We thought it would be helpful to explain the verification process for the HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) plan.
As a reminder, your clients are eligible for this plan if they:
- Are entitled to Medicare Part A and are enrolled in Medicare Part B
- Live in one of the following North Carolina counties: Alamance, Davidson, Davie, Forsyth, Guilford, Randolph, or Rockingham
- Are a United States citizen or lawfully present in the United States
- Have been diagnosed with diabetes and/or chronic heart failure (CHF)
Here’s what happens once you enroll your client into the Diabetes & Heart Care (HMO C-SNP) plan:
- Regardless of whether provider verification of the chronic condition has been received, upon enrollment, the member will receive a letter acknowledging enrollment into the plan.
- HealthTeam Advantage will make every attempt to obtain provider verification and confirm the chronic condition prior to the effective date of coverage. Clients DO NOT need to take the form to their doctor. It should be submitted with the application.
- C-SNP Provider Verification Form >
If verification of the chronic condition is not achieved by the effective date, HealthTeam Advantage has until 30 days after effective date to confirm eligibility. Our Provider Services and Healthcare Concierge teams will continue to pursue verification (and therefore eligibility) on behalf of the enrollee.
If the enrollee’s condition cannot be confirmed within the above timeframe, HealthTeam Advantage will process a disenrollment. The enrollee will be sent a disenrollment notification for not having a verified diagnosis of either diabetes or CHF. The disenrollment will be effective at the end of 30 days (two months after the effective date of enrollment) unless subsequent confirmation of either diagnosis is obtained.
Please contact Agent Support if you have any questions about this process.