The Department of Health regulations require certain services to be approved in advance (prior approval).  They include non-routine services such as environmental modifications, vehicle modifications, assistive technology, private duty nursing, hearing aids, custom made durable medical equipment, specialty drugs, experimental treatments, travel expenses for medical care, myo-electric limbs and respite care exceeding 1080 hours in a calendar year.

Yes.  The regulations developed by the Commissioner of Health establish an administrative review process.   A request for review form must be submitted within 30 days of receipt of a denial.  The enrollee may request a document-based review or a hearing, to be conducted by a hearing officer.

Claims must be submitted to the Public Consulting Group within 90 days of the date of service. Claims for qualifying health care costs will be paid within 45 days of receipt of an acceptable claims form. A request for permission to submit a claim later than 90 days from the date of service may be granted by the Fund Administrator upon a showing of good cause for the delay.

Beginning on September 1st, 2018, PCG will assume MIF Administrator responsibilities. As the MIF Administrator, PCG will be responsible to handle the day-to-day Fund operations, including, program enrollment, case management services and prior approval of certain claims and communicating approvals to the Claims Administrator. In order to understand your specific case management needs, PCG may be asking you to update your case information.

With PCG serving as the MIF Administrator, you may see some program and operational changes. For example, your currently assigned Case Manager will change. However, both the Department and PCG are committed to ensuring that this transition is completed as smoothly as possible.

There is no action required from MIF enrollees and families. By September 1, you will receive a letter introducing you to your new case manager. Each case manager is a registered nurse or licensed healthcare provider with multiple years of experience providing case management services. We ask that you review your case manager’s information and to expect PCG to contact you directly.

The Medical Indemnity Fund is committed to improving your case management experience and has chosen a provider that is an expert in health care management. PCG has a track record of successfully implementing healthcare programs for a wide range of communities and has over 30 years of experience working in the public sector implementing health and human services programs. For more information on PCG, please refer to: http://www.publicconsultinggroup.com.

Over the course of the next several weeks, the Department and PCG will be providing additional information on the transition process. Each enrollee will receive a follow-up letter in the coming weeks, providing contact information for your newly assigned case manager, as well as other general contact information to assist you.