Healthy Babies Quick Reference Card

Quick
Reference
Provider
Georgia
Planning for Healthy BabiesSM Program
1-800-454-3730 n providers.amerigroup.com
Amerigroup Community Care has contracted with the Georgia Department of Community Health (DCH) to
implement the Planning for Healthy BabiesSM (P4HB) program. The P4HB program is designed to:
n Provide family planning-related services to eligible women who meet income requirements
n Promote child-spacing intervals through effective contraceptive use
n Reduce the number of Low Birth Weight (LBW) and Very Low Birth Weight (VLBW) births
by giving participants access to prenatal planning, health education and vitamins
n Provide access to Interpregnancy Care (IPC) services for women with previous VLBW infants
The P4HB program provides family planning services at no cost to eligible women. Participants may
enroll in one of these program sections:
n Family Planning
n Interpregnancy Care (IPC)
n Resource Mother Outreach
Both IPC and Resource Mother Outreach services are limited to women who give birth to VLBW babies (babies
born weighing less than 3 pounds, 5 ounces) born on or after January 1, 2011. If a woman who gives birth
to a VLBW baby does not receive Medicaid benefits but meets state income requirements, she will be
enrolled in the IPC section of the P4HB program. The IPC section includes Family Planning and Resource
Mother Outreach services.
A woman who currently receives Medicaid benefits and gives birth to a VLBW baby is only eligible for
Resource Mother Outreach services under the P4HB program. The Resource Mother Outreach section offers
support to mothers and provides them with information on parenting, nutrition and healthy lifestyles.
The program covers:
n Annual physical exams, including Pap smears
n Contraceptives and multivitamins with folic acid
n Family planning counseling
n IPC services, including primary care and dental services, substance abuse treatment services, Resource
Mother Outreach services, and more
P4HB PROGRAM
COMPONENT
Family
Planning
Interpregnancy
Care (IPC)
ELIGIBILITY
REQUIREMENTS
COVERAGE SUMMARY/
COVERED SERVICES
The member:
nIs 18 to 44 years of age
n Is not enrolled
in Medicaid
nMeets state income
requirements
nMay have had a VLBW
baby (less than 3 pounds,
5 ounces)
nFamily planning services and supplies
The member:
nIs 18 to 44 years of age
n Is not enrolled
in Medicaid
nMeets state income
requirements
nHas had a VLBW baby
(less than 3 pounds,
5 ounces)
nPrimary care services
nOffice/outpatient visits – five per year
nManagement and treatment of
only (not primary care services)
nAnnual family planning, initial or
annual exams
nContraceptive services and supplies
nFollow-up family planning or family
planning-related service visits (up to
four visits per year)
nTreatment of major complications
related to family planning services
nPlanning for Healthy Babies (P4HB)
participant counseling and referrals for
social services such as WIC
nSterilizations
nMultivitamins with folic acid/folic acid
nHepatitis B and Tetanus diphtheria vaccines
chronic diseases
nSubstance abuse treatment (detoxification
and intensive outpatient rehabilitation)
nLimited dental
nPrescription drugs (non-family planning)
nNonemergency transportation
nCase management – Resource Mother
Outreach services listed below
nFamily Planning and Resource Mother
Outreach services
Resource
Mother
Outreach
The member:
n Is 18 to 44 years of age
nIs currently enrolled in
Medicaid (only eligible
for Resource Mother
Outreach services)
nHas had a VLBW baby
(less than 3 pounds,
5 ounces)
nCovers members who are enrolled in other
Medicaid programs. Resource Mothers
employed (or contracted) by Amerigroup
will help members:
n Adopt better behaviors like healthy
eating and smoking cessation
n Comply with primary care medical
appointments and arrange for
nonemergency medical transportation
n Obtain regular preventive health visits
and appropriate immunizations for
their children
n Comply with treatment and medications
for chronic health conditions
n Access social services support
n Connect to community resources
(e.g., WIC)
CLAIMS
The P4HB claims process requires that reimbursable procedure codes for office visits, laboratory tests
and certain other procedures carry a primary diagnosis or modifier that identifies them as family planning
services. For complete details about Amerigroup claim processes and procedures, refer to our Medicaid
provider manual.
EMERGENCY MEDICAL CARE
P4HB participants who have a family planning-related emergency medical condition should not be held
liable for payment. Once the participant’s condition is stabilized, providers must obtain precertification
for hospital admission or prior authorization for follow-up care.
ELIGIBILITY
The Georgia DCH has the sole authority for determining eligibility for the P4HB program. The DCH, or
its agent, will continue responsibility for the electronic eligibility verification system.
Eligibility is determined by DCH and includes the following:
n Women ages 18 through 44 who meet monthly family income limits
n Women who do not receive Medicaid (eligible for Family Planning services)
n Women who give birth to a baby weighing less than 3 pounds, 5 ounces and do not receive Medicaid
or lose Medicaid coverage (eligible for the IPC services)
n Women who receive Medicaid and give birth to a baby weighing less than 3 pounds, 5 ounces (eligible
for Resource Mother Outreach services only)
Exclusions
The following women are excluded from
participation in the P4HB program:
n Eligible women who become pregnant
while enrolled
n Women determined to be infertile (sterile)
or who are sterilized while enrolled in the
P4HB program
n Women who become eligible for any other
Medicaid or commercial insurance program
n Women who no longer meet the P4HB
program eligibility requirements
n Women who are or become incarcerated
or who move out of the state
PLANNING FOR HEALTHY BABIES (P4HB) PROGRAMS
Family Planning and Family Planning-related Services
The pink P4HB logo identifies the participant as eligible for Family Planning services only:
EffectiveEffective
Date: Date:
MDYEFFMDYEFF
Date of Birth:
Date of Birth:
MDYDOB
MDYDOB
Subscriber
Subscriber
#:
MEMBERID
#:
MEMBERID
Member Member
Name: Name:
MBRNAME
MBRNAME
State Identifier
State Identifier
#: MBRALTKEY
#: MBRALTKEY
SM
SM
MEMBERS:
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please callplease
1-800-855-2880.
call 1-800-855-2880.
MIEMBROS:
MIEMBROS:
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al 1-800-855-2884.
llame al 1-800-855-2884.
HOSPITALS:
HOSPITALS:
For emergency
For emergency
admissions,
admissions,
notify Amerigroup
notify Amerigroup
within 24 hours
withinafter
24 hours
treatment
after treatment
at 1-800-454-3730.
at 1-800-454-3730.
PROVIDERS:
PROVIDERS:
For preauthorizations/billing
For preauthorizations/billing
or pharmacy
or pharmacy
information,
information,
call 1-800-454-3730.
call 1-800-454-3730.
PHARMACIES:
PHARMACIES:
Submit claims
Submit
using
claims
Caremark
using Caremark
RXBIN: 004336;
RXBIN:RXPCN:
004336;ADV;
RXPCN:
RXGRP:
ADV;RX4284
RXGRP: RX4284
For technical
Forhelp,
technical
call Caremark
help, call Caremark
at 1-800-364-6331.
at 1-800-364-6331.
SUBMIT MEDICAL
SUBMIT MEDICAL
CLAIMS TO:
CLAIMS TO:
AMERIGROUP
AMERIGROUP
• P.O. BOX
• P.O.
61010
BOX
• VIRGINIA
61010 • VIRGINIA
BEACH, VA
BEACH,
23466-1010
VA 23466-1010
USE OF THIS
USECARD
OF THIS
BYCARD
ANY PERSON
BY ANY OTHER
PERSONTHAN
OTHER
THE
THAN
MEMBER
THE MEMBER
IS FRAUD.IS FRAUD.
GA02 10/11 GA02 10/11
Selection of a Primary Care Provider
Family Planning-only participants, with counseling and assistance from DCH or its agent, are encouraged to
choose a Primary Care Provider (PCP) for these services. Only specified Primary Care services related to Family
Planning are covered under the program. Amerigroup will furnish a list of available providers affiliated with the
Georgia Primary Care Association. The list also includes other PCPs serving the uninsured and underinsured
populations who are available to provide family planning primary care services.
Interpregnancy Care (IPC) Services
IPC services are noted in the chart and are available in addition to the Family Planning and Resource Mother
Outreach services described in the previous section.
The purple P4HB logo identifies the participant as eligible for IPC and Family Planning services:
EffectiveEffective
Date: Date:
MDYEFFMDYEFF
Date of Birth:
Date of Birth:
MDYDOB
MDYDOB
Subscriber
Subscriber
#:
MEMBERID
#:
MEMBERID
MEMBERS:
MEMBERS:
Please carry
Please
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all card
times.
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all times.
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card before
this card
youbefore
get medical
you get
care.
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do You do
not need tonot
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get emergency
you get emergency
care. If youcare.
haveIf an
youemergency,
have an emergency,
call 911 orcall 911 or
go to the nearest
go to the
emergency
nearest emergency
room. Always
room.
callAlways
your Amerigroup
call your Amerigroup
PCP for non-emergency
PCP for non-emergency
care.
care.
If you haveIf questions,
you have questions,
call Member
callServices
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1-800-600-4441.
at 1-800-600-4441.
If you are hearing
If you are
impaired,
hearing impaired,
please callplease
1-800-855-2880.
call 1-800-855-2880.
MIEMBROS:
MIEMBROS:
Porte estaPorte
tarjetaesta
en todo
tarjeta
momento.
en todo momento.
Muestre esta
Muestre
tarjetaesta
antes
tarjeta
de recibir
antes atención
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de recibir
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de recibirde
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emergencia.
de emergencia.
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emergencia,
emergencia,
llame al 911
llame
o vaya
al 911
a lao sala
vayade
a la
emergencias
sala de emergencias
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cercana.
siempre
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su PCP de
a su PCP de
Amerigroup
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para atención
paraque
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de no
emergencia.
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1-800-600-4441.
al 1-800-600-4441.
Si tiene deficiencia
Si tiene deficiencia
auditiva, auditiva,
llame al 1-800-855-2884.
llame al 1-800-855-2884.
HOSPITALS:
HOSPITALS:
For emergency
For emergency
admissions,
admissions,
notify Amerigroup
notify Amerigroup
within 24 hours
withinafter
24 hours
treatment
after treatment
at 1-800-454-3730.
at 1-800-454-3730.
Member Member
Name: Name:
MBRNAME
MBRNAME
State Identifier
State Identifier
#: MBRALTKEY
#: MBRALTKEY
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Primary
Provider
Care Provider
(PCP): (PCP):
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Amerigroup
Amerigroup
Member Member
Services:Services:
1-800-600-4441
1-800-600-4441
SM
SM
PROVIDERS:
PROVIDERS:
Certain services
Certainmust
services
be preauthorized.
must be preauthorized.
Care that is
Care
not that
preauthorized
is not preauthorized
may not bemay not be
covered. For
covered.
preauthorizations/billing
For preauthorizations/billing
or pharmacy
or pharmacy
information,
information,
call 1-800-454-3730.
call 1-800-454-3730.
PHARMACIES:
PHARMACIES:
Submit claims
Submit
using
claims
Caremark
using Caremark
RXBIN: 004336;
RXBIN:RXPCN:
004336;ADV;
RXPCN:
RXGRP:
ADV;RX4284.
RXGRP: RX4284.
For technical
Forhelp,
technical
call Caremark
help, call Caremark
at 1-800-364-6331.
at 1-800-364-6331.
SUBMIT MEDICAL
SUBMIT MEDICAL
CLAIMS TO:
CLAIMS TO:
AMERIGROUP
AMERIGROUP
• P.O. BOX
• P.O.
61010
BOX
• VIRGINIA
61010 • VIRGINIA
BEACH, VA
BEACH,
23466-1010
VA 23466-1010
USE OF THIS
USECARD
OF THIS
BYCARD
ANY PERSON
BY ANY OTHER
PERSONTHAN
OTHER
THE
THAN
MEMBER
THE MEMBER
IS FRAUD.IS FRAUD.
GA03 10/11 GA03 10/11
GAPEC-0409-13 04.13
PLANNING FOR HEALTHY BABIES (P4HB) PROGRAMS
Resource Mothers Outreach
The yellow P4HB logo identifies the participant as eligible for Resource Mothers Outreach
services only:
EffectiveEffective
Date: Date:
MDYEFFMDYEFF
Date of Birth:
Date of Birth:
MDYDOB
MDYDOB
Subscriber
Subscriber
#:
MEMBERID
#:
MEMBERID
MEMBERS:
MEMBERS:
Please keep
Please
this card
keepwith
this your
card Medicaid
with your ID
Medicaid
card. For
ID questions
card. For questions
about Resource
about Resource
Mother or Mother
Case Management
or Case Management
services, please
services,
callplease
Member
callServices
MemberatServices
1-800-600-4441.
at 1-800-600-4441.
For
For
medical questions,
medical questions,
please callplease
your state
call your
Medicaid
state office
Medicaid
at 1-866-211-0950.
office at 1-866-211-0950.
If you haveIf an
youemergency,
have an emergency,
call 911 orcall
go to
911
the
ornearest
go to the
emergency
nearest emergency
room. Always
room.
callAlways
your doctor
call your
for nonemergency
doctor for nonemergency
care.
care.
MIEMBROS:
MIEMBROS:
Conserve Conserve
esta tarjetaesta
junto
tarjeta
con su
junto
tarjeta
con de
su identificación
tarjeta de identificación
de Medicaid.
de Medicaid.
Para preguntas
Para preguntas
sobre servicios
sobrede
servicios
Madre Tutora
de Madre
(Resource
Tutora (Resource
Mother) o Mother)
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o Manejo
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llame
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llame a al
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al 1-800-600-4441.
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a la llame
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la oficina
Medicaid
de de
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su estado
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al estado al
1-866-211-0950.
1-866-211-0950.
Si tiene una
Si emergencia,
tiene una emergencia,
llame al 911
llame
o vaya
al 911
a lao sala
vayade
a la
emergencias
sala de emergencias
más cercana.
más cercana.
Llame siempre
Llamea siempre
su médico
a su
para
médico
atención
paraque
atención
no seaque
de no
emergencia.
sea de emergencia.
Member Member
Name: Name:
MBRNAME
MBRNAME
State Identifier
State Identifier
#: MBRALTKEY
#: MBRALTKEY
SM
SM
AMERIGROUP
AMERIGROUP
• P.O. BOX
• P.O.
61010
BOX
• VIRGINIA
61010 • VIRGINIA
BEACH, VA
BEACH,
23466-1010
VA 23466-1010
USE OF THIS
USECARD
OF THIS
BYCARD
ANY PERSON
BY ANY OTHER
PERSONTHAN
OTHER
THE
THAN
MEMBER
THE MEMBER
IS FRAUD.IS FRAUD.
GA04 10/11 GA04 10/11
Women served under the IPC component of the P4HB program and women enrolled in other Medicaid programs
who have delivered a VLBW baby on or after January 1, 2011, have access to a Resource Mother.
If you have questions or need additional information about the services described in this quick reference card,
please call Provider Services at 1-800-454-3730.