Context
When a beneficiary is enrolled in a Chronic Condition Special Needs (C-SNP) plan, the plan requires verification of the Chronic Condition. This verification is collected via the Verification of Chronic Condition (VCC) form. The Verification form must be completed by the beneficiary's primary care provider and submitted to the carrier providing the CSNP coverage. Typically, providers must submit VCC within 2 months of the member’s CSNP plan’s effective date.
If a member does not have a VCC submitted to the carrier, they will be voluntarily disenrolled from their plan and will need to enroll in a new one. If a member is disenrolled from their plan, they will be removed from the writing agent's book of business, unless the agent enrolls the member in a new plan. Members who are disenrolled have a 2-month "Loss of SNP" SEP to reenroll their client.
Carrier Verification Process
It is the members' responsibility to provide their VCC form to their PCP for submission to the carrier. Carriers will execute their own outreach to members enrolled in CSNP plans and their providers over the first 60 days of coverage. Carriers will notify agents of any outstanding VCC forms via email and through reporting in their portals. Carriers request that agents not contact providers directly for form submission, but rather connect with their clients to inform them and guide them through the verification process.
VCC Best Practices
Spark recommends that agents use the following best practices when supporting their clients through the chronic condition verification process:
Notify your CSNP clients of the requirement at the time of enrollment. It’s best that members are aware of the following:
The member’s Primarcy Care Physician (PCP) is required to verify the chronic condition that makes them eligible for CSNP coverage.
Providers verify this by completing a VCC form that must be submitted within the first 60 days of coverage. This process is common for providers to complete and is something they are aware of.
The beneficiary's new carrier will contact them when their coverage begins to inform them of the process.
You, as their agent, cannot complete the form for them, but can support in helping them in connecting with their provider.
Check your carrier portals regularly for any outstanding VCCs and contact your members regarding the form as soon as possible to remind them of the requirement.
Spark’s Client Services team can support your clients in completing the VCC process. For help from Spark, submit a Client Services ticket through your Spark platform account HERE.
Should your client be disenrolled from their CSNP coverage due to lack of verification of a chronic condition, they are eligible for the “Loss of SNP” SEP for 2 months to enroll in a new plan.
Carrier VCC Forms and Resources
Humana - must be submitted by the provider within 60 days of enrollment or the member will be disenrolled.
UnitedHealth - must be submitted by the provider within 60 days of enrollment or the member will be disenrolled.
Devoted - must be submitted by the provider within 60 days of enrollment or the member will be disenrolled.
Aetna - must be submitted by the provider within 60 days of enrollment or the member will be disenrolled.
HealthSpring - must be submitted by the provider within 60 days of enrollment or the member will be disenrolled.
SCAN
Anthem/Elevance
Pending carrier details.
Wellcare
Pending carrier details.