When Appropriate for Adult HIP applicants

  • Explain FT payment by using the Written Consent Form for Initial POWER Account Payment.
  • Obtain patient’s signature on page 2 and keep in file. Prior to giving Page 1 to the patient, Write their name, date and the MCE selected on the top of page.
  • If they are in agreement, add this statement:

I do not want to have a Presumptive Eligibility application filed as I have filed an application for HIP coverage with a FT payment.

  • Give them this Consent Form with the written statement added and explain that if they see another provider before their HIP application is approved, they should show them this document.  Attempt to explain to them that if a PE is filed after the FT is made and before they are conditionally approved, coverage cannot go back to the first of the month of when the FT was made.

We are hoping that if the patient has this document and presents it to a provider that is attempting to file a PE we may be able to reduce the occurrence of other providers filing PE when a full application has already been filed with a FT.

  • File the full HIP application with selected MCE making payment at time of application whenever possible.
  • To avoid potential problems with FSSA and the MCE acknowledging payment of the FT or POWER account contribution please follow the guideline below:

Submit a copy of the confirmation payment that was made to the selected MCE (adding any missing identifying information; name, case number or SS#, date and amount) via FAX to the FSSA document center when you submit your other verification/documents.  This is of course with the Document cover sheet in which you have written/identified the verifications attached.  This practice has been done by some other advocates and appears to improve the success of FSSA and the MCE acknowledging payment. This would also be good evidence at any appeal that would be filed when it is not handled correctly by FSSA and the MCE.

  • ClaimAid advocates will print off the receipt of any payment made with the debit/credit card, record in ACTS, and place in a secure folder to be given to the designated hospital staff on the time basis determined by the hospital. The receipt should contain the last 4 digits of the card as each advocate will have their own card.
  • The debit/credit cards are to be placed in a secure location and to be used for the sole purpose of HIP Contribution Assistance program as specified in the approved policy/procedure.

Q&A

  1. What information is requested at the time we are submitting the FT payment on line with the HIP application?

Each MCE may have some slight differences but they all ask for the card #, type (VISA or Mastercard), expiration date of the card and name on card. This can be the hospital foundation name or name on the account and does not have to be a specific person (from our experience).

 

  1. How is the FT payment verified?

We have found each MCE is different. MDwise and MHS will have an approval screen that pops up that we can print after the payment is submitted on line.  Anthem will ask for an email address to send it to which will be the advocate that completes the transaction. For each of these online transactions our advocate must write the name of the applicant as each MCE has their own method of identifying the individual; application ID#, confirmation # or approval #.  ClaimAid keeps a copy of this receipt in the event that the FSSA or MCE does not acknowledge the date of the transaction and/ or does not approve eligibility for the correct month.

  1. How is the FT or POWER account payment made over the phone completed by each MCE?

The applicant’s selected MCE is contacted by phone and the MCE must be able to see the applicant in their system to verify application has been made and they are the selected MCE on file.   The credit/debit card information is given over the phone and the MCE will send a receipt of the payment via email.

 

  1. Can ClaimAid create a monthly report of all payments made with the Hospital Debit/credit card?

Yes – talk to your manager to be sure you are updating ACTS correctly

 

  1. Can ClaimAid track the number of Contributions that are made for individuals that are not subsequently enrolled?

Yes – talk to your manager to be sure you are updating ACTS correctly

 

  1. How do we handle the situation when we need to make the payment with the MCE over the phone?

You may need to be professionally assertive and very confident when you call the MCE to make the payment.  The approval letter has the $ amount for the POWER account but the MCE sometimes will act like they don’t have it.  The MCE may ask for the provider TAX ID # and NPI#.

An advocate’s experience:

“I have had to provide the NPI and tax id for all of the facilities that I have called the MCE for.  I state I am a Patient Advocate for ClaimAid at …hospital and provide the information as a result I haven’t had any MCE rep refuse to speak to me due to not being the AR.”