Hurricane Michael Update for Staywell providers in Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Leon, Liberty, Taylor, Wakulla, and Washington counties
Effective October 19th, the disaster grace period (Grace Period) is extended through November 9th, 2018 for providers serving members in the following 12 counties identified in the October 19, 2018 Florida Medicaid Health Care Alert : Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Leon, Liberty, Taylor, Wakulla, and Washington.
All providers serving members outside of these 12 designated counties should resume normal authorization and claims submission operations.
During the Grace Period Staywell will provide coverage for all covered services provided to our eligible members in good faith in these FEMA-designated counties:
- Without prior authorization (excluding pharmacy services)
- Without regard to whether such services are provided by a participating or non-participating provider
- Without regard to service limitations
- Whether or not the enrollee has temporarily relocated to a different region or state
Staywell will pay for all medically necessary services during the Grace Period. Providers must maintain as much documentation as possible to help properly and timely adjudicate claims. We may request documentation supporting medical necessity prior to paying any claims.
If you feel any of your claims have been denied due to the circumstances directly related to the storm, we have implemented a Hurricane Michael Temporary Exception Process that allows you to seek an appeal (details for exception process located in 10/17/18 update).
Beginning 11/10/18, Staywell will return to normal business operations as it relates to the coverage and claims for members, except as described below:
- Staywell will continue to cover services furnished after the Grace Period without prior authorization and without regard to service limitations or whether such services are provided by a current Medicaid enrolled or participating provider in those instances where the provider and/or recipient could not comply with our health plan requirements because of ongoing storm-related impacts. Providers must have rendered services in good faith to maintain the member’s health and safety. Examples of such instances include:
- The provider still does not have access to the Internet or phone services as a result of continued outages, therefore could not request prior authorization timely;
- The member continues to be displaced and must receive services in a different region of the state or out-of-state; or
- The member’s assigned primary care physician or specialist’s office remains closed due to the storm and urgent care is rendered at another provider’s location without prior authorization.
Hurricane Michael update for Staywell providers outside of the following 16 counties in Regions 2 & 3, as identified in the 10/17 Statewide ESF-8 Executive Order: Bay, Calhoun, Franklin, Gadsden, Gulf, Hamilton, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, Wakulla, and Washington, Suwannee
While Staywell will not require prior authorization for medically necessary life sustaining services rendered during the Grace Period, services will be reviewed for medical necessity. For services that would have otherwise required prior authorization absent the Grace Period, providers must submit documentation supporting the service’ medical necessity after rendering services and prior to submitting a claim for reimbursement. Such documentation may be sent to Staywell’s utilization management department.
If you feel any of your claims have been denied due to the circumstances directly related to the storm, we have implemented a Hurricane Michael Temporary Exception Process that allows you to seek an appeal.
Submit a Hurricane Michael Appeal Form to our Appeals Department and we will review it expeditiously. Please make sure to include supporting documentation. By submitting an appeal through this process, you are attesting that you have been directly impacted by the storm in a manner that prevented you from following our normal health plan requirements, and that submissions will be actively reviewed for potential Fraud, Waste, Abuse and other false-claims violations. Each appeal submitted will be reviewed on a case-by-case basis, and submission of an appeal is not a guarantee of an overturn or payment.
Please send medical appeals with supporting documentation to:
Staywell Health Plan of Florida
Attn: Appeals Department - MICHAEL RELATED
P.O. Box 31368 Tampa, FL 33631-3368
For faster service, we strongly recommend using our fax process:
Fax: 1-866-201-0657 Attn: Hurricane MICHAEL Appeal
Email: Appeals.Grievances@wellcare.com (with “Hurricane MICHAEL Appeal” in the subject line)
For Staywell Providers: Provision of and Payment for Covered Services During the Disaster Grace Period for Hurricane Michael
From October 7, 2018 through 11:59 p.m. on October 21, 2018 (the “Grace Period”) Staywell will provide coverage for critical medically necessary life sustaining services, (including but not limited to: durable medical equipment and supplies, home health services, hospital services, nursing facility services, chemotherapy, dialysis services, etc.), provided to our eligible members in the 35 Florida counties included in the Governor’s October 8th Emergency Order:
- Without prior authorization;
- Without regard to whether such services are provided by a participating or non-participating provider; and
- Without regard to service limitations.
Staywell will pay for all medically necessary life sustaining services during the Grace Period. We may request documentation supporting medical necessity prior to paying any claims.
Additionally, during the Grace Period, Staywell will reimburse non-network providers at the rates established in the applicable Medicaid fee schedules incorporated by reference in Rule 59G-4.002, F.A.C. and the provider reimbursement rates/reimbursement methodologies published on the Florida Agency for Health Care Administrations’s web page for covered services rendered to Staywell members during the Grace Period, unless other rates are mutually agreed upon by the provider and Staywell.
Providers that are not already enrolled with Florida Agency For Healthcare Administration that render covered services to Staywell members during the Grace Period must complete the Agency’s provisional (temporary) enrollment process to obtain a provider identification number in order to be reimbursed for covered services rendered to enrollees who evacuated to other states. The process for provisional provider enrollment is located at http://www.mymedicaid-florida.com.
Staywell reserves the right to update this information and related processes based on continued developments related to Hurricane Michael and / or direction from the Florida Agency for Health Care Administration.
If you have any questions about our Hurricane Michael temporary exception process, we have a team of associates who can assist you. Please call our Provider Customer Service at 1-866-334-7927.