Empire BlueCross BlueShield (Empire) is offering Special Needs Plans (SNPs) to people eligible for both Medicare and Medicaid benefits or who are qualified Medicare Advantage beneficiaries. Some SNPs provide enhanced benefits to people eligible for both Medicare and Medicaid, which include supplemental benefits such as hearing, dental, vision, and transportation to medical appointments. Some SNP plans include a card or catalog for purchasing over-the-counter items, but SNPs do not charge premiums.

 

SNP members benefit from a model of care (MOC) that is used by Empire to assess needs and coordinate care. Each member receives a comprehensive health risk assessment (HRA) within 90 days of enrollment and annually thereafter, which covers physical, behavioral, and functional needs, along with a comprehensive medication review. The HRA is then used to create a member care plan. Members with multiple or complex conditions are assigned a health plan case manager.

 

SNP HRAs, care plans, and case managers support members and their providers by helping identify and escalate potential problems for early intervention, ensuring appropriate and timely follow-up appointments plus providing navigation and coordination of services across the Medicare and Medicaid programs.

 

Provider training required

Providers contracted for SNP plans are required to complete an annual training to keep up-to-date with plan benefits and requirements, including details on coordination of care and MOC elements. Every provider contracted for SNP is required to complete an attestation stating they have completed their annual training. These attestations are located at the end of the self-paced training document.

 

To take the self-paced training, please go to the MOC Provider Training link at https://www.availity.com.

 

How to access the Custom Learning Center on the Availity Portal:*

  1. Log in to the Availity Portal at https://www.availity.com.
    1. At the top of the Availity Portal, select Payer Spaces and select the appropriate payer.
  2. On the Payer Spaces landing page, select Access Your Custom Learning Center from Applications.
  3. In the Custom Learning Center, select Required Training.
  4. Select Special Needs Plan and Model of Care Overview.
  5. Select Enroll.
  6. Select Start.
  7. Once the course is completed, select Attestation and complete.

 

Not registered for the Availity Portal?

Have your organization’s designated administrator register your organization for the Availity Portal.

  1. Visit https://www.availity.com to register.
  2. Select Register.
  3. Select your organization type.
  4. In the Registration wizard, follow the prompts to complete the registration for your organization.

 

See attached for a Q&A on Special Needs Plans.

 

EBSCRNU-0186-21 July 2021

519271MUPENMUB



Featured In:
October 2021 Newsletter