Advantage require a referral
to specialists? |
| A: |
No. Referral forms are not required for Passport
Advantage members. Passport Advantage members are not required
to select a Primary Care Practitioner (PCP) but members
are encouraged to choose a medical home, usually a PCP. |
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| Q: |
Will CLIA numbers and UPIN numbers from
referring practitioners be required information on claim
forms? |
| A: |
Passport Advantage recommends that providers
bill Passport Advantage as they would bill the Medicare
program unless specifically directed to do otherwise through
written communication from the Plan. |
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