February 2016 Update

HIP 2.0 Updates

As HIP 2.0 celebrates its 1 year anniversary, ClaimAid continues to be an integral part of the enrollment and redetermination process for Hoosiers throughout the state.  An estimate of over 370,000 individuals is currently enrolled in the coverage and will have the opportunity to renew that coverage annually.  If you or your patients have questions regarding this process, please contact your ClaimAid Patient Advocate or the ClaimAid Corporate office at 800.842.4052.

What you need to know:

  • Renewal Periods – HIP annual renewal periods began in November 2015 and involve a series of notices sent by mail to members. Some members will need to update and confirm eligibility information if requested by the state.  This process includes completing a paper questionnaire and submitting documentation by a certain deadline in order to renew their coverage.  This renewal period is also when members will have the option to switch from HIP Basic to HIP Plus or change their Managed Care Entity (MCE).
  • Fast Track – HIP applicants are able to expedite the start of their HIP Plus coverage through the Fast Track option. Fast Track allows individuals to make a $10 payment toward their first POWER account contribution while the application is being processed.  If the HIP application is approved, coverage may begin the first of the month in which the Fast Track payment was made (If no PE coverage was approved). Individuals can make a Fast Track payment by credit card or debit card at the time of application but they must choose a Managed Care Entity (MCE) at that time.
  • HIP Link – This part of HIP 2.0 provides assistance to working Hoosiers to participate in their employer’s insurance plan. Employers may register their health plans with HIP Link and must meet the minimum benefit requirements of the Affordable Care Act in order to participate. Individuals can then sign up with the state and if approved, receive assistance with insurance premiums.  The employer will deduct the cost of premiums from the employees’ pay, per normal procedure.  The State will then reimburse the employee for the amount of the deduction, minus a small contribution made by the employee.  Employees must have household income at or below approximately 138% of FPL and meet other requirements such as residency and citizenship.

Presumptive Eligibility (PE) Updates

Presumptive Eligibility is temporary coverage awarded to individuals until an official determination is made by the FSSA.  Qualified Providers are allowed to assist individuals with the online application and receive a real-time presumptive eligibility determination.  If approved, individuals have immediate, temporary coverage.

What you need to know:

  • Qualified Providers must enroll and notify FSSA of their intent to receive presumptive eligibility determinations.
  • Providers will be monitored to ensure that specific performance standards set by FSSA are met.
  • The temporary coverage remains active until the last day of the month following the month of enrollment. Individuals are required to complete a full Indiana Application for Health Coverage in order to possibly keep the coverage longer.
  • Qualified Providers may designate third parties to complete the PE process on their behalf.

Marketplace Updates

The open enrollment period for the Marketplace insurance plans ended January 31st.  Going forward, consumers would need to qualify for a special enrollment period in order to sign up for health coverage outside of open enrollment.

What you need to know:

  • Special Enrollment Periods can be granted 60 days following certain life events that result in a change in family status or loss of other health coverage.
  • Certain complex situations may require additional contact with Marketplace representatives.
  • If information such as, income and citizenship, cannot be verified through the federal data hub, an inconsistency period is activated. These data matching issues can delay the application process.
  • ClaimAid Patient Advocates are Certified Application Counselors and are trained to assist patients with these complex issues at any time.

 

 For more information regarding ClaimAid services, please call 800.842.4052.  

ClaimAid offers:

  • Comprehensive Eligibility Services
  • Full Suite of Front End Revenue Cycle Tools
  • Automated Financial Assistance
  • Early-Out Programs
  • Claims Resolution
  • Application Organization Management Services
  • School-Based Medicaid Billing
  • Social Security Disability Appeals