Email: CHCproviders@upmc.edu. Hospitals and Physical Health. Provider Alerts include important updates for providers. Contact Us. Community Behavioral Health . stream Specialties. Specialized medical equipment and supplies, Health status measuring and monitoring telecare services, Activity and sensor monitoring telecare service, Medication dispensing and monitoring telecare service, CHC Translation Services and Nondiscrimination Notice (PDF). UPMC … In doing so, you attest to your organization’s compliance with the Third-Party Compliance Program requirements. <>/Metadata 3409 0 R/ViewerPreferences 3410 0 R>> Provider Contact Addresses. Community Care is a proud part of the UPMC Insurance Services Division, which also includes UPMC Health Plan, WorkPartners, and UPMC for You (Medical Assistance). Community Care is a proud part of the UPMC Insurance Services Division, which also includes UPMC Health Plan, WorkPartners, and UPMC for You (Medical Assistance). WHAT DO I NEED TO DO? <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> UPMC Community HealthChoices – MLTSS PO Box 106042 Pittsburgh, PA 15230-6042 Medicare Special Needs Plans (UPMC for Life Dual) 1-800-606-8648. Accepting New Patients. The Pennsylvania Community HealthChoices (CHC) Program is a Medicaid managed care program for persons who are 21 years of age or older and are eligible for bothMedicaid (known as Medicaid Assistance in Pennsylvania) and Medicare (the federal health insurance program) or those who require a nursing home level of care. LTSS can be provided in a nursing facility or in your home and community. Long-term nursing facility care is also covered. You must have a prescription from a participating provider. If you are a member of UPMC for Life Complete Care or any other Medicare plan, your Medicare copays will not change under UPMC Community HealthChoices. UPMC Community HealthChoices covers the same physical health benefits that are available through the Medical Assistance fee-for-service program (ACCESS) and Medical Assistance Adult Benefit Package. A prescription from a participating provider is required. Here are some examples of the kinds of HCBS covered by UPMC Community HealthChoices: Behavioral health services are offered through the existing network of behavioral health managed care organizations (BH-MCOs). (This service exceeds the $4000 lifetime maximum benefit provided by the Office of Long-Term Living's waiver program.) If you have any questions about this payment, please … If you are dually eligible for Medicare and Medical Assistance (Medicaid), your Medicare benefits are not changed or affected by UPMC Community HealthChoices. The allowance can be used on a variety of items, including household supplies, essential furniture, general moving expenses, security deposits and other items associated with personal and environmental health and safety assurances. UPMC Community HealthChoices; The same three CHC MCOs will be used across the state. UPMC Community HealthChoices For HealthChoices, an announcement was made about newly selected MCOs. UPMC Community HealthChoices, as one of three state-wide Managed Care Organizations for the Commonwealth’s Community HealthChoices (CHC) program, offers coverage for medical care and Long-term Services and Supports (LTSS) to its Members (also called “Participants”). Eligibility is based on a state determination of nursing facility clinical eligibility and a pending application with the county assistance office. Upmc Community Healthchoices Formulary Choose the community formulary listings for specific physical disabilities to management process, and manage your medicaid Other benefits. UPMC & Health Plan Launch ‘Freedom House 2.0’ ambulance. UPMC Community HealthChoices participants who are Nursing Facility Clinically Eligible (NFCE), may be eligible for additional services including: Enhanced community transition services. To find the BH-MCO in your county, call the UPMC Community HealthChoices Health Care Concierge Team. English (PDF) Arabic (PDF) Cambodian (PDF) Russian (PDF) Simplified Chinese (PDF) Spanish (PDF) Vietnamese (PDF) Participants. UPMC Community HealthChoices participants located in Pennsylvania at the time of the service will have a virtual visit with a UPMC-employed provider. Refer to Summary of Benefits for additional dental benefit information. Wednesday, November 18, 2020 at 12:00 PM – 1:00 PM EST. If the cost of the glasses or contact lenses is more than $100, you will be responsible for any cost over the $100. If you need help finding a Keystone First Community HealthChoices dentist, go to Find a Provider and select Dental. }8~����|ʦp(�&G&��_�#ԏ���-^�-�Y��l��?��|^̲;]�'QP��ɑ�%\��N�F6��]�zx�����A[z�sz�LCcviv��� �g�WC�TԿ! For the purposes of this attestation, an authorized representative is an individual who has responsibility, directly or indirectly, for all employees, contracted personnel, and delegated vendors who provide administrative and/or healt… This service offers an allowance of up to $5,000 to assist participants who are transitioning from a nursing facility to the community. ** This service lets you access a UPMC provider via live video from your computer, tablet, or smartphone—anytime, day or night. **UPMC Community HealthChoices participants can seek treatment through UPMC AnywhereCare. Added benefits. Online Event. This allowance can be used towards certain dental procedures after a benefit limit has been reached. Cleanings. This allowance can be used toward purchasing new glasses (one frame and two lenses) or contact lenses (one pair) and one fitting per year. CHC will only change how you receive your Medical Assistance coverage. UPMC Dental Advantage. These services are based on your needs, as documented in your person-centered service plan by your service coordinator. Hosted by. Community HealthChoices is the Department of Human Services (DHS) Medical Assistance (Medicaid) program that allows managed care organizations (MCOs) to coordinate medical care and long-term services and supports (LTSS) for individuals who qualify for Medical Assistance and also qualify for Medicare or require a nursing facility level of care. Copyright document.write(new Date().getFullYear());. If you are dually eligible for Medicare and Medical Assistance (Medicaid) or receive long-term services and supports, you are eligible for Community HealthChoices. endobj Services have been moved to the UPMC Presbyterian Dental Center at UPMC Montefiore. As part of Keystone First CHC, you receive the following dental benefits: Exams. Community HealthChoices (CHC) provides physical health benefits as well as long-term services and supports to eligible individuals. Welcome to Community HealthChoices! UPMC Community HealthChoices . Yes. Keystone First. This service will provide personal assistance services to eligible participants who cannot perform activities of daily living and are at risk of entering a nursing facility. This service offers an allowance of up to $5,000 to assist participants who are transitioning from a nursing … This service is best for minor issues such as colds, the flu, sore throats, skin rashes, and other nonemergency conditions. Wellness programs. UPMC Community HealthChoices . UPMC Community HealthChoices . Dentistry ; Book Appointment. Starting in January 2020, the CHC plan you choose will become your new Medical Assistance coverage. Community Homepage Health Education Advisory Committee (HEAC) Participant Advisory Committee (PAC) Home > Participants > Participant Handbook. Tod E Twichell, DDS. UPMC AnywhereCare virtual visits are not covered services when UPMC Community HealthChoices participants are traveling outside of Pennsylvania. Community HealthChoices. Services you receive at home and in your community are called home and community based services (HCBS). Community Care Behavioral Health. UPMC Health Plan Provider Services U.S. Steel Tower 600 Grant Street Pittsburgh, PA 15219 Network Development UPMC Dental … Adult vision. PA Health & Wellness (Community HealthChoices) X Provider Alerts. x��]mO�H������0��-�� �:f������N���B�us����W� 3�M�R)qb;~����뭛�Ӫ.�d���ys|Z���6����r�����*?��n�eV�����s��~γy^�����S���9��B2��ǩdU~x������������`p���၀�8,�,�:�vu7|�����M�x(��w����^M�W? Community HealthChoices (CHC) is the Department of Human Services’ (DHS) Medical Assistance (Medicaid) program that allows managed care organizations (MCOs) to coordinate medical care and long-term services and supports (LTSS) for individuals who qualify for Medical Assistance and also qualify for Medicare or require a nursing facility level of care. 8. When you become enrolled in CHC, you will choose one of three CHC plans: AmeriHealth Caritas, PA Health & Wellness, and UPMC Community HealthChoices. You can create your own personalized OnLine account by registering here. The UPMC Mobile Dental Center has closed. Select. 1-844-626-6813 (TTY: 1-844-349-8916) www.PAHealthWellness.com. Copays do not apply to pregnant participants. Medical Assistance redetermination assistance. Our services help seniors and people with physical disabilities who are dually eligible for Medicare and Medicaid live as independently as possible in their own homes and experience an improved quality of life. There are no UPMC Community HealthChoices copays for medical services and generic medications. Contact Us 24/7 Phone Lines If you are eligible for long-term services and supports (LTSS), all services available in the Office of Long-Term Living’s home and community based physical disability waiver programs are covered by UPMC Community HealthChoices. Service Coordination. Community Care is a proud part of the UPMC Insurance Services Division, which also includes UPMC Health Plan, WorkPartners, and UPMC for You (Medical Assistance). Nursing Facilities. AnywhereCare. Let’s take a look at the benefits and services CHC offers. UPMC Community HealthChoices CH2C CH2F CH2S CH2J CH2N. Are you a first time user? While this program is not strictly for the elderly, it is very relevant for seniors, as many are dually eligible for Medicaid and Medicare and / or require a level of care consistent to that … Behavioral Health. What is Community HealthChoices? Using the five geographic HealthChoices zones, implementation phases are: January 2018 - Phase 1 (Southwest) January 2019 - Phase 2 (Southeast) January 2020 - Phase 3 (Lehigh/Capital, Northwest, Northeast) Please refer to the Pennsylvania Department of Human Services (DHS) Community HealthChoices … Provider Manual, etc. If the procedure cost exceeds $500, you will be responsible for any cost over the $500. These include: $500 dental allowance. Providers who also hold HealthChoices contracts should pay specific attention to the UPMC Health Plan’s claims guidelines as there are different addresses. Contact Us 24/7 Phone Lines At the UPMC Presbyterian Dental Center, our experienced team provides general preventive and follow-up dental care, and specialized procedures to help you keep smiling with confidence. What is Community HealthChoices? UPMC Pinnacle has partnered with the Harrisburg Area Dental Society to provide uninsured and underinsured Central Pennsylvania residents with access to urgent dental care. 1 0 obj Practice Locations Phone; Susan E Calderbank, DMD43 Clinton Street, Greenville, PA 16125 (Map) 724-588-1600: Book Appointment. The current MCOs remain in place, and an announcement will be made at a later date concerning the newly selected MCOs. Participant Handbook. }��ъd@+��8��V�ʊ}�jT��Ru���e�� �X<4�]_~j���)&x�& �S"�7�1$����ށ0{t�YY��_=�/˚F=D�����g����3�ǀ0#¨I�~~g�����A�����/��&&. Hosted by UPMC Careers. The Department of Human Services (DHS) is committed to increasing opportunities for older Pennsylvanians and individuals with physical disabilities to remain in their homes. Behavioral Health. Read all plan benefits and details for Keystone First. UPMC Community HealthChoices is your secondary Medical Assistance payer instead of the Pennsylvania Department of Human Services. Pennsylvania Health & Wellness. Find care with UPMC Health Plan's Provider Directory. If you’re 21 or older and have both Medicare and Medicaid, or receive long-term supports through Medicaid because you need help with everyday personal tasks, you will be covered by Com CHC Overview. As of June 1 st, PA Health and Wellness will be switching our claims processor for Community HeathChoices and participants will get a new ID card by mail. Refer to your Medicare plan for more information on Medicare copays. There is a $3 copay for brand-name medications. Phone services. Overview. Our care is individualized and patient-focused to allow you to put your best face forward. EVS EXAMPLE #1 — continued Status: Medicaid Service Type: 1-Medical Care 4-Diagnostic X-Ray 30-Health Benefit Plan Coverage 33-Chiropractic 35-Dental Care 47-Hospital 48-Hospital - Inpatient 50-Hospital - Outpatient 86-Emergency Services 88-Pharmacy 98-Professional (Physician) Visit - Office A6-Psychotherapy AL-Vision … Health coaches. upmc 1-800-979-8762 Community Care is a proud part of the UPMC Insurance Services Division, which also includes UPMC Health Plan, WorkPartners, and UPMC for You (Medical Assistance). This service provides one-on-one coaching to help you eat healthier, lose weight, reduce stress, and quit smoking. $100 vision allowance and glasses fitting each year. An authorized representative from your organization is required to complete the Third-party Compliance Program Attestation on behalf of your organization on an annual basis. Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! PA Health & Wellness . Home- and Community-based Services; Nursing Facility; Physical Health; Service Coordination; AmeriHealth Caritas Pennsylvania Overview; UPMC Community HealthChoices Overview ; PA Health & Wellness ; CHC Data Books. This service provides assistance to help you maintain your Medical Assistance eligibility, so you do not lose access to your Medical Assistance benefits. about 1 week ago. UPMC Community HealthChoices - PHCA. Community Care is a proud part of the UPMC Insurance Services Division, which also includes UPMC Health Plan, WorkPartners, and UPMC for You (Medical Assistance). <> PRESS RELEASE. clock. This service provides online access to a program to help you feel more confident, overcome setbacks, and take control of your life and mood. UPMC Community HealthChoices participants who are Nursing Facility Clinically Eligible (NFCE), may be eligible for additional services including: Enhanced community transition services. endobj Stress management program. Health Details: Contact Information 1-888-876-2756 8 a.m. to 8 p.m. – Monday through Friday ...A. UPMC Health Plan developed UPMC Dental Advantage to offer a single source for all your health insurance ... claim to UPMC Dental Advantage with the original treatment plan (initial placement date and months of upmc health plans for individuals UPMC Community HealthChoices will administer this benefit in conjunction with a nursing home transition team, led by the participant, which will develop a budget for distributing these funds to support the facility-to-community transition. You do not need a referral to see the dentist. 4 0 obj UPMC Community HealthChoices Provider Services: 1-844-860-9303. Managed Care Organizations presentations. <> Community HealthChoices (CHC) is Pennsylvania’s managed care long-term services and supports (LTSS) program. To see a list of services covered by all plans, go to Physical and behavioral health benefits and Long-term services and supports. 24/7 Phone Lines ; Email; Member Site. As a participant of UPMC Community HealthChoices, you may be eligible to receive additional value-added benefits. 2018 Provider Summit Presentations. Susan E. Calderbank, DMD. Health coaches can also help you manage symptoms and provide treatment options for heart disease, asthma, COPD, low back pain, diabetes, or depression. 1 dental exam and 1 cleaning, per provider/group, every 180 days (6 months). Home and Community-Based Services. UPMC Community HealthChoices is a Managed Care Plan for Community HealthChoices. UPMC Cole Port Allegany Community Health Center45 Pine Street, Port Allegany, PA 16743 (Map) 814-642-2505: Book Appointment. SELECTING A PLAN CHC is a new program introduced in the Southwest Zone in 2018, the Southeast Zone in 2019, and is slated for implementation in the Lehigh/ … CY 2018 Data Book for Community HealthChoices; CY 2019 … If you are a patient and have … 3 0 obj CHC Southwest Provider Summit Presentations. %���� Health Details: UPMC Health Plan for Skilled Nursing Services and are interested in applying. E.g., dental, vision, non- emergency medical transportation, over-the-counter medication, long term services and supports 7. UPMC Community HealthChoices Northwest 4,782 $1,707,942.54 6/22/2020 7/1/2020 AmeriHealth Caritas Lehigh/Capital 8,715 $3,112,655.63 6/22/2020 7/1/2020 Pennsylvania Health & Wellness Lehigh/Capital 6,611 $2,361,189.49 6/22/2020 7/1/2020 UPMC Community HealthChoices Lehigh/Capital 6,886 $2,459,408.68 6/22/2020 7/1/2020 . 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