DentaQuest Provider TrainingAmerigroup PlansEffective 9/1/2013

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Agenda

Amerigroup Plans Effective 9/1/13 STAR+PLUS Waiver Medicare Advantage

Amerivantage Classic Amerivantage Specialty

STAR+PLUS Program STAR+PLUS was created specifically to serve the elderly

and persons with disabilities, typically known as the aged, blind and disabled population (ABD) Goal-to achieve a seamless continuum of care by integrating

acute and comprehensive care Long-Term Services and Support (LTSS) in a managed care

environment Promotes delivery of home and community-based services

The health plans are responsible for coordinating acute and LTSS through the use of a Service Coordinator.

Service Coordination is the cornerstone of the STAR+PLUS model.

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STAR+PLUS Members

Mandatory Population Supplemental Security Income (SSI) eligible adult clients

(ages 21 and over) Medical Assistance Only (MAO) Clients who qualify for 1915

(c) Nursing Facility Waiver (limited number) Dual Eligibles - those individuals who are covered by

Medicare and receive dental benefits or dental value added services

Voluntary Population SSI Children under the age of 21 Children (under the age of 21) who are Medicaid eligible

because they are in a Social Security Exclusion Program

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STAR+PLUS Waiver Program

STAR+PLUS Eligible population: Medicaid Waiver and Dual Waiver Adult Members

Covered Waiver Dental Services Treatment of injuries to the teeth or supporting structures Dentures and the cost of fitting and preparation Preventative procedures that are required to prevent the

imminent loss of teeth

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Additional Information STAR+PLUS Waiver Providers should always check the member’s

eligibility prior to rendering services. Covered dental services that indicate “Yes” in the

“Review Required” column of the ORM require documentation of medical necessity and will be subject to clinical review.

These procedures can be rendered before determination of medical necessity but require submission of proper documentation (as indicated in the “Documentation Required” column) with the claim form.

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STAR+PLUS Service Areas

Amerigroup

Bexar

El Paso

Harris

Jefferson

Lubbock

Tarrant

Travis

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Recipients must reside in a covered service area of the health plan they are enrolled in.

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Amerigroup Plans – STAR+PLUS Waiver

STAR+PLUS Eligible population: Medicaid Waiver and Dual Eligible Waiver Adult Members

Covered Waiver Dental Services Treatment of injuries to the teeth or supporting structures Dentures and the cost of fitting and preparation Preventative procedures that are required to prevent the

imminent loss of teeth

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Amerigroup STAR+PLUS ID Card

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Amerigroup Plans – Medicare Advantage Amerigroup contracts with the Centers for Medicare

and Medicaid Services (CMS).

Amerivantage Classic Health Maintenance Organization (HMO) plan designed

specifically for people who have Medicare.

Amerivantage Specialty Health Maintenance Organization Special Needs Plan

(HMO SNP) specifically designed for people who have Medicare and Medicaid (dual eligible).

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Covered Regions:El Paso Region: El Paso County, Hudspeth County

Fort Worth Region: Denton County, Tarrant County

Houston Region: Brazoria County, Fort Bend County, Harris County, Montgomery County

Lubbock Region: Lubbock County

San Antonio Region: Bexar County, Medina County

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Amerivantage Classic (Medicare) Dental Benefits Eligible population:

Members who live in a covered service area Members that have both Medicare Part A and Medicare Part B Members that do not have End-Stage Renal Disease (ESRD)

Covered Services D0120 Periodic Oral Exam (once every six months) D0272 Bitewing two films (once every 12 months) D0274 Bitewings four films (once every 12 months) D1110 Prophylaxis and hygiene instruction-adult (once every six months)

**In addition, Classic Plan members also receive a $250 / quarter comprehensive benefit.**

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Amerivantage Specialty (Medicare) Dental Benefits Eligible population:

Members who live in a covered service area Members that have both Medicare Part A and Medicare Part B Members that do not have End-Stage Renal Disease (ESRD) Members that meet special eligibility requirements (dual eligible)

Covered Services D0120 Periodic Oral Exam (once every six months) D0272 Bitewing two films (once every 12 months) D0274 Bitewings four films (once every 12 months) D1110 Prophylaxis and hygiene instruction-adult (once every six months)

**In addition, Specialty Plan members also receive a $425 / quarter comprehensive benefit.**

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Amerigroup Medicare Advantage ID Cards

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Questions