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Wellpoint | D-SNP Eligibility Check is Back in mProducer

Wellpoint | D-SNP Eligibility Check is Back in mProducer

Wellpoint | D-SNP Eligibility Check is Back in mProducer
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Once again, you can check D-SNP eligibility in mProducer for New Jersey clients.

Dual Special Needs Plan (D-SNP) eligibility lookup is back.

To find out if your New Jersey clients are eligible for a D-SNP plan, you can check their Medicaid eligibility level in mProducer.

  1. Sign in to mProducer.
  2. Select Eligibility Check – Medicare and Medicaid button.
  3. Click on the D-SNP Eligibility Check tab.
  4. Enter the beneficiary’s information and select Check Eligibility.

Save time by using convenient 24/7 online tools to check Medicaid eligibility.

For more information, contact a Pinnacle Financial Services representative today 1 (800) 772-6881 x7731 | sales@pfsinsurance.com

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881 support@pfsinsurance.com

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Cigna | Important updates

Cigna | Important updates

Cigna | Important updates
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Updated compliance requirements and other reminders below.

 

Revised Scope of Appointment (SOA) paper form

We’ve revised our SOA paper form. This revised form includes an area where you can document exceptions to the 48-hour waiting period. Log in to Producers’ University to download/view the form.

Please begin to use the revised form as soon as possible, but no later than July 1, 2024. The use of older versions of the Cigna Healthcare SOA paper form should be discontinued immediately.

Background: The Centers for Medicare & Medicaid Services (CMS) requires agents to document the scope of a personal marketing appointment at least 48 hours before the appointment to ensure an understanding of what will be discussed between the agent and the Medicare beneficiary or their authorized representative.

The 48-hour waiting period is waived for:

(1) SOAs completed during the last four days of a valid election period and

(2) unscheduled in-person visits (walk-ins) initiated by the beneficiary.

The SOA form must be completed in its entirety and retained for 10 years. It must also be provided to Cigna Healthcare upon request.

Prescription Drug Plan (PDP) application tips

In order to ensure your PDP customer applications are processed correctly and in a timely fashion, please ensure you are following the tips below.

  • Remember to sign and date your applications at the bottom. Broker sign dates are required for PDP applications. Applications with missing dates cannot be processed correctly and will result in delays. 
  • Please do not fax your PDP applications to our Medicare Advantage fax number. The correct PDP fax number is 1.800.735.1469.  
  • We encourage you to contact the automated phone number, 1.800.222.6700, 24-48 hours after fax submission to confirm receipt of the faxed application.
  • All customer applications must be submitted through the broker portal (CignaforBrokers.com), not the consumer portal. You will not receive commissions if you submit an application via the consumer portal.
  •  If you are having issues completing online enrollments for your customers in the broker portal, please contact our Cigna Agent Resource Line (CARL) at 866.442.7516. 

Common PDP application mistakes

In addition to following the tips listed above, please avoid the common errors found on PDP applications below.

  • Complete all required data fields on the application unless marked as optional.
  • When submitting an application using a SEP, please ensure that the proper election type is being utilized. Pay close attention to SEPs that require an end date. These dates and election types need to be accurate, or it could cause a delay in processing and/or could possibly cause the enrollment application to be denied.
  • Ensure that the plan, effective dates, and Member Beneficiary Identifier (MBI) are listed correctly on the application.

Sign up for direct deposit

If you haven’t already, we encourage you to sign up for Electronic Funds Transfer (EFT) payments, or direct deposit, as soon as possible. Signing up is easy! Just follow the steps below:

After signing up, please allow up to 30 days for EFT to become effective. Once it’s effective, you’ll be glad you enrolled!

For more information, contact a Pinnacle Financial Services representative today 1 (800) 772-6881 x7731 | sales@pfsinsurance.com

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881 support@pfsinsurance.com

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Aetna | Guidelines for the disaster/emergency SEPAetna

Aetna | Guidelines for the disaster/emergency SEPAetna

Aetna | Guidelines for the disaster/emergency SEPAetna
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Review requirements for the disaster/
emergency Special Enrollment Period (SEP)

Overview of the SEP for Government Entity-Declared Disaster or Other Emergency

A special enrollment period (SEP) exists for individuals affected by a disaster or other emergency declared by a federal, state or local government entity who were unable to, and did not make an election during another valid election period. 

This SEP allows for enrollment and disenrollment elections. For more information, go to CY 2024 MA Enrollment and Disenrollment Guidance [42 CFR 422.62(b)(18)].

When can this SEP be used? 

A disaster/emergency SEP is only applicable to those beneficiaries who were prevented from submitting an enrollment or disenrollment request during a given election period due to a declared disaster or emergency.
CMS strictly limits when the disaster/emergency SEP may be used.  

Individuals are eligible for this SEP if they: 

  • Reside, or resided at the start of the SEP eligibility period, in an area for which a federal, state or local government entity has declared a disaster or other emergency, or they do not reside in an affected area but rely on help making health care decisions from one or more individuals who reside in an affected area; and
  • Were eligible for another election period at the time of the SEP eligibility period; and
  • Did not make an election during that other valid election period due to the disaster or other emergency.

Enrollment instructions

IMPORTANT: Remember, you cannot use this SEP opportunity to proactively market to beneficiaries. However, you can assist any clients who contact you about this SEP.

  • If an individual wants to enroll and believes they may qualify for this SEP, you need to ask the beneficiary if they can show proof that they lived/live in an impacted area at the start of the incident period. If they do not have proof, ask them to verbally attest. 
  • When helping eligible clients enroll, please select the weather-related or major disaster option in the Reasons for Special Enrollment Period Eligibility section of the application.  

Questions? We’re here to help

If you have any questions, please contact your local Aetna Medicare Broker Manager for assistance. Login to Producer World to find contact information for Broker Managers in your state.

For more information, contact a Pinnacle Financial Services representative today 1 (800) 772-6881 x7731 | sales@pfsinsurance.com

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881 support@pfsinsurance.com

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Contact a Pinnacle Financial Service representative today for assistance.

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Wellcare | Enhanced PCP Change Service, DST-SEP Updates, 24/7 Nurse Advice & More

Wellcare | Enhanced PCP Change Service, DST-SEP Updates, 24/7 Nurse Advice & More

Wellcare | Enhanced PCP Change Service, DST-SEP Updates, 24/7 Nurse Advice & More
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Important Updates and Reminders for Wellcare Agents

Welcome to the latest edition of Wellcare Insider, your source for important updates and reminders to help you provide excellent service and grow your business all year long.

Today’s edition has information on the following topics:

  • New! PCP Changes – Enhanced service options for making PCP changes
  • DST-SEP Updates – View our updated resource for pending & current SEPs
  • 24/7 Nurse Advice – Connect your members to Wellcare’s care advice line
  • Broker Resources – Bookmark these links for ongoing sales success

Set Your Members Up For Success!

New! PCP Changes Via Broker Support or Centene Workbench

We’ve recently expanded our service capabilities to accept PCP changes through Centene Workbench or by calling Broker Support, 866-822-1339.

Important Information

  • For the PCP change to be processed, the requesting broker must reflect as the Broker of Record for the member’s active policy.
  • Requests to retroactively change the PCP effective date should be directed to Member Services using the number on the back of your client’s member ID card.
  • Approved PCP changes will be effective on the 1st of the following month from the date the ticket was resolved in Centene Workbench. The new provider must be in the member’s network and accepting new patients.

Please review the Member PCP Change Request resource for details on required information for initiating a request and instructions on submitting a PCP change through Centene Workbench.

Access Centene Workbench through your Single Sign-On portal.

DST-SEP Updates

As a reminder, an emergency or disaster Special Enrollment Period (DST-SEP) may be granted to individuals that reside in an affected service area where a Federal, State or Local Government Entity has declared a State of Emergency impacting individuals in a specific geographical area. The declaration allows for a one-time SEP in the event an individual was unable to make an election during another qualifying election period.

Stay up-to-date with all the developments pertaining to DST-SEP declarations in your service areas. Our updated Special Enrollment Period (SEP) – FEMA / State Declarations resource provides links to all active state and Federal declarations, details on DST-SEPs pending compliance review and a listing of declarations expired within the last six months.

DST-SEP Guidelines

Agents should keep in mind the DST-SEP should not be used as a marketing tool to promote Medicare Advantage (MA) or Prescription Drug Plan (PDP) sales. Agents should never actively market this special enrollment period. The opportunity for a SEP is ONLY available to beneficiaries who:

  • Reside, or resided at the start of the SEP eligibility period, in an area for which a federal, state or local government entity has declared a disaster or other emergency, or they do not reside in an affected area but rely on help making healthcare decisions from one or more individuals who reside in an affected area; and
  • Were eligible for another election period at the time of the SEP eligibility period, and;
  • Did not make an election during that other valid election period due to the disaster or other emergency.

Should you have any questions regarding the DST-SEP application process, please reach out to your local Sales Leader. 

24/7 Nurse Advice Line

We understand that helping your members make informed health-care choices is an important part of being their trusted advisor. When members have questions about when, where or if they should seek care for a particular concern, connecting them with Wellcare’s 24/7 Nurse Advice Line is a safe and convenient resource for obtaining needed healthcare guidance.

Members may connect with nurse practitioners to discuss symptoms and get advice on what to do next, including:

  • Answers to questions about their health
  • Determining whether treatment from a doctor should be sought immediately

Members may call the Nurse Advice Line, 800-581-9952 (TTY: 711) anytime of the day or night. The number is also available on the back of the Member IDcard.

For more information, contact a Pinnacle Financial Services representative today 1 (800) 772-6881 x7731 | sales@pfsinsurance.com

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881 support@pfsinsurance.com

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Contact a Pinnacle Financial Service representative today for assistance.

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Molina | Malina Matters

Molina | Malina Matters

Molina | Malina Matters
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Extra! Get the News Here!

2024 Certification Blackout: In preparation for our 2025 selling year, Molina Medicare is closing contracting on Saturday, June 1, 2024 until the opening of the 2025 contracting season, currently targeted for Monday, July 8, 2024.

During this closure we will not be accepting new requests for agent or agency contracts, additional state appointments, releases, or any other contracting requests. 

Our Broker Services Unit is available to answer any questions at (866) 440-9788.

Declared disasters/states of emergency: Currently the states of California, Massachusetts, Michigan, Ohio, Texas, and Washington have declared disasters/states of emergency in certain areas of those states. Contact your Broker Channel Manager for more information. We will continue to apprise you of declared disasters/states of emergency in the states where Molina has Medicare plans.

Medicare Producer Guide: The 2024 Molina Medicare Producer Guide has just been updated for Q2. You can check it out here on the Molina Agent Center.

Molina Medicare Videos: Check out the newest Molina video for members on how to obtain and use Durable Medical Equipment (DME). You can find it and other helpful member videos here.

For more information, contact a Pinnacle Financial Services representative today 1 (800) 772-6881 x7731 | sales@pfsinsurance.com

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881 support@pfsinsurance.com

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Contact a Pinnacle Financial Service representative today for assistance.

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