1. What is Connected Senior Care Advantage?
Connected Senior Care Advantage is an advanced population health model that provides higher quality, more efficient care for Medicare Advantage patients. In coordination with locally operated health plans, this program was effective on January 1, 2019. It includes Medicare Advantage members that see an Austin Regional Clinic (ARC), Premier Family Physician (PFP), or Capital Medical Clinic (Capital Medical) primary care physician for their care.
In this program, most clinical and administrative services historically provided by the health plan are now provided by Connected Senior Care Advantage for our WellCare members:
- Connected Senior Care Advantage population health management will be woven further into the medical care provided by Connected Senior Care Advantage and the consulting specialists, where appropriate.
- Network provider contracting and credentialing will be performed under this model.
- Utilization management will be coordinated through Connected Senior Care Advantage.
- Connected Senior Care Advantage may also process and pay claims for healthcare services provided to patients, thereby allowing for quality and cost transparency to better service our patient population.
2. What benefits does the Connected Senior Care Advantage model bring to our patients?
The Connected Senior Care Advantage model integrates high quality medical care with important administrative services. As a result, it will provide greater communication and coordination between primary care physicians and specialists. The combination of a team-based approach, along with the tools, quantitative quality and cost metrics, and other data and technology to manage risk, results in patients receiving consistently high medical care.
3. How do I contract with Connected Senior Care Advantage?
Questions regarding network contracting should be directed to CSCAContracting@connectedseniorcare.com or (737) 236-0999 or Toll Free at (833) 282-8883.
4. Are other providers in the Greater Austin area also contracting with Connected Senior Care Advantage?
Yes, most large groups and health systems in the Austin area are contracted with Connected Senior Care Advantage.
5. What are the benefits for providers to join the network?
Connected Senior Care Advantage would like to work with like-minded providers who share our philosophy and standard for delivering the highest quality of care, service and support for our Medicare Advantage patients. As healthcare providers make the shift from a fee-for-service to value-based reimbursement world, new partnerships will be essential for physicians and health systems as they will be required to redesign their care delivery process to deliver higher quality outcomes, become more efficient and reduce unnecessary costs.
In this partnership, we’ll be able to have a clearer view on patient history and more data and analysis than we have had before for quality and cost metrics. This program is a natural building block with our provider colleagues who join our Connected Senior Care Advantage network to offer a more coordinated healthcare experience for our patients.
6. What is the downside for me?
We don’t see any downside. The Connected Senior Care Advantage medical leadership, headed by Dr. Kevin Spencer, are providing the resources, support staff and attention to detail that will help to ensure the program’s success. We welcome your questions and ideas.
7. What type of product is this: PPO, HMO?
The Connected Senior Care Advantage program will provide care and services for patients with both PPO and HMO coverage.
8. What types of plans are included: e.g., commercial, Medicare, Medicaid?
Only Medicare Advantage for now.
9. Could signing this contract bind me to other types of insurance, e.g., Worker’s Comp, discount networks, national PPO’s?
No, it is not exclusive.
10. Who is the leadership team that will be involved in managing this partnership?
Patti Parker, President, Austin Market
Kevin Spencer, MD: Medical Director, Connected Senior Care Advantage
11. If I have questions about claims, referrals and credentialing, to whom do I direct those questions?
Please direct questions to our customer service team at 737-236-0999.
12. What are my rights as a provider being credentialed through Connected Senior Care Advantage?
The Provider has the right, upon request, to be informed of the status of his/her credentialing application. The Provider has the right to review the information submitted in support of his/her credentialing application.
As an applicant for credentialing/recredentialing, you have a right to review non-privileged information obtained for the purpose of evaluating your application. This includes information obtained from outside sources such as liability insurance carriers, Medical Boards, National Practitioner Data Bank. It does not include review of information that is privileged, such as references or recommendations which are protected by law from disclosure.
You may request to review such information at any time by sending a written request via fax or letter to the Credentialing Committee Chairperson at Connected Senior Care Advantage, 6210 U.S Hwy 290 E., Suite 450, Austin TX 78723. Fax number (512) 960-1193. Following receipt of your request, you will be contacted by the Credentialing Committee Chairperson, or his/her designee, within three working days to arrange a date and time for review of the information in the Credentialing Department.
You will be notified in writing, by fax or letter, when information obtained by primary source varies significantly from information provided on your application. Sources will not be revealed in information obtained is not intended for verification of credentialing elements or is protected from disclosure by law.
If you believe that erroneous information has been supplied to Connected Senior Care Advantage by primary sources, you may correct such information by submitting written notification to the Credentialing Committee Chairperson at the above cited address/fax number. Your notification, via letter or fax, must include a detailed explanation of the discrepancy and must be returned to Connected Senior Care Advantage within fourteen working days of your credentials file review date and/or the date that Connected Senior Care Advantage notified you of the discrepancy
Upon receipt of your notification, Connected Senior Care Advantage will re-verify the primary source information under consideration. If the primary source information has changed, an immediate correction will be made to your credentials file. You will be notified of this action. If the primary source information remains inconsistent with your notification, you will be advised of same through letter or fax. You will be requested to provide proof of correction by the primary source to Credentialing Committee Chairperson via letter or fax as cited above within ten working days. Subsequently, a second re-verification of primary source information will be performed. If, after ten working days, primary source information remains inconsistent and in dispute, you will be subject to adverse action up to administrative termination.