Medicaid submissions; Recertification’s; Roster Checks; Surplus; Pooled Income Trusts 

FHS Consultants provides numerous services to several MLTC’s. We provide them with weekly, customized reports to assure that member eligibility continues without interruption.

MLTC’s are mandated to upgrade Medicaid coverage for members who require Skilled Nursing Home care. FHS contacts the member and/or responsible party, explains the need to convert their Medicaid, assists with gathering the documentation, and performs various duties required to complete the upgrade in coverage. FHS reviews the information and informs the MLTC of anticipated issues that Medicaid will discover, including missing documentation and “illegal” transfers.

REVIEW OF PENDING MEDICAID APPLICATIONS

• • FHS contacts potential members and forwards a checklist of documentation which is required for Long Term Care or Community based Medicaid approval.
• • FHS assist's families with obtaining the necessary paperwork.
• • FHS prepares Medicaid applications for Medicaid submission, and follows up with Medicaid for the approval.

RECERTIFICATION / DROP OF COVERAGE

• • FHS tracks the expiration dates of all re-certifications and completes and submits the case to Medicaid.
• • FHS works with family member to obtain re-certification paperwork.
• • FHS monitors all the members of the MLTC for drops in coverage due to SSI or other unanticipated causes, and works with the member and Medicaid to reestablish eligibility.

ROSTER CHECKS

• • Insurance eligibility
• • Information discrepancies
• • Loss of coverage

POOLED INCOME TRUSTS

FHS works with members to:

• • Complete the necessary paperwork
• • Choose the trust that is most economical for them
• • Forward the necessary paperwork to Medicaid for approval

UPGRADING COMMUNITY BASED MEDICAID TO NURSING HOME COVERAGE

MLTC'S are mandated to upgrade the Medicaid coverage for members who require Nursing Home care. FHS Consultants contacts the member and/or their responsible party, explains the need to convert their Medicaid, and performs the following duties:

• • Forwards a comprehensive checklist of documentation that is required
• • Assists families with obtaining the information from financial institutions
• • Review's for completeness
• • Completes the required Medicaid forms
• • Notifies the plan of anticipated issues that Medicaid will discover, including missing documentation and “illegal” transfers.

SURPLUS/NAMI

• • FHS Consultants ascertains the correct Surplus/NAMI amount for each member.
• • FHS sends invoices to responsible party and follows-up for payment.
• • FHS deposits the checks received and provides monthly reports to the plan of all the charges, cash receipts and aging reports.

sues that may arise, as well as a projection of NAMI due by the member. We also institute controls and follow-up procedures to assure that member eligibility continues without interruption.  

REVIEW OF PENDING MEDICAID APPLICATIONS

•  • FHS contacts potential members and forwards a checklist of documentation which is required for Long Term Care or Community based Medicaid approval.
•  • FHS assist's families with obtaining the necessary paperwork.
•  • FHS prepare's Medicaid applications for Medicaid submission.

RECERTIFICATION

•  • FHS Consultants tracks the expiration dates of all re-certifications and completes and submits the case to Medicaid.
•  • FHS works with family member to obtain re-certification paperwork.
•  • FHS institutes controls and follow-up procedures to assure that member's eligibility continues without interruption.

ROSTER CHECKS

•  • Insurance eligibility
•  • Information discrepancies
•  • Loss of coverage

POOLED INCOME TRUSTS

FHS works with members to:

•  • Complete the necessary paperwork
•  • Choose the trust that is most economical for them
•  • Establish the trust
•  • Forward the necessary paperwork to Medicaid for approval

UPGRADING COMMUNITY BASED MEDICAID TO NURSING HOME COVERAGE

MLTC'S are required to upgrade the Medicaid coverage for members who require Nursing Home care. FHS Consultants contacts the member and/or their responsible party, explains the need to convert their Medicaid, and performs the following duties:

•  • Forwards a comprehensive checklist of documentation that is required
•  • Assists families with obtaining the information from financial institutions Review's for completeness
•  • Complete's the required Medicaid forms
•  • Provide's and analysis of potential issues that may arise
•  • Provide's projected NAMI due by the member

SURPLUS

•  • FHS Consultants ascertains the correct Surplus Income.
•  • FHS sends invoices to responsible party and follows-up for payment.