Aetna Transition of Care Authorizations Extended through December 31, 2019 Update
To ensure all provider contracting and credentialing have been completed, Aetna Better Health of Kansas is extending the Transition of Care period for prior authorizations through December 31, 2019. Aetna Better Health of Kansas will process all claims with dates of service through December 31, 2019 for services requiring prior authorizations as if they are from participating providers. The member must be enrolled and eligible on each date of service.
UPDATE: Providers do not need to submit requests for adjustments.
Aetna Better Health will be reprocessing claims denied as:
- Non-participating provider
- No prior authorization where provider is non-participating
During the transition of care period (dates of service through 12/31/19), the non-participating provider authorization process is the same as if the non-participating provider was a participating provider.
- Providers eligible to participate in Kansas Medicaid and not yet contracted with Aetna Better Health of Kansas will be paid as “in network” at 100 percent of the Medicaid Fee-For-Service (FFS) rate through December 31, 2019.
- Providers not yet contracted or credentialed with Aetna Better Health of Kansas do not need to prior authorize every service until January 1, 2020. Until January 1st, participating and nonparticipating providers alike should follow the plan's service prior authorization/notification policies for participating providers. Beginning January 1, 2020, noncontracted providers must follow Aetna Better Health’s regular noncontracted provider service authorization procedures.
Providers can visit the Aetna Better Health of Kansas Secure Web Portal located on our website (aetnabetterhealth.com/kansas) to access our Provider PA Tool to search multiple codes simultaneously for prior authorization requirements.
If you have questions about this communication, please contact Aetna Better Health of Kansas Provider Experience Department at 1-855-221-5656.
KanCare
Eligibility Transition Rapid Response Calls
Effective January 1st, 2020, KDHE will assume full responsibility for processing eligibility for Elderly, Disabled and Long Term Care medical programs. Beginning September 2019 through December 2019, the eligibility workload will be phased over to KDHE from our eligibility contractor, Maximus. To ensure the transition of eligibility processing to the State is going smoothly, and to hear about any issues emerging early on, KDHE and Maximus are holding weekly transition rapid response calls. The calls will occur on Wednesdays at 10:00 AM, until December 18, 2019. State and Maximus staff will be on the line to provide updates, announcements and take questions from stakeholders related to the transition.
The call will occur on Wednesdays at 10:00 AM. (Beginning Sept 11th)
The toll-free conference line number for these calls is: 1-855-982-6833.
There is no conference code; just tell the operator you are calling into the KanCare Eligibility Transition call.
Call Recording and Transcripts: (click for transcript and recording)
Robert (Bob) Bethel Joint Committee on
Home and Community Based Services and KanCare Oversight
Date: November 18th and 19th, 2019
Time: 9:00 AM
Place: 548-S; State Capitol Bldg
If you are interested in providing testimony, please note the deadlines for inclusion in the agenda (August 20) and to provide paper and electronic copies of your testimony (August 22) detailed in the attached agenda.
The meeting will be livestreamed and recorded. You may listen to the meeting live or listen to the recording at a later date at http://sg001-harmony.sliq.net/00287/Harmony/en/View/Calendar/. Please select the meeting date and then the Committee.
Joint Committee Information
KanCare Amerigroup Contract Update
The State of Kansas contract with Amerigroup expired December 31, 2018. Amerigroup maintained a local office until 3/31/19 to assist with the transition out of the Kansas market. As of 4/1/19, all Kansas emails and phone numbers are no longer in service. You must call the national provider assistance line, 1-800-454-3730 for assistance.
Providers have an on-going contractual relationship which survives the KanCare contract termination. Providers should use the terms of that contract for resolution of any issues or disputes. Depending upon the contract, normal provider disputes would follow the reconsideration, appeal and fair hearing pathway to resolve issues. Important to note, Amerigroup will consider a group appeal for the same issue. Please see the claims appeal form on the website below for instructions on how to do multiple claim appeals.
Please look at the bottom of the following website for Amerigroup guidelines, as well as any forms which may be required:
https://www.kancare.ks.gov/providers/health-plan-information
If you have followed these procedures and still need assistance, email KanCare at KDHE.KanCare@ks.gov with appeal/fair hearing information, the amount in dispute and a description of the issue.