NESP Centene Patient List Communication
Pharmacy has been doing the sow for NTC member that was on their patient list but now they are not on your list. Please document below for further research to see if they qualify to be on the "grandfathered" patient list. They MUST NOT be LTC or Dual eligible. You will be at risk for monthly reimbursement if we don't save NTC 2:1 (ie if we don't save the plan from doing this care)
Pharmacy Name
Pharmacy NPI
NTC Member Name
First Name
Last Name
Member Birthdate
-
Month
-
Day
Year
Date
Nebraska Total Care Member ID
Reason for Status change request
Patient IS NOT LTC or DUAL eligible (Medicare is now primary) and would benefit from Chronic Care Mgmt and we think we can get 2:1 ROI
IF member opted out, what was their reason?
Member Name
First Name
Last Name
Member Birthdate
-
Month
-
Day
Year
Date
Nebraska Total Care Member ID
Reason for Status change request
Patient IS NOT LTC or DUAL eligible (Medicare is now primary) and would benefit from Chronic Care Mgmt and we think we can get 2:1 ROI
Member Name
First Name
Last Name
Member Birthdate
-
Month
-
Day
Year
Date
Nebraska Total Care Member ID
Reason for Status change request
Patient IS NOT LTC or DUAL eligible (Medicare is now primary) and would benefit from Chronic Care Mgmt and we think we can get 2:1 ROI
Any additional communication/comments
NTC Patient Claims below cost
Submit
Should be Empty: