What if a member exceeds the number of allowable trips per year?
A warning will pop up and not let you move forward with the trip creation without selecting a different insurance or changing the date of service to be a different calendar year.
How do I know what the coverage period is?
Coverage periods, if defined, will appear under the insurance section of the blue box during trip creation. They're also displayed on a member's profile in the insurance section.
Which insurance represents the D-SNP?
D-SNP insurance is identified by the following:
Group number must be "NMDSPN2"
Program ID number must be one of:
NMDSNPF2
NMDSNPP2
NMDSNPF3
NMDSNPP3
NMDSNPF4
NMDSNPP4
NMDSNPQ4
Do I have to select the D-SNP insurance first, as those trips need to be exhausted before moving to Medicaid?
The first-defined, active DSNP coverage will be auto-selected. If a member has a DSNP coverage defined in their profile, but it is not active, the next active coverage will be auto-selected. If a member does not have any active coverage, the inactive DSNP coverage will be selected if defined; otherwise, the first-defined coverage will be selected.
How do I know how many trips remain?
"Completed" and "scheduled" trip counts for the current calendar year are displayed in the blue box during trip creation. These two numbers can be added together to calculate the total number of trips exhausted by the selected coverage in the current year. Currently, there is no way to see trip counts for other calendar years. (we may also consider adding trip counts to the member profile, but this is not currently implemented)
What if I mistakenly book a trip over limit?
The system will prevent exceeding the limit. If, for any reason, the trip limit for a coverage is exceeded, future bookings with the same coverage will not be possible.
What happens if I reach my trip limit for D-SNP coverage when scheduling recurring trips?
If your trips exceed the yearly limit:
Schedule trips up to the limit, then book the rest through Medicaid.
Or, wait until the new calendar year to book the remaining trips once your trip limit resets.