MCO
Aetna and HPP: LTSS Credentialing Contacts
September 6, 2024On August 22, 2024, The Department of Human Services (DHS) announced applicants selected through a Request for Applications (RFA) process to administer Pennsylvania’s Community HealthChoices (CHC) program, the Medicaid managed care program that covers adults…
AmeriHealth Caritas/Keystone First Provides PHA Clarification on Manual Edit Signature Requirements!
July 29, 2024PHA has been seeking clarification from AmeriHealth Caritas/Keystone First (AC/KF) on what an acceptable participant signature is for purposes of documenting Manual Edits. In November 2023, AC/KF released guidance that…
UPMC Ends Current VBP – New VBP Coming in 2024
July 8, 2024Home Care providers may have heard or be in receipt of a letter indicating that UPMC is NOT renewing the July 1, 2023, Amendment to the Community HealthChoices Personal Assistance…
UPMC Updates Referral Broadcast Process
July 1, 2024Providers should expect to see a higher-than-normal volume of broadcast referrals over the coming days as UPMC works with HHAeXchange to change their processes so that referrals needing caregiver placements…
Lunch and Learn Recap: RFA for Managed Care Organizations in Community HealthChoices
February 19, 2024On Friday, PHA hosted a Lunch and Learn to discuss the 500+ page document. Mia Haney, CEO, identified important CHC Agreement terms and potential changes that can affect PAS providers. Members…
Fraud Waste and Abuse Reporting
February 19, 2024A CHC-MCO must inform all network providers of the Pennsylvania Medical Assistance (MA) Provider Self-Review Protocol, which allows providers to voluntarily disclose overpayments or improper payments of MA funds. This…
Centene Names Richard Fisher as New CEO
January 29, 2024The current President & CEO of Wellcare, Richard Fisher, is taking on a new role in Centene’s operations team to bring more Medicare expertise to Centene. He’ll be working with…
AmeriHealth Caritas Names New CEO, Former Aetna Executive
January 22, 2024Kelly A. Munson has been selected to lead AmeriHealth Caritas as President and Chief Executive Officer starting February 1, 2024. Munson will succeed Paul A. Tufano, who stepped down in…
UPMC Updates Policy on Use of Consumer Cell Phones
March 13, 2023As reported in last week’s Connections, the Department of Human Services (DHS) addressed the use of consumer cell phones for EVV at the March MLTSS meeting, clarifying that DHS does not have…
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