GoHealth has identified high denial rates associated with Fully Integrated Dual Eligible plans in Arizona, Florida, Virgina, and Tennessee. Most commonly these plans are denied due to lack of verification. Please use the below links for helpful information to avoid such denials.
How do I dodge denials on Arizona FIDE?
Please watch this video for additional information.
The state of Arizona offers Fully Integrated Dual Eligible plans to members who receive institutionalized levels of care. These plans are for the most at-risk populations. A major cause of denials is due to Agents not thoroughly verifying information. Use these steps to avoid denials:
Step 1: Check Jarvis and look up the member in the portal to determine what the member is and is not eligible for.
Step 2: If no is listed next to a plan, do not try to enroll a member into the plan. This will result in an denial.
Checking Jarvis will ensure you have access to current information and can make effective decisions when assisting members.
Full Arizona article here.
How do I dodge denials on Florida FIDE?
Please watch this video for additional information.
The state of Florida offers Fully Integrated Dual Eligible plans to members who receive institutionalized levels of care. These plans are for the most at-risk populations. A major cause of denials is due to Agents not thoroughly verifying information. Use these steps to avoid denials:
Step 1: Check Jarvis and look up the member in the portal to determine what the member is and is not eligible for.
Step 2: If no is listed next to a plan, do not try to enroll a member into the plan. This will result in an denial.
Checking Jarvis will ensure you have access to current information and can make effective decisions when assisting members.
Full Florida article here.
How do I dodge denials on Virginia FIDE?
Please watch this video for additional information.
The state of Virginia offers Fully Integrated Dual Eligible plans to members who receive institutionalized levels of care. These plans are for the most at-risk populations. A major cause of denials is due to Agents not thoroughly verifying information. Use these steps to avoid denials:
Step 1: Check Jarvis and look up the member in the portal to determine what the member is and is not eligible for.
Step 2: If no is listed next to a plan, do not try to enroll a member into the plan. This will result in an denial.
Checking Jarvis will ensure you have access to current information and can make effective decisions when assisting members.
Full Virginia article here.
How do I dodge denials on Tennessee FIDE?
Please watch this video for additional information.
The state of Tennessee offers Fully Integrated Dual Eligible plans to members who receive institutionalized levels of care. These plans are for the most at-risk populations. A major cause of denials is due to Agents not thoroughly verifying information. Use these steps to avoid denials:
Step 1: Check Jarvis and look up the member in the portal to determine what the member is and is not eligible for.
Step 2: If no is listed next to a plan, do not try to enroll a member into the plan. This will result in an denial.
Checking Jarvis will ensure you have access to current information and can make effective decisions when assisting members.
Full Tennessee 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.
