August 2013 Update

Open enrollment in the Health Insurance Marketplace begins October 1st as required by the Affordable Care Act (ACA). Changes to Medicaid and Marketplace enrollment processes and procedures in Indiana will also begin in October with new coverage options becoming effective January 1st, 2014.  As part of our ongoing commitment to our clients, we are pleased to announce several enhanced services that will ensure you have the information and resources needed throughout this transition. Our goal remains to provide you and your patients / clients / consumers with the ClaimAid Advantage.

The Indiana Navigator Program

  • On May 11, 2013, Governor Pence signed into law House Bill 1328 (Indiana Code 27-19), which established guidelines for the Federally Facilitated Marketplace operating in Indiana.
  • What you need to know: Beginning on October 1, 2013 any individual meeting the definition of “Navigator” in IC 27-19-2-12 must become certified by the State of Indiana to assist Hoosier consumers in completing applications for health insurance and health care plans under Medicaid and the Federally Facilitated Marketplace. ClaimAid advocates will all be certified as Indiana Navigators to assist with the enrollment in Medicaid and Marketplace plans. This includes completing the required background checks, pre-certification training course, registration, exam as well as meet the necessary conflict of interest standards.

ClaimAid’s Application Organization Management (AOM) Service

  • House Bill 1328 also requires organizations meeting the definition of “Application Organization” in IC 27-19-2-3, must become certified by the State of Indiana.
  • What you need to know:  ClaimAid patient advocates operate under ClaimAid’s Application Organization certification. If ClaimAid staff perform all enrollment functions for your company, certification is not required.  If your organization has other staff that assists with Medicaid or Marketplace enrollment, certification is required and your organization must register as an Application Organization (AO). ClaimAid’s AOM service is simple and affordable solution to ensure that your company and staff meet the application standards and remain in compliance with the new requirements.

Hospital Based Presumptive Eligibility

  • Effective January 1, 2014, the ACA requires that the state of Indiana permit hospitals that meet state requirements to make PE determinations for certain eligibility groups.
  • What you need to know: To enroll as a Qualified Provider (QP) eligible to make PE determinations, the hospital must be an IHCP enrolled hospital which has amended their provider agreement. ClaimAid can assist with the process and operation of this program. If you would like more information or your organization has decided to enroll as a QP, please let us know.

For more details and up-to-date information, please contact J Hopkins, Vice President at 800.842.4052 x126 or by email at jhopkins@claimaid.com.