April 2021 Prime Stakeholder Update

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Prime Stakeholder Update - April 2021

Non-Emergency Medical Transportation (NEMT) Provider Name Change

Please note that the NEMT provider LogistiCare has changed its name to ModivCare. Phone numbers and other processes will not change. In addition, ModivCare can still be contacted by Healthy Connections Prime members, facilities providers, and transportation providers in the same ways as before.

Reminder of Key Healthy Connections Prime Benefits and Guidance

care coordinator

Healthy Connections Prime would like to highlight some of the useful materials that can be found in our Member and Advocate Toolkit as well as our Provider Toolkit. These materials and others on our website provide valuable information on program benefits and practices.  We encourage you to look at the materials if you have not seen them already or need a refresher.

Member and Advocate Toolkit:

How Can Your Care Coordinator Help You?

As a reminder, Care Coordinators (sometimes called Care Managers) help to get our members the services they need to get or stay healthy. Care Coordinators contact members when they join a Medicare-Medicaid Plan to learn more about them and the services they need. The Care Coordinators can help members access the types of help in the picture to the right. Please refer to this document to learn more about how Care Coordinators can help members.

No Estate Recovery for Members

Estate recovery is a program required by federal law that allows a health care program or plan to recover funds from a beneficiary’s estate for services received in a nursing facility and for home and community-based services. For members of Healthy Connections Prime, such medical expenses that were received while in Healthy Connections Prime are NOT subject to estate recovery. Please refer to this document to learn more about estate recovery and how it applies to Healthy Connections Prime members.

Provider Toolkit:

Waiver Case Manager FAQs

Healthy Connections Prime members can also be in one of the following three Community Long Term Care

(CLTC) waivers: Community Choices waiver, HIV/AIDS waiver, and Mechanical Ventilator Dependent waiver. These members each have an assigned Waiver Case Manager. The member’s MMP Care Coordinator will work with the Waiver Case Manager to make sure the member is getting the waiver services they need. Waiver Case Managers can refer to this document in our Provider Toolkit to get more information. Examples of FAQs covered include:

  • What is the Waiver Case Manager’s role for Healthy Connections Prime members?
  • How does Healthy Connections Prime affect me?
  • Do services overlap between a Care Coordinator and a Waiver Case Manager?
  • How does CLTC’s role with my waiver clients change?

Continuity of Care

Members who enroll in an MMP have a six-month continuity of care period. During this transition period, plans are required to ensure that care continues uninterrupted. During the transition period, MMPs will contact out-of-network providers who offer services to new members with information on how to join the network or how to enter into a single case agreement to continue to care for the member after the six-month continuity of care period. Please refer to this document for further information on this important topic. Topics include:

  • How out-of-network providers and services are affected by a member’s enrollment with Healthy Connections Prime
  • How members are protected during the continuity of care period
  • Transition processes for providers
  • How payments are handled during the continuity of care period

Improper Billing of Healthy Connections Prime Members

As a reminder, providers must not bill Healthy Connections Prime members for:

  • Any Medicare Part A and B costs
  • Any Medicaid-covered medical services or items with the exception of allowable copays/cost-sharing

Further guidance for providers on appropriate billing for our members can be found in this document.

Other Updates & Recently Posted Documents

Additional program information is available on Healthy Connections Prime’s Program Data page. The most recently posted information is linked below.

Join the Healthy Connections Prime Distribution List

Requests to join the Healthy Connections Prime email distribution list can be emailed to prime@scdhhs.gov or submitted at this link.

Request a Presentation for More Information

Providers or organizations that are interested in learning more about Healthy Connections Prime and would like to request a free presentation and/or training session can email primeproviders@scdhhs.gov. The email should include contact information and the desired location and date for the presentation or training.

For More Information and the Latest News

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More information about Healthy Connections Prime can be found on our website at http://www.scdhhs.gov/prime. The website contains helpful information such as member FAQs, a provider toolkit and program data.

Our Member and Advocate Materials page provides numerous resources, such as a plan comparison chart and an explanation of important terms. Also included on this page are short videos that can help caregivers and their loved ones learn more about Healthy Connections Prime. Click on this link and scroll down to “Interactive Scenarios” to access the videos.

Program questions can be directed to the SC Thrive Customer Service Center at (800) 726-8774, Monday-Friday, 8:30 a.m.-5 p.m. TTY users call 711. This call is free. Providers can also email questions to primeproviders@scdhhs.gov.

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