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Medicaid Care Coordination Plans provide the kinds of services that can help providers manage some of the most expensive and time-consuming challenges in providing care to Medicaid consumers, including:

• Streamlined Claims Payment
  Overall, 98% of claims are paid within 30 days - about 30 million per year!

• Fewer Missed Appointments
  Case managers (typically nurses or social workers) help ensure that consumers schedule and attend exams and appointments, even making reminder calls and arranging transportation when needed.
• Supplementation of Office Hours
  Plans provide 24-hour nurse hotlines to supplement provider office hours and direct patients to the appropriate venue for care.
• Medication Checks
  Plans provide for review of prescriptions to identify potentially dangerous drug interactions and prevent over-prescription of drugs which multiple providers may not be in a position to coordinate.
• Minimal or no Co-Pays
  While not required, Ohio's Care Coordination Plans have waived co-pays for consumers. This encourages consumers to see their doctor early instead of waiting until they are very sick, and also save providers the complications of collecting fees from their patients.
• Minimal Authorization Requirements
  There are times when authorizations are essential to ensure the most effective and efficient health care for consumers. However, checks on prescribed services are requested on fewer than 3% of claims processed (based on January-June 2007). And there's more:
  • Pharmacy approvals are turned around in an average 12.4 hours.
  • Non-pharmacy approvals are turned around in an average of 3.2 calendar days.
• Plans are staffed for fast service: calls from providers are picked up in an average of under 30 seconds.

Claims Disputes

Each Care Coordination Plan has its own procedure. Please visit the website of your plan to find out more.