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The Administrative Care Coordination Unit (ACCU), is a program developed to guide and assist those community members with Medicaid, Medical Assistance and the Maryland Children’s Health Insurance Program through their benefits and serve as a resource.
If you are new to the Medicaid program and need assistance understanding your benefits, the ACCU can help to explain what is included in your coverage. After you have chosen a Managed Care Organization (MCO), the ACCU can help you to find a primary care doctor, pediatrician or specialist that accepts that MCO. Finding a provider “in network” with your MCO will help to ensure you get the most out of the benefits offered.
Under some circumstances, there are services that may not be covered. The first resource is to contact customer service using the number on the back of your insurance card. They can assist you by explaining why a service was not covered. You can also contact the ACCU/Ombudsman to help learn your options and connect with someone who can help to begin the appeal process to possibly have those services covered. An appeal is a process where the ordering provider submits extra documentation explaining why you would benefit from the service or why they feel it is necessary. The MCO will take a further look into the information and decide whether the service can be covered at that time.
The same goes for medications. Occasionally a medication is denied because the insurance would like you to try other selected medications before the one your provider ordered. You may have already tried them, and the insurance is just not aware. Through the appeal process the provider will submit documentation about your medication history and the necessity of the prescribed medication is evaluated and hopefully approved. The ACCU/Ombudsman can assist with helping keep you updated during this process, answer any questions and connect you with other parts of the care team to work to have your needs met.
The ACCU can also provide other resources and education. If your provider has recommended some routine and age related screenings and you are unsure if they are covered services, where to get them or what health benefits come from them, the ACCU can provide useful education and a list of providers where you can receive these covered services.
The ACCU can also provide assistance if you are having similar issues for a Medicaid covered child in your care. If the child has complicated health care needs and you are concerned about covered services and resources, the ACCU can offer guidance and resources. Sometimes those resources can be local program offerings that you may not have been aware of. Connections to care concerning mental health can also be provided.
