BENEFITS
PHARMACY
CLAIMS
QUALITY
BENEFITS
Learn About CoOportunity Health's 2015 Products
Prepare for the new year by registering for a CoOportunity Health webinar.
Community Assisters (90 minutes) - Final 3 Sessions
If you're helping members of your community pick coverage that's right for them, it's important to understand the options available. Three classes remain:
To locate educational tools you can use when working with Nebraska and Iowa consumers, visit coOportunityhealth.com/ConsumerAssister.
Providers (45 - 60 minutes) - December and January Sessions
If you schedule patients or need to understand benefits and coverage requirements, this session will provide an overview. To register, select a date below:
IMCP Coverage Transitions
November 30, 2014, is the last day that CoOportunity Health covered members who have the Iowa Marketplace Choice Plan (IMCP)-one component of Iowa's Medicaid Expansion program.
We have and will continue to work collaboratively with the Iowa Department of Human Services (DHS) and Iowa Medicaid Enterprise (IME) to ensure a seamless transition of these individuals to the Iowa Wellness Plan effective December 1, 2014. Please ask these patients for new insurance information beginning December 1, or call Iowa Medicaid Enterprise (IME) member eligibility verification system (ELVS) at 1.800.338.7752 or 1.515.323.9639 for information.
This change in no way affects our presence as a health insurance carrier in Iowa and Nebraska. We currently serve more than 85,000 individual and group members. During the individual Open Enrollment Period (November 15, 2014, through February 15, 2015), we'll be a coverage option for those looking to renew, change, or purchase insurance for 2015.
For more information about the IMCP transition or our 2015 products, check these documents:
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Patients' Benefits and Coverage May Change in 2015
You can verify coverage and benefits 24/7 - without being put on hold.
During the current Open Enrollment Period (November 15 - February 15), you may have several patients who change coverage. Even those who keep the same coverage for 2015 could have some different cost shares in 2015.
To check benefits and eligibility for our members, log on to our secure Provider website at coOportunityhealth.com/Provider and select the Eligibility Inquiry tool. You'll find:
- Identification numbers (enter the patient's name and birthday)
- Product names
- Cost share amounts
Remember, each of our members - regardless of age - has a unique identification number, so it's important to ask for the card that carries the patient name. Numbers are not necessarily sequential within a family.
Need to register for access? Register now.
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Reminder: 2014 and 2015 Drug List and Provider Directories Available
Our Provider Directories and Drug List are changing effective January 1, 2015. Please use 2014 versions for this year's services, 2015 versions when planning 2015 services.
Please note:
- The 2015 network status for some providers is changing for some products, so it's important to:
- Check the 2015 provider directory for each product when patients ask about your network status for 2015.
- Check the status of other providers for each product before referring our members for services beginning January 1.
- More drugs will require prior authorization in 2015. Help members avoid delays or problems at the pharmacy by checking coverage requirements of drugs you commonly prescribe.
- A number of high-cost drugs will move to tier 4 in 2015. Instead of paying a $150 copayment, members will pay a coinsurance for these drugs. Help members pay less by prescribing less costly alternatives when possible.
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PHARMACY
Hepatitis C Medications Added to Trial Drug Program
Hepatitis C medications have been added to our trial drug program effective December 1, 2014. All fills and refills of Harvoni, Sovaldi, and Olysio now have a maximum quantity limit of 14 days. This program may apply to hepatitis C medications that will be marketed in the future.
These drugs continue to require a prior authorization. To request a prior authorization for Harvoni, Sovaldi, or Olysio, submit a completed Sovaldi Prior Authorization form. This form will soon be replaced by a Hepatitis C Drug Regimen Initial Request form, which will be accessible from our Forms page.
All three drugs are specialty drugs and must be purchased through CVS Caremark Specialty Pharmacy.
Remember to stay current on changes to our drug requirements by checking our Drug List periodically.
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CLAIMS
File 2014 Services by March 1, 2015
We encourage you to file claims for 2014 services no later than March 1, 2015. To be considered timely, claims must be filed within 365 days of the date of service.
Iowa Marketplace Choice Plan (IMCP) - Professional and outpatient claims will process based on coverage in place on the date of service. Facility inpatient claims will process based on the admission date. Members' last day of coverage with CoOportunity Health was November 30, 2014.
QUALITY
Access Quality Improvement Program Description Online
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Tools for New Providers and Staff Members
Access these tools to learn more about us at coOportunityhealth.com/Provider.
For access to our secure Provider website tools, contact your organization's site delegate or register today.
