SecureBlue (MSHO) and Skilled Nursing ... - Blue Cross MN



|Member name: |      |

|Member ID |      |

|Effective Date |      |

|Care Coordinator |      |

|Contact information: |Phone:       |

Skilled Nursing Facility Service

Blue Cross and Blue Shield of Minnesota and Blue Plus are participating in Minnesota Senior Care Plus (MSC+) by offering Blue Advantage. MSC+ is a program with the Minnesota Department of Human Services (DHS). It is for people ages 65 and older who are dually eligible for Medicare & Medicaid or eligible for Medicaid alone. Medicaid benefits are administered and managed through BluePlus as chosen by the recipient.

Blue Advantage Nursing Facility Benefits

For Blue Advantage members, Blue Plus is responsible for 180 days of care in a nursing facility for members entering the facility after their enrollment in MSC+, including Medicaid-covered days only. Medicare covered days and services are billed separately to Medicare. A Care Coordinator works closely with individual Blue Advantage members to assist them in achieving optimal medical and social stability; assist with transitions between care settings; and work with providers to manage member needs, answer health plan questions and support our members with health care decisions.

Nursing Facility Responsibilities

• Support and implement the resident’s care plan.

• Alert Care Coordinator of resident’s:

▪ Significant change in health status

▪ Admissions or discharge from any inpatient setting

▪ Enrollment in hospice

▪ Hospitalization

▪ Discharge from Nursing Home setting

▪ Death

▪ Care conference date/time so the care coordinator can attend as needed.

• Work collaboratively with the Care Coordinator, physician, family, and health plan.

• Provide information for resident assessment.

• Assist the care coordinator for discharge planning to allow member to return to the community, if appropriate.

Billing Requirements

• The first 180 Medicaid covered days for Blue Advantage members must be billed to Blue Plus. Complete the Minimum Data Set (MDS) in order to determine the rate to be billed.

• Services eligible under Medicare Part A or Part B should be submitted directly to Medicare.

| Department |Questions |

|BluePlus Enrollment Line |Monday through Friday 8am-8pm |

|1-866-477-1584 or 651-662-3584 | |

| |Member specific issues |

|Clinical Guide Resource Team |Blue Plus and community resources: i.e. formulary questions, transportation |

|1-866-518-8447 |alternatives, etc. |

|Clinical.guide.resource.team@ |Assist with referrals, if applicable |

|Customer Service Center Help Line |Appeals |

|651-662-5545 or 1-888-740-6013 |Grievances |

| |Assistance to find a dentist provider |

|Delta Dental (member use) |Scheduling assistance |

|651-406-5907 or 1-800-774-9049 | |

|Delta Dental Care Coordinator (non-member use) | |

|651-994-5198 or 1-866-303-8138 | |

| |Benefits questions |

|Member Services |Interpreter services |

|MSC+ 651-662-5545 or 1-888-711-9862 |Assistance finding a provider |

|TTY: 711 |Questions/grievances |

| |Assistance to find a pharmacy |

|Prime Therapeutics |Available 24/7 to assist with prior authorizations |

|1-800-509-0545 | |

| |Provider assistance |

|Provider Service |Contract/provider access questions |

|651-662-5200 or 1-800-262-0820 |Claims questions |

|providers | |

| |BlueRide Common Carrier and Special Transportation for medical appointments |

|Transportation (BlueRide) |For general questions/concerns: Transportation.liaison@ |

|651-662-8648 or 1-866-340-8648 | |

| |Assistance with Prior Authorization requests |

|Utilization Management |Surgical/DME Prior Authorizations Fax: 651-662-2810 |

|651-662-5540 or 1-800-711-9868 |Standard Prior Authorization Fax: 651-662-4022 |

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