Limited Income Newly Eligible Transition NET Program

1
Limited Income Newly Eligible Transition (NET)
Program

• Medicaid Subrogation

2
What is new for 2010?

• The POS FE / WellPoint POS program becomes the
  Limited Income NET program and will be
  administered by Humana.
• CMS will auto-assign Full Benefit Dual-Eligible
  Beneficiaries with a retroactive enrollment
  period to the LI NET Program.
• The LI NET Program will accept and process
  Medicaid Subrogation claims for these members.

3
What is the Process for a Medicaid Agency?

• Identify State Medicaid members who have
  retroactively become Full Benefit Dual-Eligible
  Beneficiaries.
• Identify Medicaid paid claims for these members.
• Submit these claims via electronic data file to
  the LI NET Program.

4
What will LI NET do?

• The LI NET Program will process the claim file.
• LI NET Program will send an electronic report
  listing the outcome of each claim to the Medicaid
  Agency.
• LI NET Program will mail a check with supporting
  details for paid claims to the Medicaid Agency.

5
What is Needed to Process Claims?

• General data elements for pharmacy claim
  processing for example
• Beneficiary HICN
• Prescription date of fill
• Prescriber ID
• Pharmacy ID
• NDC
• Pay-to information
• Medicaid Agency Tax ID Number
• Address to mail the check
• Name to put on the check

6
Coming Soon

• Checklist for submitting claim data files
• FAQs Frequently Asked Questions
• More info on how to contact the LI NET Program
  for Medicaid Subrogation