GoHealth has identified high denial rates associated with Managed Care Organization plans in Virgina. Please reference the below link to better understand how to avoid MCO related denials.
How do I dodge denials on Virginia MCO?
Please watch this video for additional information.
Medicaid programs are administered by carriers who bid on contracts from the state. When a carrier is awarded a contract, they become a state’s Managed Care Organization (MCO). States can have several carriers acting as an MCO, to which Medicaid beneficiaries are assigned.
In Virginia, the MCO may have a DSNP plan to which only their assigned beneficiaries may join. In the case of Aetna, this plan is Aetna Better Health of Virginia plan H16 10-001. Only those assigned Aetna as an MCO can join this plan. If Aetna is not their MCO, they may join H16 10-002. If a member already has this plan, they cannot have another Aetna plan because Aetna is not their MCO.
United Healthcare is a similar carrier. Their MCO contract is United Healthcare Dual Complete One H74 64-005. If a member has this plan, they cannot be assigned to United Healthcare Dual Complete H74 94-001 because this plan is reserved for members that does not have United HealthCare as their MCO. For further information, please review the documents below.
Full article here.
This is neither legal nor accounting advice. If you have questions, please consult a lawyer or accountant. The information included in this post was provided by the entity referenced herein.
