Care Improvement Plus Chronic Verification – Take Charge!

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Author: Chris Hagerstrom

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Care Improvement Plus offers one of the most widely available Chronic Special Needs Plans in Arkansas, Georgia, Illinois, Indiana, Iowa, Missouri, Nebraska, New Mexico, North Carolina, South Carolina, Texas and Wisconsin.  Along with a benefits package specifically designed to meet the needs of those dealing with diabetes, cardiovascular disorders and/or chronic heart failure, it is a great opportunity to continue to write Medicare Advantage business year-round!!

Different than traditional Medicare Advantage plans, the Chronic SNP plans require verification to confirm they have been diagnosed with a qualifying chronic condition.  As the writing agent, it is very important for you to be involved in the verification process to ensure the client’s application is approved and verified within CMS guidelines.

If a qualifying chronic condition cannot be verified within 60 days of the plan effective date, the member will be disenrolled.  A letter is sent to the member 30 days prior to their disenrollment effective date explaining that the plan has not been able to verify their qualifying chronic condition.  The letter provides the member with instructions to contact the plan if they believe they received the letter in error and are eligible based on a qualifying diagnosis they received.  The member is directed to contact CIP at 1-866-673-3590, Monday through Friday, from 8:00 am to 5:00 pm CST (TTY 1-800-713-1603).

Note: There are instances where a member receives the notification advising them of disenrollment when their verification has been received but is still being processed.  In these cases, CIP will call members and notify them that they have been verified and will not be disenrolled.

If a member contacts you about receiving a notice from CIP about disenrollment, you can help the member verify their qualifying chronic condition following these steps:

  1. Help the member contact their provider (the doctor that diagnosed them with the qualifying chronic condition) and confirm they have verified the qualifying condition with CIP.
  2. If the provider has not verified the qualifying condition with CIP, request that they fill out the Provider Verification form and submit it according to the instructions on the form.
  3. Once the provider has submitted the form, please allow five days for processing.  Once the member is verified they will receive a call from CIP.  If the member does not receive a call after five days, help them call CIP at 1-866-673-3590 to check on the verification.

Being a part of the chronic verification process at the time of enrollment is highly recommended as well.  Please help the client contact their provider to complete the verification form at the time of enrollment to prevent any disruptions in the future.

Chris Hagerstrom is the Product Manager at Jack Schroeder and Associates, LLC. Through years of experience he has become an expert with Medicare, Life Insurance, Annuities and Supplemental Health and how to successfully navigate the senior market.

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