August 30, 2021
This communication is issued on behalf of the Division of Health Benefits (DHB):
- As a reminder, a beneficiary currently enrolled with a Standard Plan Health Plan may be later identified as part of a population excluded or exempted from Standard Plan enrollment.
- This will result in the beneficiary's disenrollment from the Standard Plan.
- While this list is not exhaustive, excluded and exempt populations include beneficiaries who
- The majority of disenrollments will occur on the first of each month.
- WellCare is currently enacting time-limited PA flexibilities that may result in no prior authorization transferring to Medicaid Direct.
- If a disenrolled beneficiary's service requires a PA in Medicaid Direct, the provider may be required to submit a PA request to Medicaid Direct.
- DHB has established additional retroactive review flexibilities to support providers through this transition.
- Providers should confirm the beneficiary's current and future enrollment segment to determine if the member is disenrolling to Medicaid Direct.
- For additional information please review the August 26, 2021 AHEC Provider Office Hours presentation available on the Medicaid Managed Care Website.
- DHB will also be publishing a Medicaid Bulletin with additional information.
- If you have questions about the status of a current PA, please contact our Provider Services Line at 866-799-5318.
