Care Improvement Plus! This provider manual

qualify for programs that they may be entitled to. These programs can include: local, state, and federal
assistance programs.
SECTION B – ELIGIBILITY & PLAN DESCRIPTION
Eligibility Verification Procedure
Members should present their Care Improvement Plus ID card (or temporary proof of coverage if they
have not yet received their ID card) upon arrival for services. If a member is enrolled in our Dual
Advantage plan, they will also need to present their State Medicaid card. Providers are encouraged to
validate the identity of the person presenting an ID card by requesting some form of photo
identification, such as a driver’s license, in addition to the ID card. Please see Appendix A for an
example of our ID cards.
Member eligibility may be confirmed by visiting the secure provider self-service center at
www.careimprovementplus.com, or by calling a provider service representative at 1-866-679-3119,
Monday through Friday from 8:00 a.m. to 8:00 p.m.
The ID card does not guarantee eligibility. Member eligibility must be verified at each visit. Failure
to verify eligibility may result in delay or non-payment of claims.
Disease State Verification
Members that wish to enroll in a Care Improvement Plus Chronic Special Needs Plan must have their
disease state verified by a provider within 30 days of enrollment. A Chronic Condition Verification form
will be faxed to your office at the time of the beneficiary enrollment for your completion. See Appendix
I for a sample of this form. If we do not receive a completed form we will make an attempt to contact
your office via telephone.
Secure Provider Portal
The secure provider portal serves as a resource for providers. The portal allows providers to check
member eligibility and claims status as well as other services. To access the provider portal, visit our
website at https://www.careimprovementplus.com/providers/Default.aspx
Plan Description
Care Improvement Plus:
• Has an open access network, which means members may use any Medicare-approved provider
that will accept payment from Care Improvement Plus, however;
o Members that use an out-of-network provider may have higher costs for covered services
o Members in our Dual Advantage plan should use a provider that accepts Medicare and
Medicaid
• Because our Plan is a Regional/Local Preferred Provider Organization, if no contracted
network provider is readily available members can access care at in-network cost-sharing
from an out-of-network provider.
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