What is a PHP in Medicaid?
What is a PHP in Medicaid?
Prepaid Health Plan – As distinct from an MCO, a PHP is a non-comprehensive health plan that provides only certain services, such as dental services or non-emergency medical transportation.4 Most PHPs are paid on a risk, or capitated, basis.
What does LME MCO mean on my Medicaid card?
Managed Care Organizations
Local Management Entities – Managed Care Organizations (LME-MCOs) manage the care of beneficiaries who receive services for mental health, developmental disabilities or substance use disorders.
Does NC Medicaid cover transitional care management?
Long-Term Services and Supports (LTSS) Care Management With the transition to managed care, Medicaid can offer significant opportunities to improve care coordination, access to community-based services and outcomes for beneficiaries receiving these services.
Does NC Medicaid require referrals for specialists?
Click the one called “Medicaid” for Medicaid providers and the one called “Health Choice” for NC Health Choice providers. You need a referral from your Primary Care Provider (PCP) to see a specialist. Only your PCP can refer you to another doctor.
What is PHP medical insurance?
PHP (HMO SNP) is a Medicare Advantage health plan with prescription drug coverage for Medicare beneficiaries who have HIV and live in Los Angeles County, California. The plan is backed by AIDS Healthcare Foundation and its more than 30 years of HIV health care experience. For 2022, PHP is rated at 4 stars by Medicare.
What does PHP stand for in managed care?
PHP is an abbreviation for partial hospitalization program. This type of addiction treatment program is more intensive than IOP (intensive outpatient) but less so than full inpatient or residental rehab. Compared to IOP, partial hospitalization requires more visits and sessions per week.
What is a North Carolina LME?
LME stands for local management entity, the local government in North Carolina that is responsible for providing community-based, publicly-funded mental health, intellectual and developmental disabilities, and substance use disorder services.
What is the meaning of LME?
The London Metal Exchange (LME) is a commodities exchange that deals in metals futures and options. The LME is a non-ferrous exchange, meaning the exchange does not trade iron and steel. Instead, tradable contracts include aluminum, copper, gold, silver, cobalt, and zinc.
What is the difference between managed care Medicaid and traditional Medicaid?
Under the FFS model, the state pays providers directly for each covered service received by a Medicaid beneficiary. Under managed care, the state pays a fee to a managed care plan for each person enrolled in the plan.
What is the difference between Medicaid and NC Health Choice?
Unlike Medicaid, the NC Health Choice for Children program is limited by the amount of funds that are available. Therefore, it is open only to children on a first come, first served basis.
Where can I find NCNC Medicaid quick reference guides for providers?
NC Medicaid’s Managed Care Prepaid Health Plans (PHPs) created quick reference guides to include the most current and comprehensive information for providers. The PHP quick reference guides are available on the Provider Playbook Fact Sheet webpage under the Health Plan Resources section.
What id do you use for NC health insurance claims?
Health plans are required to allow providers to use the member’s North Carolina Medicaid or NC Health Choice Identification number to search in their health plan provider portals. Some health plans also allow providers to search by their patient’s health plan member ID as well. What member ID should be used when submitting claims?
What is the NCNC Medicaid provider Ombudsman?
NC Medicaid offers a Provider Ombudsman to assist providers by receiving and responding to inquiries, concerns and complaints regarding health plans. This service is intended to represent the interests of the provider community, provide supportive resources and assist with issues through resolution.
How do I change my Primary Care Provider (PCP)?
Beneficiaries must contact their assigned health plan to request a change of their PCP. Newly eligible NC Medicaid beneficiaries required to enroll in a health plan may choose a health plan and/or a PCP/AMH at the time of application.
