2 MEDICARE ADVANTAGE OVERVIEW
2.2 Plans serviced by IntegraNet Health
We have contracted with licensed health maintenance organization who have contracted with CMS to provide Dual-Eligible Special Needs Plans (D-SNPs), Chronic Special Needs Plan (C-SNPs), as well as traditional Medicare Advantage Prescription Drug health plans.
For Amerigroup/Anthem Medicare Advantage we are delegated for the following functions in the Houston, San Antonio and North Texas Markets:
Plans included are as follows:
All plans listed above include full Medicare Part D prescription drug coverage, as well as supplemental benefits covering other health care services beyond those offered by traditional fee-for-service Medicare. Not all plans are offered in all service areas or carry the same supplemental benefits. Please see the appropriate Summary of Benefits document online at https://providers.amerigroup.com or for more information.
Amerivantage Dual Coordination (HMO SNP), Amerivantage Dual Premier (HMO SNP), and Amerivantage Dual Secure (HMO SNP) are available to Medicare beneficiaries who are entitled to Medicare Part A (Part A), enrolled in Medicare Part B (Part B) and eligible for coverage of Medicare cost sharing and in some cases additional Medical Assistance from the state (either as full benefit dual-eligible, Qualified Medicare Beneficiary (QMB or QMB Plus), or Specified Low-income Medicare Beneficiary (SLMB Plus). (Low-income Subsidy [LIS] copays are by the state SNP Agreement). Any cost sharing applied to Medicare-covered medical services can be billed to the appropriate Medicaid carrier for process in accordance to the beneficiary’s Medicaid coverage. Please always refer to the Explanation of Payment (EOP) sent with each claim processed.
Amerivantage Dual Coordination (HMO SNP), Amerivantage Dual Premier (HMO SNP), and Amerivantage Dual Secure (HMO SNP) plans do not have out-of-network benefits. All out-of-network services must be authorized prior to rendering services.
Amerivantage Classic (HMO) and Amerivantage Select (HMO) plans are available to Medicare beneficiaries who are entitled to Part A and enrolled in Part B. These plans have copays for most services. Amerivantage Classic (HMO) and Amerivantage Select (HMO) plans do not have out-ofnetwork benefits. All out-of-network services must be authorized prior to rendering services.
Amerivantage COPD (HMO SNP), Amerivantage Diabetes (HMO SNP), Amerivantage Heart (HMO SNP), and Amerivantage ESRD (HMO-POS SNP) are Chronic Condition Special Needs Plans (C-SNPs). C-SNPs restrict enrollment to special needs individuals with specific severe or disabling chronic conditions. C-SNPs focus on monitoring health status, managing chronic diseases, avoiding inappropriate hospitalizations and helping beneficiaries move from high risk to lower risk on the care continuum.
We are contracted for Network Management for the following plans, but Utilization Management (UM), Case Management, Claims, Customer Service, etc. are administered by the respective health plans: