Minnesota Senior Care Plus (MSC+)

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Question mark in a bubbleQuestions? Need help? Call Member Services! All calls during business hours are answered by a person, not a machine. We're here to help you. You can also go to the PrimeWest Health Member Web Portal to get more information about your services, to contact us, or to ask for print copies of your member materials.

Program Description

Minnesota Senior Care Plus (MSC+) is a program for people age 65 and over who have Medical Assistance (Medicaid). People apply for Medical Assistance (Medicaid) through their county Social/Human/Family Services/Tribal office. While you are in PrimeWest Health's MSC+ program, you will work with a county case manager. Your county case manager can help you arrange health care and support services. County case managers and PrimeWest Health care coordinators work together to help you maintain your health whether you live in your own home or in a care facility.

To get the most up-to-date information about the Medical Assistance (Medicaid) program, go to the Minnesota Department of Human Services (DHS) website.

Enrollment/Eligibility

To apply for Medical Assistance (Medicaid) coverage, contact the Social/Human/Family Services department for your county or the Tribal office. If you are eligible for Medical Assistance (Medicaid), you will be able to enroll in PrimeWest Health MSC+ for your covered services if you live in our service area. Our service area includes the following counties: Beltrami, Big Stone, Clearwater, Douglas, Grant, Hubbard, McLeod, Meeker, Pipestone, Pope, Renville, Stevens, and Traverse.

Note: People who qualify for MSC+ and have Medicare may also qualify for PrimeWest Senior Health Complete (HMO SNP). To learn more, visit the PrimeWest Senior Health Complete (HMO SNP) section of this website.

Benefits

To learn about the benefits and coverage provided by MSC+, read the Member Handbook. It gives details about the health care services we cover. It tells how to get your health care as a PrimeWest Health MSC+ member. It also explains the rights, benefits, and responsibilities of members. 

Organization Determinations
PrimeWest Health has made an organization determination when it makes a decision about whether items or services are covered or how much you have to pay for covered items or services. Organization determinations are also called “coverage decisions” in the Member Handbook. Standard organization determinations are made as quickly as the member’s health condition requires and not more than 14 calendar days (10 business days) from the date we get the request. Expedited organization determinations are made as quickly as the member’s health condition requires and not more than 72 hours from the date we get the request. Expedited organization determinations are for cases where the provider or PrimeWest Health decides that following the standard time frame could seriously jeopardize the member’s life or health, or ability to attain, maintain, or regain maximum function. You can ask for an organization determination in either of the following ways:

  1. By Phone
    If you call us, we will need to get more information from your health care provider. Start by calling Member Services.
  2. By Mail or Fax
    You and your health care provider can print and fax or mail the Medical Service Authorization Request Form. Your provider can download the form from the Service Authorization page of our website. The form should be sent to:

    Mail: PrimeWest Health Service Authorization
            3905 Dakota St
            Alexandria, MN 56308

    Fax: 1-866-431-0804 (toll free)

Providers and Pharmacies

Prescription Drug Benefits

Drug Coverage

  • To see if specific prescription drugs are covered by PrimeWest Health MSC+, see the List of Covered Drugs or use our online search feature. Note: If you have other insurance coverage, contact that insurance plan for information about its drug coverage. If you have Medicare, you must enroll in a Medicare Prescription Drug Plan (Part D) to get most of your prescription drug services. PrimeWest Health will not pay for any Part D eligible drugs when you have Medicare through another plan.
  • To see if your drug is considered a specialty drug, see our Specialty Drug List. You must use MedImpact Direct Specialty network to fill specialty drug prescriptions. The Specialty Drug List tells how to do this. If you or your provider have questions, call 1-855-873-8739 (toll free; TTY 711).
  • To see if any of your over-the-counter drugs are covered by PrimeWest Health MSC+, use our online search feature. The items included there are covered when you have a prescription from your health care provider or pharmacist.
  • If the drug you are taking is not on our List of Covered Drugs, read the Member Handbook to find out what you can do. This includes instructions for both new and current members.
  • If you want help managing your prescription drugs, read about our Medication Therapy Management program and its eligibility requirements.

Restrictions on covered drugs
Some drugs have restrictions on coverage. The restrictions are called Utilization Management (UM) programs. UM programs include Prior Authorization, Quantity Limits, and Step Therapy. Read more about our Utilization Management programs.

You may ask for an exception to the drug coverage and restriction rules by using the Formulary Exception Form. Note: This form must be completed by a health care provider. You can also submit an online Formulary Exception.

Cost Sharing (copays/deductibles/premiums)

Cost sharing refers to your responsibility to pay an amount towards your medical costs. For more information about what cost sharing you may have, see the Member Handbook or call Member Services.

Appeals and Grievances (complaints)

If you disagree with a decision or have a complaint about your health care, services, or coverage, you may file a Grievance (complaint) or Appeal. You may use the online PrimeWest Health Member Appeal and Grievance Form to submit your Grievance or health plan Appeal. If you do not agree with the outcome of your health plan Appeal, you can request a State Appeal (State Fair Hearing).  Read more about the processes for doing any of these things in the Member Handbook.

Member Outreach

PrimeWest Health hosts stakeholder meetings for our members. These meetings give members and their advocates and providers a chance to learn about their benefits and how to navigate the health care system. Members, advocates, and providers share their ideas, opinions, concerns, and suggestions about the services offered by PrimeWest Health. This stakeholders’ group has helped PrimeWest Health identify and put in place changes to provide better service to our members. If you want to see a copy of the minutes from the stakeholders’ meetings, call Member Services.

Contact Us

Call: Member Services: 1-866-431-0801
TTY users: 1-800-627-3529 or 711
Hours are Monday – Friday, 8 a.m. – 8 p.m.

Utilization Management: 1-866-431-0803
  Questions about where to get services, getting authorization for services, or restrictions on prescription drugs
Hours are Monday – Friday, 8 a.m. – 4:30 p.m.

Calls to all of these numbers are free.
 
Write:

PrimeWest Health
3905 Dakota St
Alexandria, MN 56308

 

Email: To contact Member Services through secure email, sign in to the Member Web Portal.

Member Web Portal

Log in to the PrimeWest Health Member Web Portal to view your benefits and member information. Once logged in, you can do the following:

  • Ask for a new member ID card
  • Update your member information
  • Complete a Health Risk Assessment and use online tools to keep you healthy
  • Ask to have disease management or care management services
  • Ask questions
  • Ask for materials
  • View services that need authorization
  • View eligibility and claims status 
  • Find information about copays, drug-drug interactions, and drugs' common side effects

How does our website work for you? If you have comments, questions, or feedback about our website, please call Member Services. We look forward to hearing from you!

PW_10-18_405
DHS_Approved_12/07/2018
Updated_02/05/2019