MISSED APPOINTMENTS:
* Missed appointments by the member must be followed-up by the Provider.
The CarePlus Member Services Department will assist the Provider in this
process if necessary. If the patient does not go to the previously scheduled appointment without prior
cancellation, Provider must document within the medical records. A Provider may charge a fee for missed
appointments, provided such fees apply uniformly and at the same amount for all
Medicare and non-Medicare patients.
APPOINTMENT SCHEDULING CRITERIA:
To ensure accessibility and availability of health services to plan members,
the following standards have been set forth by the Centers for Medicare &
Medicaid Services (CMS):
- Urgently needed services or Emergency – immediately.
* Non-urgent, but in need of attention – within one (1) week.
* Routine and Preventive Care – within 30 days. Non-emergent complaints
that do not restrict a
member’s activity or are chronic in nature.
* Provider agrees to maintain hours that do not discriminate against Members’
accessibility to
Provider
IDENTIFYING/VERIFYING CAREPLUS MEMBERS:
Upon enrollment, CarePlus will send the member an Acknowledgement of Enrollment
Letter, which will also include the member’s Evidence of Coverage (EOC) and
Member Identification (ID) Card. The EOC educates the patient on the following
subjects:
-How to schedule an appointment;
-What to do in case of an Emergency;
-How to contact their PCP during and after business hours; and
-How to access “out-of-area services”.
Each Plan Member will be identified as follows:
Each Plan member will be identified by a CarePlus member ID card which
indicates assignment to a
specific PCP and co-payment guidelines. All CarePlus Plan Members are sent an
ID card which will be presented at the time of each visit. When membership
eligibility cannot be determined, you may contact the Provider Services Queue
for “Eligibility Verification” at 1-866-313-7587, Monday through Friday from
8:00 a.m. to 5:00 p.m.
