VBID Model Hospice Benefit Component Participating Plans

VBID Model Hospice Benefit Component Quick Links:

Under the Value-Based Insurance Design (VBID) Model, in Calendar Year (CY) 2023, fifteen Medicare Advantage Organizations (MAOs) will participate in the Hospice Benefit Component, offering 119 plan benefit packages (PBPs).

Note:

A downloadable list of PBPs with service area and comprehensive contact information can be found here.

Highlighted Contacts for MAOs Participating in the Hospice Benefit Component in CY 2023

Cambia Health Solutions with plans in select counties in OR, UT, and WA
- Hospice Network Administrative Contact [Hospice provider network / contracting assistance]
- Amy Kraft, (e): Amy.Kraft@regence.com; (p): 503-553-5055
- Provider Administrative Support Contact [Member eligibility, claims billing, etc.]
- Provider Customer Service, (p): 800-253-0838
- Provider Website: https://www.regence.com/provider/products/medical/medicare
Catholic Health Care Systems (ArchCare) with plans in select counties in NY
- Hospice Network Administrative Contact: Victor Fama; (e): vfama@archcare.org; (p): 646-584-7984
CVS with plans in select counties in OH and PA
- Hospice Network Administrative Contact: Sara Rose Mollitor; (e): MollitorS@aetna.com; (p): 202-559-8234
Elevance Health (MMM Healthcare, LLC) with plans in select counties in PR
- Primary: Myra Plumey Rivera, (e): myra.plumey@mmmhc.com; (p): 787-379-3327
- Secondary: Marieva Hiraldo Espada; (e): marieva.hiraldo@mmmhc.com; (p): 787-223-1672
Guidewell with plans in select counties in PR
- Primary: Myra M. Velez Plumey, (e): myra.velez@ssspr.com; (p): 787-749-4949 ext. 832-6354
- Secondary: Provider’s Call Center: 1-855-886-7474
Hawaii Medical Service Association with plans in select counties in HI
- Primary: (p): *Oahu – 1-808-948-6330 or *Neighbor Islands – 1-800-790-4672 toll-free
- Website for providers: https://prc.hmsa.com/s/article/Medicare-Advantage-Hospice-VBID-TCC
- Secondary: Dr. Toby Smith; (e): toby_smith@hmsa.com
Highmark Health with plans in select counties in PA
- Primary: Anthony Zambino, (e): Anthony.Zambino@highmark.com; (p): 302-421-3122
- Hospice Network Administrative and Clinical/Patient Support Contacts:
  - Monica Valeri, (e): Monica.Valeri@helionhealthcare.com; (p): 412-544-8069
  - Neyrissa Bodnar, (e); Neyrissa.Bodnar@helionhealthcare.com; (p): 4212-544-8069
  - General; (e): HelionNetworkOperations@helionhealthcare.com; (p): 412-544-8069
Humana Inc. with plans in select counties in CO, FL, GA, IN, KY, OH, VA, and WI
- Primary: Kevin Curey, (e): kcurey@humana.com; (p): 502-580-4059
- Secondary: Susanne McComic, (e): smccomic1@Humana.com; (p) (858) 378-8305
- Provider-facing Mailbox: hospiceVBID@humana.com
- Humana’s information for hospice providers: https://www.humana.com/hospice
Kaiser Foundation Health Plan, Inc. with plans in select counties in CA
- There are two steps to submit notices and claims for Kaiser Permanente Senior Advantage Ventura County Plan (H0524-034 and H0524-083) members:
  - Send the Notice of Election to KP-NOE@kp.org; and
  - Submit claims via the Electronic Data Interchange (EDI) process. To sign up for EDI, please contact your clearinghouse and provide the appropriate payer ID.
- Where do you get more information for Kaiser Foundation Health Plans, Inc?
  - For questions regarding member benefits and/or eligibility, please call Kaiser Permanente Member Services at 1-800-443-0815.
  - For questions regarding claims payment and/or to receive a Kaiser Permanente Provider Payment Dispute Resolution Form, please call Kaiser Permanente Claims Services at 1-800-390-3510
- For all other questions regarding hospice:
  - Administrative: email scalhcs-divert@kp.org
Louisiana Health Services and Indemnity Company with plans in select counties in AR, LA, and MS
- Hospice Network Administrative Contact: Noble Ellington; (e): neellington@vhpla.com; (p): (318) 998-3380
- Clinical and Patient Support Contact: Lynne LeBlanc; (e): lleblanc@vhpla.com; (p): (318) 998-3261
Marquis Advantage, Inc. dba AgeRight Advantage Health Plan in select counties in OR
- Hospice Network Administrative Contact
  - Lisa Hynes; (e); lhynes@agerightcs.com; (p); (971) 206-5143
- Clinical and Patient Support Contact
  - Lindsey Schaub: (e): lmschaub@agerightcs.com
Presbyterian Healthcare Services (PHS) with plans in select counties in NM
- Participating Presbyterian Senior Care plans include H3204-001, H3204-007 and H3204-008
- Submitting Notices of Election (NOE) and claims
  - Please submit NOEs via the Electronic Data Interchange (EDI) process, working with your clearinghouse. If you are unable to submit via EDI, please send the NOE to PHS’s secure email box: PHPHospiceNOE_NOTR@phs.org
- Contracted Providers may view and submit claim inquiries by going to this link: https://www.phs.org/providers/Pages/default.aspx and registering for the Provider Portal.
- For general inquiries, including contracting questions, contact PHS’s provider network Executives. A list of contacts is here: http://docs.phs.org/idc/groups/public/@phs/@php/documents/phscontent/pel_00140718.pdf
- View PHS’s frequently asked questions document at: https://mailchi.mp/2eeb4ad2ea87/presbyterian-shares-hospice-vbid-fact-sheet-and-faqs
SCAN Group with SCAN Health Plan in select counties in CA
- Participating SCAN Health Plan: SCAN Embrace I-SNP plans in CA: H5425-086, H5425-087 and H5425-091.
- For information on eligibility, claims/NOE submission, TCC benefits, and supplemental benefits, visit: https://www.scanhealthplan.com/vbid
- Providers may check member eligibility, register for SCAN’s clearinghouse Office Ally, and access other provider resources by visiting: https://www.scanhealthplan.com/providers
- For all VBID hospice inquiries, contact:
  - Primary: VBID Support team; (e):VBIDHospice@scanhealthplan.com
  - Secondary: Anthony Casillas; (e): a.casillas@scanhealthplan.com; (p): (562) 989-8321
  - Tertiary: Alison Foster; (e): afoster@scanhealthplan.com
UnitedHealth Group with plans in select counties in AL, IL, OK, and TX
- UHC Hospice Network Administrative Contact
  - Primary: Jennifer R. Smith; (e): hospicevbid@uhc.com; (p): 952-931-4041
  - Website: UHCprovider.com/mahospice
- Clinical – Provider/Patient Support Contact (Alabama, Illinois, Oklahoma)
  - Primary: Mindy Stewart-Coffee
  - Patient/Pre-Hospice Consult (p): 833-753-2970
  - Provider Clinical Inquiries (Transitional Concurrent Care) (p): 833-753-2970 (e): Support@envoycareadvocates.com
- Clinical – Provider/Patient Support Contact (Texas)
  - Primary: Elizabeth Lamb, (e): VBIDCCHospice@wellmed.net
  - Patient/Pre-Hospice Consult (p): 361-252-6978
  - Provider Clinical Inquiries (Transitional Concurrent Care) (p): 361-252-6978
Visiting Nurse Service of New York (VNSNY) with plans in select counties in NY
- Hospice Network Administrative Contact: James Biebel, (e): James.Biebel@vnsny.org (p): 646-477-4265
- Hospice Provider Billing: Tacheima Bien-Aime; (e): Tacheima.Bien-aime@vnsny.org
- VNSNY’s Hospice FAQ page: https://www.vnshealthplans.org/hospice-benefit/

Hospice Network Administrative Contact for MAO Participating in CY 2022 ONLY or CY 2021 and CY 2022 ONLY

AvMed with plans in select counties in FL
- Hospice Network Administrative Contact: Joseph Young, Director, Hospital and Ancillary Contracting; (e): joseph.young@avmed.org; (p): 305-671-5437, ext. 27300
- Secondary: Jacqueline Crews; (e): Jackie.crews@avmed.org; (p): 352-337-8832
Intermountain Health Care, Inc. with plans in select counties in ID and UT
- Primary: Chris Engh Secondary: Russell Gardner
- Primary (e): chris.engh@selecthealth.org Secondary (e): Russell.gardner@selecthealth.org;
- Primary (p): 801-442-9075; Secondary (p): 801-442-7282

Hospice Network Administrative Contact for MAO Participating in CY 2021 ONLY

Commonwealth Care Alliance, Inc. with plans in select counties in MA
- Kathy Devaney, (e): kdevaney@commonwealthcare.org and (p): 617-426-0600 Ext. 1306 and alternative (p): 857-216-8480
- The Commonwealth Care Alliance (CCA) Hospice VBID Page provides an overview of the program, important links and documents, examples of documents and notifications, sessions sign-ups and key CCA contacts.

Key:

(e): Email address

(p): Business phone number