Medicaid Hotline Administration
Outreach and education to Medicaid consumers over the phone has been a mainstay
of AHS’ consumer relations efforts since 1986 and is utilized in the vast majority
of our current contracts. Using advanced telephone systems and techniques, our telephone
workers handle outreach, education, application assistance, and enrollment for a
variety of health programs (enrollment broker, PCCM, EPSDT, SCHIP, and Medicaid
consumer hotline efforts), comprehensive health assessments, care coordination,
linkages with medical homes, complaints resolution, and even appointment scheduling
and referral to needed services (such as disease management, transportation, dental
care, child care, etc.).
Blending telecommunications and an intensive initial and ongoing training effort
in effective phone usage, outreach, education and enrollment, a variety of health
programs are conducted through our Helplines (so called because they function as
virtual I&Rs, routing callers to needed transmedical services beyond our contract
obligations).
Ohio Medicaid Consumer Hotline Project
In 2002, AHS was awarded a contract to by the Ohio Department of Job and Family
Services (ODJFS) to administer the State’s Medicaid Consumer Hotline. Making full
use of the corporate skills acquired during decades of Call Center management, in
this contract we provide, in essence, one-call entry-point access to a host of Medicaid
and Medicaid-related services (the State of Ohio offers approximately 50 different
Medicaid-related programs to its residents – ranging from pre-natal to long-term
institutional care). The Medicaid Consumer Hotline has become recognized as the
predominant “information clearinghouse” for callers regarding their Medicaid-related
questions.
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Customer Service Representatives consistently respond to the following types of
inquiries:
- ABD Medicaid
- Billing
- Breast and Cervical Cancer Project
- Children’s Buy-In
- Complaints/fair hearings
- Disability Assistance
- General Benefits
- Healthy Start
- HIPAA
- Home Health Care
- Long Term Care
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- Medicaid Buy-In for Workers with Disabilities
- Medicare
- Medicare Part D
- Medicare Premium Assistance
- Premium Collection
- Prescription Coverage
- Prior Authorization
- Reimbursement
- Requests for applications
- Third Party Liability
- Tort
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Premium Collection
In addition, as part of this contract, AHS worked with the State to develop a robust
premium collection system for the Medicaid Buy-In for Workers with Disabilities
(MBIWD) where enrollees who meet certain criteria are eligible to receive or maintain
coverage by paying a monthly premium. Through our operation of the Premium Collection
Project, AHS established all procedures and protocols necessary to ensure the timely
and accurate exchange of data between all involved systems. In cooperation with
the State, AHS implemented the monthly invoice/remittance slip mailing, daily file
processing, monthly reconciliation, and day-to-day lockbox operations. We developed
a fully secure system to track all facets of premium collection activities.
Most recently, this contract was combined with our Ohio Enrollment Broker contract.
Additional details on this contract are available at www.ohiomh.com.
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