What are the conditions that patients must meet in order to reach an agreement on a case-by-case basis? To obtain a case-by-case agreement, you, as a health care provider, must commit to billing your patient with the insurance company. The goal of the SCAs is to meet the important needs of the patient; billing costs a network provider more than a network provider. The following conditions call into question your patient`s case for an CAS: providers who only participate with Sunshine Health maintain this agreement and Staywell members will be members of the health care in October 2021. Suppliers of both networks receive, in accordance with the notification, product contracts valid until July 1, 2021 at the latest. Yes, yes. There are no restrictions (limits) for whom you can see. If you are not satisfied with the opportunities offered by our supplier network, your preferred supplier can request an agreement on a case-by-case basis. The agreement on a case-by-case basis is approved when the provider meets the State-established Medicaid registration criteria and can be certified by health-beacon options. Please continue to treat the members of each health plan as part of your current contract. Our operating systems for each health plan, including claims and supplier services, remain separate.
If you have any questions, your relationship provider is available, whether your question is Sunshine Health or WellCare. In some cases, your representative may change. We will let you know in advance if this happens. You can also call our dedicated supplier relationship number at 1-407-551-3200, option 2. We are not a provider for Florida Medicaid (Straight Medicaid), but have several Medicaid HMO plans. For health insurance for which we are not online, full payment is required at the time of service. You can ask your insurance company for a case-by-case agreement that it can grant in special circumstances. Benefits that are not covered by your health insurance plan are provided upon request and full payment is required at the time of service. Examples of benefits that are not normally covered by health insurance plans include performance tests, letters to third parties, school follow-up and consultation with other professionals. Sometimes an insurance company may have a “payment policy with the highest in network rate,” in which case you will not be able to negotiate the rate.
You still have the option to refuse the SCA if the sentence and conditions are not acceptable to you. What needs to be taken into account when approving individual case agreements, if you get approval of an agreement on a case-by-case basis, can be a tedious and frustrating task. Our mission is to help you. However, if the SCA has been approved, our task is not complete. In this regard, we need your support to consider the following aspects: How big is the single box agreement We have already mentioned how you should focus on the services included in the agreement. If your patient needs multiple treatments and therapies, the contract must cover reimbursement for all treatments or the maximum number of treatments. It should be noted that insurance companies have a legal obligation to properly treat patients by well-trained professionals. Therefore, if the insurance plan does not cover off-network services, and there are no in-network providers with the specified specialty, then you, as a qualified provider, can negotiate your usual full fees as a meeting rate for new patients.