VBID Model Hospice Benefit Component Participating Plans

VBID Model Hospice Benefit Component Quick Links:

Overview  |  Coverage  |  Participating Plans  |  Billing & Payment  |  Outreach & Education  |  FAQs

Under the Value-Based Insurance Design (VBID) Model, in Calendar Year (CY) 2024, thirteen Medicare Advantage Organizations (MAOs) will participate in the Hospice Benefit Component, offering 78 plan benefit packages (PBPs).

Highlighted Contacts for MAOs Participating in the Hospice Benefit Component in CY 2024

• Cambia Health Solutions with plans in select counties in OR, UT, and WA
  • Hospice Network Administrative Contact [Hospice provider network / contracting assistance]
  • Amy Kraft, (e): Amy.Kraft@regence.com; (p): 503-553-5055
  • Provider Administrative Support Contact [Member eligibility, claims billing, etc.] Provider Customer Service, (p): 800-253-0838 Provider Website: https://www.regence.com/provider/products/medical/medicare
• CVS with plans in select counties in OH and PA
  • Provider - Administrative Support Contact [Member eligibility, claims billing, etc.] Martisha Upson, (e): upsonm@aetna.com, (p):  860-996-3723 
  • Clinical – Provider/Patient Support Contact (p): 833-433-1197 MedicareCMDirectReferrals@AETNA.com [Notices of Election (NOEs) should be sent to this secure email] 
  • For all other VBID hospice inquiries, contact: 
    • Primary: Rose Mollitor, (e) mollitors@aetna.com, (p): 202-510-3089 
    • Secondary: Gabby Oron, (e) orong@aetna.com, (p): 860-306-8715
• First Sacramento Capital Funding dba ProCare Advantage Plan with plans in select counties in TX
  • Primary Contact: Sarah Daggs; (e) sdaggs@elysianhospice.com (p) 817-343-3421
• Guidewell Mutual Holding Corporation with plans in select counties in PR
  • Primary Contact: Myra M. Velez Plumey, (e): myra.velez@ssspr.com; (p): 787-749-4949 ext. 832-6354
  • Secondary Contact: Provider’s Call Center: 1-855-886-7474
• Hawaii Medical Service Association with plans in select counties in HI
  • Primary Contact: (p): *Oahu – 1-808-948-6330 or *Neighbor Islands – 1-800-790-4672 toll-free
  • Website for providers: https://prc.hmsa.com/s/article/Medicare-Advantage-Hospice-VBID-TCC
  • Secondary: Dr. Toby Smith; (e): toby_smith@hmsa.com
• Highmark Health with plans in select counties in PA
  • Primary:  Anthony Zambino, (e): Anthony.Zambino@highmark.com; (p): 302-421-3122
  • Hospice Network Administrative and Clinical/Patient Support Contacts: 
    • Monica Valeri, (e): Monica.Valeri@helionhealthcare.com; (p): 412-544-8069
    • Neyrissa Bodnar, (e); Neyrissa.Bodnar@helionhealthcare.com; (p): 4212-544-8069
    • General; (e): HelionNetworkOperations@helionhealthcare.com; (p): 412-544-8069 
• Humana Inc. with plans in select counties in CO, FL, GA, IN, KY, OH, VA, and WI
  • Primary: Kevin Curey, (e): kcurey@humana.com; (p): 502-580-4059
  • Secondary: Susanne McComic, (e): smccomic1@Humana.com; (p) (858) 449-18002
  • Provider-facing Mailbox: hospiceVBID@humana.com
  • Humana’s information for hospice providers: https://www.humana.com/hospice
• Kaiser Foundation Health Plan, Inc. with plans in select counties in CA
  • There are two steps to submit notices and claims for Kaiser Permanente Senior Advantage Ventura County Plan (H0524-034 and H0524-083) members:
    • Send the Notice of Election to KP-NOE@kp.org; and 
    • Submit claims via the Electronic Data Interchange (EDI) process. To sign up for EDI, please contact your clearinghouse and provide the appropriate payer ID.
  • Where do you get more information for Kaiser Foundation Health Plans, Inc?
    • Registering for the Online Affiliate portal allows you to check member benefits, eligibility, and submit provider disputes. To register for access to KP Online Affiliate Link, visit: http://providers.kaiserpermanente.org
    • Alternatively, for questions regarding member benefits and/or eligibility, please call Kaiser Permanente Member Services at 1-800-443-0815.
    • For questions regarding claims payment and/or to receive a Kaiser Permanente Provider Payment Dispute Resolution Form, please call Kaiser Permanente Claims Services at 1-800-390-3510
  • For all other questions regarding hospice:
    • Administrative: email scalhcs-divert@kp.org
• Louisiana Health Services and Indemnity Company with plans in select counties in AR, LA, and MS
  • Hospice Network Administrative Contact: Monica Suire; (e): monica.suire@bcbsla.com; (p): (225) 298-1916
  • Clinical and Patient Support Contact: Lynne LeBlanc; (e): lleblanc@vhpla.com; (p): (318) 998-3261
  • Provider website: https://www.vantagehealthplan.com/physicians/comfortcare
• Marquis Advantage, Inc. dba AgeRight Advantage Health Plan H1372-001 in select counties in OR
  • Primary Contact: Lindsey Schaub; (e): lmschaub@agerightcs.com, (p): 971-206-5179
  • Secondary Contact: Provider Call Center; (p) 1-844-854-6885 or website: https://agerightadvantage.com/for-providers/provider-documents/
  • Other Information: Please submit NOEs via the Electronic Data Interchange (EDI) process, working with your clearinghouse. Alternatively, you may submit the NOE form to the AgeRight Advantage Health Plan secure mailbox: HospiceNOE@agerightadvantage.com
  • Provider website: https://agerightadvantage.com/providers/ 
• SCAN Group with SCAN Health Plan in select counties in CA
  • Participating SCAN Health Plan: SCAN Embrace I-SNP plans in CA: H5425-086, H5425-087 and H5425-091.
  • Primary Contact: VBID Support team; (e):VBIDHospice@scanhealthplan.com; (p): (855) 828-7226
  • Secondary Contact: Elise Smith, (e): e.smith@scanhealthplan.com; (p): (562) 308-2817 and Alison Foster; (e): afoster@scanhealthplan.com
  • For information on eligibility, claims/NOE submission, TCC benefits, and supplemental benefits, visit: https://www.scanhealthplan.com/vbid
  • Providers may check member eligibility, register for SCAN’s clearinghouse Office Ally, and access other provider resources by visiting: https://www.scanhealthplan.com/providers
  • For urgent clinical inquiries, please contact the SCAN Mobile Care Team care management team by phone at (855) 828-7226
• Sentara Health Care (dba AvMed Inc.) with plans in select counties in FL
  • Hospice Network Administrative Contact: Ian Andes (e) ian.andes@avmed.org (p) 305-671-5437, ext. 24987
  • Clinical and Patient Support Contact: Ellis Seligman (e) ellis.seligman@avmed.org (p) 352-372-8400, ext. 40783 
  • Additional Contacts: Lynn Williams, RN, BSN, MBA, CCM (e) lynn.williams@avmed.org (p) 954-627-6238
• Visiting Nurse Service of New York (VNSNY) with plans in select counties in NY
  • Primary Contact: Jonathan Powell, (e): jonathan.powell@vnshealth.org
  • Other Hospice Network Administrative and Clinical/Patient Support Contacts:
    • Hospice Network Administrative Contact: James Biebel, (e): James.Biebel@vnshealth.org (p): 646-477-4265
    • Hospice Provider Billing: Vivienne Broughton; (e): vivienne.broughton@vnshealth.org
    • Clinical and Patient Support Contact: (e): Esther.Conteh@vnshealth.or
  • VNSNY’s Hospice FAQ page: https://www.vnshealthplans.org/hospice-benefit/

Highlighted Contacts for MAOs Previously Participating in the Hospice Benefit Component in CY 2021, CY 2022, and/or CY 2023

The list of MAOs below have participated in the Hospice Benefit Component in CY 2021, CY 2022, and/or CY 2023 but not in CY 2024. For more information on the specific years of participation for each MAO, please reference the downloadable list of PBPs above.

• Catholic Health Care System (CHCS) with plans in select counties in NY
  • Hospice Network Administrative Contact: Victor Fama; (e): vfama@archcare.org; (p): 646-584-7984
• Commonwealth Care Alliance, Inc. with plans in select counties in MA
  • Kathy Devaney, (e): kdevaney@commonwealthcare.org and (p): 617-426-0600 Ext. 1306 and alternative (p): 857-216-8480
  • The Commonwealth Care Alliance (CCA) Hospice VBID Page provides an overview of the program, important links and documents, examples of documents and notifications, sessions sign-ups and key CCA contacts.
• Elevance Health, Inc. (MMM Healthcare, LLC) with plans in select counties in PR
  • Primary Contact: Myra Plumey Rivera, (e): myra.plumey@mmmhc.com; (p): 787-379-3327
  • Secondary Contact: Marieva Hiraldo Espada; (e): marieva.hiraldo@mmmhc.com; (p): 787-223-1672
• Intermountain Health Care, Inc. with plans in select counties in ID and UT
  • Primary: Chris Engh; (e): chris.engh@selecthealth.org; (p): 801-442-9075
  • Secondary: Russell Gardner (e): Russell.gardner@selecthealth.org; (p): 801-442-7282
• Presbyterian Healthcare Services (PHS) with plans in select counties in NM
  • Participating Presbyterian Senior Care plans include H3204-001, H3204-007 and H3204-008
  • Submitting Notices of Election (NOE) and claims: please submit NOEs via the Electronic Data Interchange (EDI) process, working with your clearinghouse. If you are unable to submit via EDI, please send the NOE to PHS’s secure email box: PHPHospiceNOE_NOTR@phs.org
  • Contracted Providers may view and submit claim inquiries by going to this link: https://www.phs.org/providers/Pages/default.aspx and registering for the Provider Portal.
  • For general inquiries, including contracting questions, contact PHS’s provider network Executives. A list of contacts is here: http://docs.phs.org/idc/groups/public/@phs/@php/documents/phscontent/pel_00140718.pdf
  • View PHS’s frequently asked questions document at: https://mailchi.mp/2eeb4ad2ea87/presbyterian-shares-hospice-vbid-fact-sheet-and-faqs
• UnitedHealth Group with plans in select counties in AL, IL, OK, and TX
  • UHC Hospice Network Administrative Contact: Jennifer R. Smith; (e): hospicevbid@uhc.com; (p): 952-931-4041
  • Website: UHCprovider.com/mahospice
  • Mindy Stewart-Coffee
  • Patient/Pre-Hospice Consult (p): 833-753-2970
  • Provider Clinical Inquiries (Transitional Concurrent Care) (p): 833-753-2970 (e): HospiceTCC@optum.com
  • Clinical – Provider/Patient Support Contact (Texas)
    • Connie Molina, (e): VBIDCCHospice@wellmed.net
    • Patient/Pre-Hospice Consult (p): 361-371-3710
    • Provider Clinical Inquiries (Transitional Concurrent Care) (p): 361-371-3710