1. How do I correct problems with a member's primary insurance information not being up-to-date?

2. Where do I refer a member if he/she has claim questions?

3. How is a member's network determined?

4. What are the primary responsibilities of the Hoosier Healthwise BA And the Helpline?

5. Can the BA's or the Helpline Rep. give a member his/her ID number, often called a RID?

6. How long does it take for a member to change his/her Primary Medical Provider (PMP)?

7. Can the BA's or the Helpline Rep. order new or replacement Hoosier Healthwise ID cards for members?

8. Where do I refer a member who has questions about premium payments for Hoosier Healthwise Package C?

9. If a member is on a Restricted Card and wants to change his/her assigned PMP, whom should he/she contact?

10. What Hoosier Healthwise eligibility categories do I need to refer to a B.A. because they need to select a PMP?

11. What eligibility categories currently DO NOT need to see a B.A. and do not select a PMP?

1.  How do I correct problems with a member’s primary insurance information not being up-to-date?

Electronic Data Systems (EDS) manages the Third Party Liability Unit and you, the caseworker, should report the problem to them at (317) 488-5046.

2.  Where do I refer a member if they have claims questions?

The network in which he or she is enrolled, with the exception of dental and behavioral health claims, handles a member’s claims. All dental and behavioral health claims are handled by Electronic Data Systems (EDS), regardless of network. EDS also handles all traditional Medicaid and PCCM member claims. Harmony Health, Managed Health Services, and MDwise handle the claims for their members. If the member does not know which network they are enrolled with, refer them to the local Hoosier Healthwise Benefit Advocate or 1-800-889-9949.

• EDS Member Hotline: 1-800-457-4584

• Harmony Health: 1-800-608-8158

• Managed Health Services: 1-800-414-5946

• MDwise: 1-800-356-1204

• CareSource: 1-800-488-0134

• Molina: 1-800-642-4509

3.  How Is A Member’s Network Determined?

Each member is able to select the Primary Medical Provider (PMP) of his or her choice. Each PMP is enrolled with and actively accepting patients in one network. The network is either Primary Care Case Management (PCCM) or Risk-Based Managed Care (RBMC), which includes Harmony Health, Managed Health Services, MDwise, CareSource, and Molina. The doctor will choose the network that they want to contract with. When the member is assigned to a PMP they become enrolled in the network with which the doctor is contracted.

 

4.  What Are The Primary Responsibilities Of The Hoosier Healthwise Benefit Advocates And The Hoosier Healthwise Helpline?

The Benefit Advocates (BA’s) and Helpline Representatives instruct members on how they can apply for the Hoosier Healthwise program and basic application information. They are responsible for taking the Primary Medical Provider (PMP) selections in order to prevent the members from being assigned to a PMP that they did not choose. They give education on the program, such as how to get a hold of the PMP if the office is closed, how to appropriately utilize the emergency room, canceling appointments ahead of time, what network a member is enrolled in, which pharmacies they can use, and which PMP’s and dentists accept Hoosier Healthwise. The BA’s and Helpline Representatives serve as a resource to help members navigate through the system, often referring them to other agencies and companies for the help they need.

 

5.  Can The Benefit Advocate’s Or Hoosier Healthwise Helpline Give A Member His/Her Identification Number, Often Called A RID?

No, the BA’s and Helpline Representatives are not able to give out Hoosier Healthwise ID numbers. This policy is to ensure the confidentiality for the member. Members that need their number are referred back to their caseworker.

 

6.  How Long Does It Take For A Member To Change His/Her Primary Medical Provider (PMP)?

When a PMP selection request is taken from a member it is input into the computer system, which assigns the start date of the PMP selection. Changes generally take 30-45 days in order to become effective.

 

7.  Can The Benefit Advocate’s Or Hoosier Healthwise Helpline Order New Or Replacement Hoosier Healthwise Identification Cards For Members?

No, the BA’s and Helpline Representatives do not have the ability to order cards for members. They can only fill out a report of change form requesting a new card that is then sent to the caseworker to order the card.

 

8.  Where Do I Refer A Member Who Has Questions About Premium Payments For Hoosier Healthwise Package C?

New Package C members will be mailed a premium invoice shortly after they are determined eligible. Package C Members who have questions about premium payments can call the Package C Payment Line at 1-866-404-7113. Premium payment checks or money orders should be mailed to:

9.  If A Member Is On A Restricted Card And Wants To Change His/Her Assigned Primary Medical Provider (PMP), Whom Should He/She Contact?

In order for a member who is on a restricted-card to change his/her PMP, he/she needs to contact Health Care Excel. Health Care Excel is the company that manages the restricted-card program and they can be reached at 1-800-457-4515.

 

10.  What Hoosier Healthwise Eligibility Categories Do I Need To Refer To A Benefit Advocate Because They Need To Select A Primary Medical Provider (PMP)?
 

All of the above categories must select a Primary Medical Provider or they will be assigned to one.

 

11.  What Eligibility Categories Currently DO NOT Need To See A Benefit Advocate And Do Not Select Primary Medical Providers (PMP)?
 

The above categories do not select Primary Medical Providers and do not need to see a Benefit Advocate. Those members are considered to be receiving traditional Medicaid and are able to see any doctor that will accept Medicaid.