1. What is COPC Senior Care Advantage?
COPC Senior Care Advantage is an advanced population health model that provides higher quality, more efficient care for Medicare Advantage patients. In coordination with the locally operated health plans, this program will be effective January 1, 2018 and will include Medicare Advantage members that see a COPC primary care physician for their care.
In this program, most clinical and administrative services historically provided by the health plan are now provided by COPC Senior Care Advantage:
- COPC care management and disease management programs will be woven further into the medical care provided by COPC and the consulting specialists, where appropriate.
- Network provider contracting and credentialing will be performed under this model.
- Utilization management will be coordinated through COPC Senior Care Advantage.
- COPC Senior Care Advantage will also process and pay claims for healthcare services provide to patients, thereby allowing for quality and cost transparency to better serve our patient population.
2. What benefits does the COPC Senior Care Advantage program bring to our patients?
The COPC Senior Care Advantage program integrates our high-quality medical care with important administrative services; as a result, this new partnership will provide greater communication and coordination between primary care physicians and specialists. Additionally, COPC physicians and consulting specialists will have increased visibility to quantitative quality and cost metrics. The combination of a team-based approach (with care managers, nurses, social workers, care navigators, and physicians), along with the tools, data and technology to manage risk, results in patients receiving consistently high medical care from all physicians caring for them.
3. How do I contract with COPC Senior Care Advantage?
Questions regarding network contracting should be directed to COPCContracting@COPCAdvantage.com or (614) 350-2638.
4. Are other providers in the Columbus metro area also signing onto COPC Senior Care Advantage?
Yes, we are in discussions with specialists’ practices, health systems and ancillary providers to contract with us.
5. What are the benefits for providers to join the network?
COPC 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 COPC 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. Naturally, it will take time to put all the systems in place to begin the program for patients starting January 1, 2018. The COPC Senior Care Advantage medical leadership, headed by Dr. Mary Cook and Dr. Wulf, are providing the resources, support staff and attention to detail to ensure that the program will be ready to care for patients on January 1, 2018. We welcome your questions and ideas in the planning stage now to make the program even more successful.
7. What type of product is this: PPO, HMO?
The COPC 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?
Bill Wulf, M.D.: CEO of COPC
Mary Cook, M.D.: Medical Director, COPC Senior Care Advantage
Ben Shaker, President, COPC Senior Care Advantage
11. If I have questions about claims, referrals and credentialing, to whom do I direct those questions?
The COPC Senior Care Advantage team looks forward to your questions. For now, please direct all questions regarding administrative processes to COPCContracting@COPCAdvantage.com.
12. What are my rights as a provider being credentialed through CORE Care Select?
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 included 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 CORE Care Select at COPC Senior Care Advantage, 570 Polaris Parkway – Suite 250, Westerville, OH 43082. Fax number (614) 423-2873. 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 CORE Care Select, Inc. 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 CORE Care Select, Inc. within fourteen working days of your credentials file review date and/or the date that CORE Care Select, Inc. notified you of the discrepancy.
Upon receipt of your notification, CORE Care Select, Inc. 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 reverification 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.