Administrative Care Coordination/Ombudsman Program
This program provides education and outreach to Medical Assistance (MA) recipients to increase awareness of Medical Assistance Programs.
- Assists beneficiaries to navigate the Medicaid/HealthChoice Program
- Serves as a resource for beneficiaries and providers
- Helps beneficiaries to understand and utilize their Medicaid benefits
- Educates on the importance of preventive health care and appointment compliance
- Assists beneficiaries to re-enter the health care system
- Explains Managed Care Organization (MCO) choices and how to enroll or change
- Educates/assists with the need to select a primary care provider
- Assists with coordination of care, access to services and works with the MCOs to ensure beneficiaries receive covered services
- Assists with billing issues, pharmacy needs, transportation, etc.
- Investigates disputes between beneficiaries and the Managed Care Organizations (MCOs)
- Explains beneficiary appeal and grievance rights