Transcription
Molina MarketplaceCalifornia Broker TrainingAmy DeMarcoCA Broker Channel Manager
The Molina StoryWhile working as an emergency room physician,Dr. C. David Molina saw a need to change how the healthcare system cared for people on a budget.In 1980, he opened a community clinic where caring for people was moreimportant than their ability to pay. Today, his legacy lives on throughMolina Healthcare, a company that cares for more than 4 million membersin 13 states serving people with Medicare, Medicaid, and Marketplace,Molina Healthcare remains true to Dr. Molina’s convictions: treating eachperson like a member of the family.Our Molina MissionTo provide quality healthcare services to financiallyvulnerable families and individuals covered bygovernment programs
2018: We’re fixing the plane while in flight.Core OpsCare DeliveryCost of Care2019: The future is looking bright!3
We Are Here to Stay!!#152 on the Fortune 500 Listin 20184
Member Experience ImprovementsNetwork audit Reached out to all provider networks to confirm participationClaims overhaul Improved accuracy and speed of claims approval and paymentMember Services leadership New VP who is spearheading restructuring and trainingWellness Assessment Enhanced ability to identify high riskmembers and incentivize them to seetheir PCP and health needs met5
Molina Marketplace2019 Rate Changes
Next Open Enrollment PeriodCovered California “sign up period” dates: October 15, 2018 – January 15, 2019 Renewals will start October 1, 2018Passive Renewals will start October 31, 2018Healthcare.gov states only have until 12/15/18 for OEPSome members may qualify for a Special Election Period (SEP)year-round7
Covered CA 2019 Benefits Chart8
Molina Marketplace in 2019Molina’s Covered CA averageplan change percentage is 1.4%,with most of our Silver plansseeing a %-5%5%N. Los Angeles150%-4%7%S. Los Angeles162%-2%9%Inland Empire170%-4%7%185%1%12%19-3%-6%4%ImperialSan BernardinoRiversideOrangeSan DiegoSanDiegoImperial9
Molina LA Region 16 Rates2nd lowest cost QHP in Silver, Gold andPlatinum3rd lowest in BronzeLosAngelesSan BernardinoRiversideSanDiegoImperial10
Molina LA Region 15 Rates4th lowest cost QHP in Silver and GoldLosAngelesSan BernardinoRiversideSanDiegoImperial11
Molina Orange County Rates2nd lowest cost QHP in Bronze, Silver and Gold1st lowest cost in PlatinumLosAngelesSan BernardinoRiversideSanDiegoImperial12
Molina San Diego Rates1st lowest cost QHP in Bronze, Silver, and Gold2nd lowest cost in PlatinumLosAngelesSan BernardinoRiversideSanDiegoImperial13
Molina Inland Empire Rates1st lowest cost QHP in Bronze, Gold and Platinum2nd lowest in Silver (by 1)LosAngelesSan BernardinoRiversideSanDiegoImperial14
Molina Imperial Rates1st lowest cost QHP in Bronze, Silver, Gold and PlatinumLosAngelesSan BernardinoRiversideSanDiegoImperial15
Molina MarketplaceProvider Network
IPA’s/Medical Groups – Los Angeles County Allied Pacific IPAAltaMed Medical GroupAngeles IPAAsian Community MedicalGroupBella Vista Medical GroupCalifornia Pacific PhysiciansMedical GroupEl Proyecto Del BarrioGlobal Care Medical GroupGolden Shore Medical GroupHealthcare LA IPAHealthy New Life Medical CorpHigh Desert Medical Group(Heritage)La Salle Medical Associates IPALakeside Medical Group(Heritage)Noble Community MedicalAssociates Preferred IPA of CaliforniaRegal Medical Group(Heritage)Regent Medical GroupSeoul Medical GroupSerra Community MedicalGroupSierra Medical Group(Heritage)South Atlantic Medical GroupSouthern California Children’sHealthcareSouthland Advantage MedicalGroupSouthland San Gabriel ValleyMedical GroupSuperior Choice MedicalCenterUnited Physicians InternationalVantage Medical Group17
Hospitals – Los Angeles County Alhambra Hospital Medical CenterAurora Charter Oak Hospital – Behavioral HealthAurora Las Encinas Hospital – Behavioral HealthBeverly HospitalCitrus Valley Medical Center – West Covina CampusCitrus Valley Medical Center – Covina CampusCoast Plaza HospitalCollege Hospital of Cerritos - Behavioral HealthCollege Medical Center – Long BeachCommunity Hospital of Huntington ParkEast Los Angeles Doctors HospitalEncino Hospital Medical CenterFoothill Presbyterian HospitalGarfield Medical CenterGlendale Adventist Medical CenterGood Samaritan HospitalGreater El Monte Medical CenterHarbor UCLA Medical CenterHollywood Presbyterian Medical CenterKeck Hospital of USCLA County – USC Medical CenterLakewood Regional Medical CenterLos Alamitos Medical Center Los Angeles Community HospitalMartin Luther King Jr Community HospitalMemorial Hospital of GardenaMethodist Hospital of Southern CaliforniaMiller Children’s Hospital Long BeachMonterey Park HospitalNorwalk Community HospitalOlive View UCLA Medical CenterPacific Alliance Medical CenterPacifica Hospital of the ValleyPomona Valley Hospital Medical CenterPromise Hospital of East LARancho Los Amigos Rehabilitation Medical CenteSilver Lake Medical CenterSouthern CA Hospital at Culver CitySouthern CA Hospital at HollywoodSouthern CA Hospital at Van NuysSt. Francis Medical CenterSt. Vincent Medical CenterTwin Town Treatment Centers North HollywoodTwin Town Treatment Centers West HollywoodTwin Town Treatment Centers TorranceValley Presbyterian HospitalWhite Memorial Medical CenterWhittier Hospital Medical Center18
Urgent Care Centers - LA County US Healthworks Medical Group (LA, City of Industry,Compton, Torrance, Chatsworth, El Monte, Ontario,Pomona, Saugus, Valencia, Commerce, Van Nuys)Dusk to Dawn (Gardena, LA, Lynwood, Paramount)AME Medical Group (Long Beach, 2 in Downey)Long Beach Urgent Care (Long Beach)MedPost Urgent Care (Cerritos, Cypress, LosAlamitos, Long Beach, La Habra)Concentra Urgent Care (La Palma)Greater Covina Healthcare Urgent Care (Covina)AP Urgent Care Center (City of Industry)Chino Total Care Walk-in Clinic (Chino)Smart Clinic Urgent Care (West Covina, Santa Clarita)MD After-Hour Care Center (Monterey Park)Imperial Primary Care Medical Group (La Mirada)After Hours Medical Group Inc. (Whittier, La Habra)Central Avenue Urgent Care (Montclair)Orthopedic Medical Center Urgent Care (LA)Rapid Care Urgent Care Center (Glendale, Burbank)Glenoaks Urgent Care Medical Group (Glendale)Reseda Family Medicine Urgent Care (Reseda)Reliant Immediate Care (2 in LA, Montebello) AltaMed (Los Angeles, El Monte)Pacific Alliance Medical Center (LA)Silverlake Medical Center (LA)Proactive Urgent Care (El Segundo, LA)A.N.D. Inc., Urgent Care (North Hollywood)Reliant Immediate Care Medical Group (LA)Serra Community Medical Clinic (Sun Valley)Urgent Care Center of South Bay (Torrance)Encino Urgent Care (Encino)AMG Medical Corp. (Alhambra)Valley Urgent Care (Northridge)ProActive Urgent Care Services (LA)Teodoro Diaz MD (Ontario)Pasadena Community UCC (Pasadena)Glendora Urgent Care (Glendora)Los Angeles Urgent Care (LA)Burbank Urgent Care (Burbank)Montebello Urgent Care (Montebello)Temple Medical Center (LA)Wilmington Urgent Care (Wilmington)South Atlantic Medical Group (LA)Sierra UCC (Palmdale, Lancaster)Mend Health (2 in Sherman Oaks)19
IPA’s/MG’s – Orange CountyIPA/Medical Groups Heritage Provider Network Affiliated Doctors of OC Regal Medical Group Lakeside Medical Group Monarch Health Plan20
Hospitals – Orange County Anaheim Regional Medical CenterAnaheim Lighthouse – Behavioral HealthChapman Global Medical CenterCHOC Children’s HospitalCHOC Children’s Hospital at MissionCoastal Communities HospitalCollege Hospital of Costa MesaFountain Valley Regional Hospital andMedical CenterGarden Grove Hospital and Medical CenterHealthbridge Children’s RehabilitationHospitalHealthSouth Tustin Rehabilitation HospitalHuntington Beach Hospital Kindred Hospital Santa AnaKindred Hospital WestminsterLa Palma Intercommunity HospitalLos Alamitos Medical CenterMiller Children’s HospitalOrange Coast Memorial Medical CenterPark Anaheim Healthcare - RehabPlacentia-Linda HospitalSaddleback Memorial Medical CenterSaddleback Memorial San Clemente CampusSeal Beach Health and RehabiliationUniversity of California Irvine (UCI) MedicalCenter West Anaheim Medical Center Western Medical Center – Anaheim Western Medical Center – Santa Ana21
Urgent Care Centers - Orange County Concentra Urgent Care (Anaheim, La Palma, Placentia)AME Medical Group (Anaheim, Long Beach)Hoag UCC (Anaheim Hills, Huntington Beach, Tustin, Orange)OC UCC (Anaheim, Foothill Ranch, Huntington Beach, Orange) Gateway Urgent Care (Anaheim Hills) Surfside Urgent Care (Laguna Beach) Xpress Urgent Care (Costa Mesa, Tustin) Laguna Dana Urgent Care (Dana Point, Laguna Beach) Clinica Medica, Dr. Don Garcia (Anaheim, Buena Park) MemorialCare (Huntington Beach, Westminster) Family Care Centers (Costa Mesa, Fountain Valley, IrvineOptumCare (Ladera Ranch, Mission Viejo, SJC, Seal Beach) Saddleback UCC (Lake Forest, Mission Viejo) South County UCC (San Clemente) Hybrid MD (San Clemente) Caduceus Urgent Care (Laguna Beach, Yorba Linda) Newport Urgent Care (Newport Beach) Marque UCC (Newport Beach, Rancho Santa Margarita) Imperial Primary Care Medical (La Mirada Sunrise Multispecialist MC (Orange, Tustin) South County UCC (San Clemente) Kids Doc (Mission Viejo)MedPost Urgent Care (Brea, Cerritos,Costa Mesa, Cypress, HuntingtonBeach, Los Alamitos, Anaheim Hills, LaHabra, Long Beach, Yorba Linda)Sand Canyon Urgent Care (Irvine)US HealthWorks (Santa Ana)Nellie Gail Urgent Care (Laguna Hills)Long Beach Urgent CareNewport Urgent CarePacific Urgent Care (Fullerton, Orange)Hawaiian Gardens Walk-inCypress Urgent CareBrea Urgent CareAnaheim Urgent CareMarque Urgent Care (Aliso Viejo)South Coast Pediatrics (Santa Ana)AltaMed (Garden Grove)Vital UCC (Newport Beach)Dyer’s Urgent Care (Laguna Hills)Mission Medical (Mission Viejo)Advance Urgent MC (Santa Ana)San Juan Pediatrics (SJC)22
IPA’s/Medical Groups in Riverside and San Bernardino Counties Desert Oasis Medical GroupGolden Shore Medical GroupHeritage Victor Valley Medical GroupInland Faculty Medical GroupLa Salle Medical AssociatesRegal Medical GroupVantage Medical Group23
Hospitals in Riverside and San Bernardino Counties Arrowhead Regional MedicalCenterCasa Colina HospitalColton Clinical ServicesCorona Regional Medical CenterDesert Regional Medical CenterDesert Treatment Clinic –Behavioral HealthHemet Valley Medical Center Inland Valley Medical CenterJFK Memorial HospitalLoma Linda University Medical CenterLoma Linda University Medical Center –MurrietaLoma Linda University Children’s HospitalMenifee Valley Medical CenterPacific Grove HospitalParkview Community HospitalPomona Valley Hospital and Medical CenterRancho Springs Medical CenterRiverside County Regional Medical CenterRiverside Treatment CenterSan Antonio Community HospitalSan Gorgonio Memorial HospitalTemecula Valley HospitalTemecula Valley Treatment CenterVictor Valley Global Community Hospital24
Urgent Care Centers - Riverside and San Bernardino US Healthworks Medical Group (Chino, San Bernardino, Ontario, Pomona, Colton, Moreno Valley, Riverside) Desert Oasis (Palm Springs, Indio, Yucca Valley) Desert Regional Immediate Care (Palm Desert) Healthcare Express Urgent Care (Palm Desert) Dr. Mike’s Walk-In Clinic (Apple Valley, Hesperia, Barstow, Victorville) Family Practice Associates (Hesperia) CareFirst Medical Group (Ontario) Hayes Medical and UCC (Ontario) Novak Urgent Care (Indio) Canyon Lake UCC (Lake Elsinore) Moreno Valley UCC (Moreno Valley)Concentra UCC (Rancho Cucamonga) Reddy Care Medical (Pomona) Mission Grove Medical (Riverside)A Plus Walk In (Menifee, Murrieta, Sun City)West Point MC (Fontana, San Bernardino, Rancho Cuc) Medicross Clinic (Corona) Premier (Pomona, Chino Hills, Indio, Palm Springs) Alta Loma Medical Group (Rancho Cucamonga) Inland UCC (Temecula, Wildomar, Menifee) Trinity Medical Clinic (Ontario)Desert Urgent Care (Palm Desert)Manzoor Kazi Medical Assoc (Palm Desert)Yucaipa Urgent Care (Yucaipa)Teodoro Diaz MD (Ontario)Rapid Care (Rancho Cucamonga)Consumer Medical Group (Rancho CucamongaSan Jacinto Family and UCC (San Jacinto)Advanced Medical and UCC (Upland)Apex Urgent Care (Beaumont)Comprehensive Primary Care (Fontana)Apple Urgent Care (Hemet, Perris)Meridian Urgent Care (Barstow, Beaumont,Apple Valley, Hesperia)Heritage Victor Valley UCC (Victorville)Pinnacle Medical Group (Rialto, SanBernardino, Fontana, Yucaipa)Parkview Outpatient (Riverside)Impact Care Access Network Inc (Hesperia)Integrated Health & Wellness (Apple Valley)Inland Urgent Care (Wildomar)Doctors Express Urgent Care (Riverside)SJ Medical Clinic UCC (San Jacinto)25
IPA’s/MG’s and Hospitals – San Diego CountyIPAs/Medical Groups- San Diego Vantage Medical Group Integrated Health PartnersHospitals – San Diego County Alvarado Parkway Institute Aurora Behavioral Health of San Diego Kindred Hospital San Diego Palomar Medical Center Escondido Pomerado Hospital Community Care IPA Rady’s Children’s Hospital San DiegoScripps Memorial Hospital EncinitasScripps Memorial Hospital La JollaScripps Mercy Hospital Chula VistaScripps Mercy Hospital San DiegoScripps Green HospitalSharp Memorial HospitalSharp Chula Vista Medical CenterSharp Mesa Vista HospitalSharp Mary Birch HospitalSharp Grossmont HospitalSharp Coronado HospitalTri-City Medical CenterUCSD Medical CenterUCSD Thornton HospitalVibra Hospital of San Diego26
Community Clinics – San Diego CountySan Diego Community Clinics (FQHC) Borrego Community Health Foundation - El Cajon, Escondido, La Mesa, Borrego Springs Community Health Systems, Inc. - Fallbrook Family Health Center Family Health Centers of San Diego - El Cajon (Chase, Main), Lemon Grove, Spring Valley, ChulaVista, San Diego (Federal, Market, 30th, Polk, El Cajon, 4th, Island, Broadway, Commercial, Elm,Mission, National, 6th) Imperial Beach Community Clinic -Imperial Beach, San Diego La Maestra Family Clinic - El Cajon (Broadway, 1st), San Diego, National City Logan Heights Family Counseling Center – San Diego Mountain Health & Community Services - Santee, Alpine, Escondido, San Diego (Date, Elm,Valley Parkway, 25th, El Cajon) Neighborhood Healthcare - Lakeside, El Cajon, Escondido (Elm, Valley Pkwy), Pauma Valley North County Health Services – Encinitas, Carlsbad, Ramona, San Marcos, Oceanside (Mesa,Mission, Crouch) Operation Samahan - San Diego (Camino Ruiz, Carmel Mountain), National City San Diego American Indian Health Center – San Diego, San Diego Family Care – San Diego (Polk, University, Linda Vista) San Ysidro Health Center – Chula Vista, El Cajon, San Diego, National City (D, 8th), San Ysidro(3rd, Beyer), Otay Southern Indian Health Council, Inc.- Campo, Alpine St. Vincent De Paul Village – Sa Diego Vista Community Clinic – Oceanside, Vista (Pier View, Durian, Vale Terrace), Chula Vista27
Urgent Care Centers - San Diego County AFC Urgent Care (Bonita/Chula Vista, San Diego, Santee)Centro Medico (Escondido, El Cajon)Coronado Bay Urgent Care (Imperial Beach)Emergency Care Dynamics (San Diego)MD Today Urgent Care (2 locations in San Diego)Partners Urgent Care (Eastlake/Chula Vista, Grossmont/LaMesa, San Diego)A Plus Walk-in Urgent Care (Fallbrook)Rady’s Children’s Urgent Care (La Mesa, San Diego,Escondido, Oceanside)South Coast Medical Clinic and San Diego Physical Therapy(National City)28
IPA’s/MG’s/Hospitals – Imperial CountyIPA/Medical Groups Community Care IPA EasyAccess Care IPAHospitals Pioneers Memorial Hospital El Centro Regional Medical Center29
Online Provider 30
Advanced Online Provider SearchSearch by Specialty, Name, Language, Hospital and IPA affiliations31
Pharmacy Services and PrescriptionsMolina contracts our pharmacies through CVS/CaremarkYou can find a list of our contracted pharmacies in your area here:http://www2.caremark.com/micro/asset/mp ca pharmloc.htm32
Molina MarketplaceBroker Resources
Covered CA Pay Now and PCP SelectionBrokers can help their member: Pay first month’s premium Setup auto-pay Select their PCPAll at the time of applicationMembers who pay at time of signing will receive a printablerecap of their plan, payment and PCP, AND they’ll get theirmember ID card within 10 business daysMember effectuation rates are also much higher if payment istaken when they apply34
Molina Broker PortalEasy Access to Broker Support Tools
Broker Portal FunctionalityBook of Business, Member Payment info and Grace Period Status
BSU (Broker Support Unit)Phone: 1.855.885.3179Broker Services - # 1MPBrokerSupport@MolinaHealthcare.com General inquiries, account access issues, member EOC and SBC questionsBroker Care Team- # 2MPBrokerCareTeam@MolinaHealthcare.com Member access to care issues, billing discrepancies, terminations in errorCommission Team- # 3MPBrokerCommissionInquiry@MolinaHealthcare.com Broker Book of Business reconciliation for unpaid policiesContracting Inquiries - # 4MPBrokerContracting@MolinaHealthcare.com Appointment requests, E&O/license/contact information updates37Monday through Friday – 8:00 AM to 5:00 PM (CST)
CARE Team – Member issue resolution supportMarketplace Broker Communication And Resolution Experts Access to CareBilling IssueClaimsEnrollmentMember ServicesPrior Authorization Status ReviewSan BernardinoLosAngelesRiversideSanDiegoImperial38
Free Promo Itemsfor Brokers hand sanitizer keychainhand sanitizerlip balmfirst aid kitclick penID card holdergel ball stress relieverphysician figurine stress relieverbaseball stress relieverfootball stress relieverSan mo item orders\MOLINA Promo Item Order Form.docx39
My MolinaMember Portal
My Molina – Self Service MemberToolMyMolina.com View invoice and real-time balance Change PCP Sign up for AutoPay, or make a payment View Claim History View Plan and Benefits Print ID Card View/Print SBC or EOC Get Reminders for Health Services View Drug Formulary and much more!41
42 2013 Molina Healthcare, Inc.
Donald Duck
44 2013 Molina Healthcare, Inc.
HealthinHand App View your Member ID Card Pay your bill View your health records View your benefits and eligibilityTest App Username: memappusermpcaPassword: Testing123 Find a new doctor, change yourdoctor, or view your doctor's contactinformation Access to many more services!45
Invoicing and Payment OptionsBinder invoice mailed upon receipt of enrollmentfile from the Exchange and monthly thereafterBinder Due Date CA Binder Due Date is 1st of coverageeffective monthPremium Due Date thereafter is: 26th of the month prior for CA, or 4 businessdays prior to the beginning of the coverageeffective month, whichever is earlierAutoPay Autopay debits on the 23rd of the month, ornext business day1. AutoPay – for convenience and peace ofmind. Register at MyMolina.com2. Online (Mobile Device or Desktop) - canuse savings or checking account, credit ordebit card at MolinaPayment.com. Or login to MyMolina.com.3. IVR – savings or checking account, Visa,MasterCard or Discover card.4. Mail – submit payments with couponfrom invoice. Allow 15 days for receiptand processing.5. Cash – go to MoneyGram.com to find alocation, or call (800) 666-3947.Always include the Subscriber ID or Account Number withpayments to avoid processing delays46
Molina New MemberCommunications
Communications Process for New MembersMember can select PCP andmake binder premiumpayment through Pay NowCorrespondence triggered daily when 834 file transaction is receivedfrom the ExchangeApplicationWelcome letterBinder InvoiceStartMembers can registerfor Autopay duringenrollment application
Aurora Las Encinas Hospital –Behavioral Health Beverly Hospital Citrus Valley Medical Center –West Covina Campus . Park Anaheim Healthcare - Rehab Placentia-Linda Hospital Saddleback Memoria
