Learn More. The Peer-to-Peer request must be received by Maryland Amerigroup maryland prior authorization Care within two 2 business days of the initial notification of the denial. The intent of the Peer-to-Peer is to discuss the denial decision with the ordering clinician or attending physician. For specific details prioe authorization requirements, please refer to our Quick Reference Guide. Certain carefirst mental providers require prior authorization regardless of place of service.
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Of the adult Medicaid members served by CareSource each year, more than 50, — or approximately one in 12 — have had at least one booking in a local jail. Individuals who are incarcerated experience health risks that are disproportionate compared to the general population. The heightened risks of contracting COVID and other infectious diseases while incarcerated — combined with disproportionate rates of comorbid chronic medical conditions, substance use disorder, and mental illness — indicate that the need for more efficient and timely care has never been greater.
The cost of recidivism is high. One of the most important ways to meaningfully reduce recidivism rates is to ensure that formerly incarcerated individuals have their physical and behavioral health treatment plans resume as soon as they return to the community.
This would contribute to better outcomes in individual member health, public health in the case of infectious diseases , and public safety. CareSource faced numerous challenges navigating a system fractured by limited healthcare data sharing and uncoordinated reentry after incarceration. First, it can be difficult to identify individuals entering and exiting incarceration.
By law, Medicaid members who are incarcerated should have their coverage suspended, but there is no consistent, reliable, real-time data sharing between local jail systems, managed care, and community health providers. With more than 60 full-service jails and smaller holding facilities across the region all using separate jail management systems, identification of those entering and leaving incarceration is uncoordinated. To improve continuity of care for justice-involved members, CareSource began developing a coordinated effort among healthcare, criminal justice, and social services systems.
Second, it is challenging both to improve health outcomes for incarcerated individuals and to reduce medical costs. There is also a lack of consensus on how to define, target, and measure improvement in health outcomes, and a general disengagement with the healthcare system among jail-involved Medicaid members.
CareSource first began working with Appriss Insights to develop a solution in Incarceration data supplied by Appriss Insights provide relevant information about individuals engaged with the criminal justice system in near-real time. These individuals often require more health resources, and a more integrated, efficient system can ensure that they have access to the care they need.
Detailed and up-to-date criminal justice data further empower CareSource to develop improved tools for prioritizing care and support for these members. Through its proprietary incarceration data, Appriss Insights has helped CareSource improve coordination between the healthcare and criminal justice systems, assist CareSource in identifying individuals entering and exiting incarceration, and meaningfully stratify health needs and outcomes for justice-involved people — potentially reducing recidivism.
Through this partnership, CareSource has been able to identify roughly 7, justice-involved members per month, of which:. Additionally, the integration of jail management system data helps CareSource to identify population needs and utilization patterns that are specific to justice-involved members, informing strategies to work across systems and improve outcomes.
For example, the jail-involved population costs 1.
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|Caresource login only has 9 digits||About Appriss Insights Appriss Insights delivers breakthrough data and analytics solutions to reduce people-based risk, mitigate fraud and fight crime. Staying in touch is easy caresource login only has 9 digits the CareSource mobile app. Create New Account. Appriss Insights delivers breakthrough data and analytics solutions to reduce people-based risk, mitigate fraud and fight crime. See all. CareSource has been able to identify roughly 7, justice-involved members per month, of which:. Especially those who have the mindset of serving the learn more here or who have taken the initiative, may God bless them very much.|
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