GoHealth has identified high denial rates associated with DSNP policies in Indiana due to age restrictions. Please reference the below link to better understand how to avoid age restriction denials.
How do I dodge denials on Indiana DSNPs?
Please watch this video for additional information.
In Indiana, there are nine 2024 HMO DSNPs:
- UHC Dual Complete IN-S001 H0271-063. For members 60+.
- UHC Dual Complete IN-S002 H0271-005. For members under 60.
- UHC Dual Complete IN-D001 H0271-054. Does not have an age restriction.
- Humana Gold Plus Integrated SNPDE H5619-054. For members 60+.
- Humana Gold Plus SNPDE H5619-158. For members under 60.
- Humana Gold Plus H5619-156. Does not have an age restriction.
- Anthem Full Dual Advantage H3447-048. For members 60+.
- Anthem Full Dual Advantage H3447-020. For members under 60.
- Anthem Dual Advantage H3447-046. Does not have an age restriction.
The marketplace and Humana and UnitedHealth carrier portals do not consider the age criteria when revealing locked and unlocked plans. Just because a plan is unlocked, it does not mean that eligibility requirement is met.
Use these steps before selecting one of the nine 2024 Indiana HMO DNPs to avoid denials:
• To avoid Anthem and Humana denials, review the Summary of Benefits to determine the age criteria. If the member does not meet the minimum age, the application will result in a denial. Then, review unlocked plans before enrollment to verify Medicare, Medicaid, and age eligibility.
• To avoid UnitedHealthcare denials, review Lead Guidance to determine age criteria. If the member does not meet the minimum age, the application will result in a denial. Then, review unlocked plans before enrollment to verify Medicare, Medicaid, and age eligibility.
Note: The member must be 60 years of age by January 1, 2024 to be eligible for any of the full duals 60+ plans. The member may select the Age 60+ plan to begin as soon as the first day of their birth month.
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.
