SecureBlue (MSHO) and Skilled Nursing Facility Service



|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 is participating in Minnesota Senior Health Options (MSHO) by offering SecureBlue. MSHO is a program with the Centers for Medicare & Medicaid Services (CMS) and 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. SecureBlue enrollment is voluntary.

SecureBlue Nursing Facility Benefits

For SecureBlue members, Blue Plus is responsible for 180 days of care in a nursing facility for members entering the facility after their enrollment in MSHO, including both Medicare-covered and Medicaid-covered days. In addition, SecureBlue benefits include all Medicare-covered Skilled Nursing Facility (SNF) benefits for members currently residing in nursing facilities. A Care Coordinator works closely with individual SecureBlue 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 may 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

• All Medicare-covered days for SecureBlue members must be billed to Blue Plus. Complete the Minimum Data Set (MDS) in order to determine the rate to be billed.

• Bill Medicare rates for Medicare-covered days, and Medical Assistance rates for Medicaid-covered days.

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

| Department |Questions |

| |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 |

|651-662-4357 |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 |

|MSHO 651-662-6013 or 1-888-740-6013 |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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