- Category: Carrier Updates
- Published: Thursday, 02 November 2017
- Written by Rebekah Williams
A message from the University of Maryland Health Advantage Sales and Marketing Department:
Thank you for all the hard work you have put into AEP thus far. We have made great strides towards accomplishing our goals and need to continue the momentum to reach and surpass our expectations and goals.
As we are all aware, one of University of Maryland Health Advantage’s (UMHA) competitors will not be offering their Medicare Advantage plans for the Contract Year of 2018 in Anne Arundel, Baltimore, Calvert, Charles, and St. Mary’s counties. With that said, UMHA is an option as a replacement plan for your clients that reside in those counties that fall in the UMHA service area (Anne Arundel, Baltimore, and Charles counties).
UMHA is conscientious of the member experience and wants to ensure that it focuses on minimizing beneficiary disruption and provider access for any beneficiary that wishes to select UMHA as their replacement plan.
We ask that you continue your standard process of reviewing all providers and facilities that a beneficiary currently uses up against UMHA’s up-to-date searchable provider directory to determine if they participate with UMHA. If the providers and/or facilities are not participating with UMHA, you must fully disclose that to the beneficiary and make sure they understand that they will have to select new providers and/or facilities that are within UMHA’s network in order to receive all the benefits and services offered under UMHA’s Medicare Advantage Plans by providing full disclosure and assisting the beneficiary in the selection of new providers and/or facilities, you can help reduce the risk of UMHA receiving “marketing misrepresentation” grievances and CTMs on this matter.
Remember, any new enrollee that is currently receiving care from a non-participating provider may be granted continuation of care. Continuation of care would allow a new enrollee to complete an existing treatment plan. The existing treatment plan must have a defined and reasonable completion date. The beneficiary will be expected to transition to a participating provider. If the existing treatment plan is expected to involve extensive treatment beyond 90 days of the beneficiary’s effective date, the treating provider will be expected to collaborate with the health plan on a reasonable and safe care transition to a participating provider. This care must be approved by the health plan and the terms and conditions must be agreed upon by both UMHA and the nonparticipating provider.
As a reminder, you have access to our Provider Nomination Form, located on the agent portal (https://www.ummedicareadvantage.org/For-Agents). If you feel there is a doctor that should become contracted with UMHA, fill out the form and email it to [email protected]
If you have any questions, please contact Joe Aggazio (443-652-6049) or Wanda Turner (410-595-2633).
University of Maryland Health Advantage
Sales and Marketing Department