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MMC Ovulation Enhancing Drugs Prior Authorization Effective December 1

Medicaid Managed Care plan benefits now cover some ovulation-enhancing drugs for individuals ages 21 through 44 experiencing infertility.

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Hospice Benefit Clarification

Once a member begins receiving hospice services, all care for their terminal illness will be coordinated by the hospice organization.  A review of our records indicates that hospice services for our members who have commercial or Medicaid Managed Care coverage may have been reimbursed improperly by the Health Plan. The hospice organization that provided the services should have been the responsible payer.

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InterQual® Criteria 2019 Update

Our Health Plan uses nationally recognized criteria, including InterQual, to determine appropriateness of care for our members.

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