Members who select an in-network hospice are eligible to receive relevant TCC services as the member and their family move into hospice. This means that certain curative therapies and services related to the member’s terminal diagnosis may be continued after the member begins hospice to ease the transition to hospice and to keep the member’s usual care team engaged in the process. Examples of TCC include (but are not limited to): stepdown chemotherapy for members with a terminal cancer diagnosis, neurologist visits for those with a terminal Alzheimer’s disease diagnosis, behavioral health therapy visits, etc.

TCC services must be authorized by SCAN Health Plan at the time of hospice election. Members and/or their legal Power of Attorneys (POAs) should consult with their Embrace primary care provider on which TCC services are right for them. Upon hospice admission, the SCAN Embrace case management team will authorize any TCC services agreed upon by the member’s primary care team and member and/or POA. Members will then receive an authorization from SCAN Health Plan and can contact the specified provider to access those TCC services.

For more information about TCC or to request information about a specific TCC therapy or service, please contact the SCAN Embrace team at 855-828-7226 or SCAN Member Services at 1-800-559-3500 (TTY 711) or email VBIDHospice@scanhealthplan.com.

Members who select an in-network hospice are able to spend a one-time $500 allowance on any combination of the supplemental benefits below to support their social and emotional needs during the hospice election:

1. MemoryWell, professionally written life stories to help members share what matters most to them with their families and care providers – provided in-person or virtually. [For more information about the MemoryWell benefit option, visit https://www.memorywell.com/scan];
2. Anticipatory grief counseling sessions with a SCAN-contracted, licensed behavioral health provider provided via telehealth

SCAN has created bundled combinations of benefits within those two selections, and Members will be allowed to allocate their $500 across the two options as they choose during the hospice consultation process.

Through the VBID program, SCAN has partnered with its in-network hospice providers to deliver a coordinated care model. SCAN primary care providers have established direct connections with hospice care teams and frequently communicate updates on members’ care to ensure a seamless experience for members and their loved ones while on hospice. The SCAN case management team will continue supporting members after they’ve elected hospice. Members can reach the SCAN case management team at 855-828-7226.

Notice of Election (NOE) and Notice of Termination/Revocation (NOTR) should be submitted to both SCAN and to the Centers for Medicare and Medicaid (CMS) via your MAC as submitted today within five (5) calendar days of the hospice admission date.

Effective 5/22/2023, SCAN is no longer requiring NOEs, Certification of Terminal Illness, or hospice consents to be sent via email upon admission.

In instances where a NOE is not timely filed to SCAN, SCAN shall not cover and pay for the days of hospice care from the hospice admission date to the date the NOE is submitted to, and accepted by, the A/B MAC (HHH). These days shall be a provider liability, and the provider shall not bill the beneficiary for them. The hospice shall report these non-covered days on the claim with an occurrence span code 77, and charges for all claim lines reporting these days shall be reported as non-covered, or the claim will be returned to the provider.

Please notify the SCAN Case Management team by phone (855-828-7226) or email (VBIDHospice@scanhealthplan.com) or via TigerConnect within 24 hours of patient’s discharge, transfer, or revocation from hospice.

SCAN encourages Providers to submit claims electronically utilizing the EDI 837 Healthcare Claim Transaction. Providers can contact their Clearinghouse (provide SCAN’s Payer ID# SCAN1) and Practice Management System (PMS) vendor or Hospital Information System (HIS) vendor to establish EDI 837 connectivity with SCAN.

• Note: Provider submission must comply with current HIPAA EDI standards.
• SCAN Clearinghouse Information
  ◦ SCAN EDI 837 Vendor: SCAN partners with Office Ally at no cost to providers
  ◦ SCAN’s Payer ID#: SCAN1
  
• Office Ally Contact Information:
  ◦ Phone: (360) 975-7000 (Mon-Fri, 5am-9pm PST, Sat/Sun 6am-5pm PST)
  ◦ Email: info@officeally.com
  ◦ Live Chat: support.officeally.com
  
• SCAN Claims Contact Information:
  ◦ Phone: (800) 307-8003, Mon-Fri, 8am-4pm PST
  

You can access the provider section found near the bottom of the landing page. There you can register as a provider and access Office Ally and important provider information, including member eligibility verification tools or by visiting https://www.scanhealthplan.com/providers.

All claims should be submitted according to CMS requirements to be considered a clean claim.

Provider shall submit to SCAN bills for Covered Services monthly in accordance with Medicare billing requirements. Claims must be filed no later than the close of the period ending one (1) calendar year after the date of service. Claims submitted after one (1) calendar year after the date of service will be denied and Provider shall not bill the Member or the Member's estate, as applicable.

SCAN will pay clean claims within sixty (60) calendar days of receipt for contracted providers and within thirty (30) calendar days of receipt for non-contracted providers. Providers will receive payment in the amount indicated in the provider’s contract or at the Original Medicare rate. Payment will be reduced by contractually determined amounts and by CMS sequestration appropriate at the time of payment.

Payment will be in the form of a payment card or a check. For details on payment methods, please visit the SCAN Provider Portal or the Change Health Care website.

Copayments, deductibles, and coinsurance amounts (MOOP) found in a member’s plan may apply to select services while member participates in the SCAN hospice program.

Member balance billing (MBB) is strictly prohibited.  SCAN payments to providers are considered payment in full, less any copays, coinsurance, or deductibles – which are the financial responsibility of the Member. Providers are prohibited from seeking additional payment from Members for any other unpaid balances.

Claims status can be checked on-line via SCAN’s Provider Portal. To register, please go to https://www.scanhealthplan.com/providers and follow the registration process.

Contracted providers can file a provider dispute for claims disposition by accessing the provider portal and submitting an electronic request. SCAN will review the request for dispute, review the claim, review the contract, and provide feedback within fourteen (14) calendar days. Note some requests may require additional time to review and respond with a determination.

Non-contracted providers can submit a grievance/appeal by faxing their complaint to SCAN or by submitting the complaint through the provider portal.

Providers can access the Provider Operations Manual for details by accessing the SCAN Provider Portal.

Mail: 

SCAN Claims Department
PO Box 22698
Long Beach, CA 90801-5616

Fax: 562-997-1835
Provider Portal: https://www.scanhealthplan.com/providers

Mail:
SCAN
Attention: Claims – 2^nd Level Appeal
PO Box 22698
Long Beach, CA 90801-5616