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Providers

Our Providers Are Dedicated to High-Quality, Compassionate Care.

CommuniCare Advantage invites providers in our service areas who are committed to quality, compassionate care for residents enrolled in our ISNP (Institutional Special Needs Plan) or our CSNP (Chronic Condition Special Needs Plan) to join our growing network.

Medicare Advantage plans originated in the Balanced Budget Act of 1997 passed by the U.S. Congress. Originally known as Medicare+Choice or Part C plans, they became known as Medicare Advantage Plans following the Medicare Prescription Drug, Improvement and Modernization Act of 2003. These plans offer a more coordinated approach to healthcare for beneficiaries than traditional, fee-for-service Medicare. Special Needs Plans were also included in the legislation to address those who live in long-term care and those with chronic conditions (for CommuniCare Advantage, diabetes mellitus, chronic heart failure, and cardiovascular conditions).

ISNP. CommuniCare Advantage’s ISNP applies to residents who are living in a participating CommuniCare nursing home in selected Ohio, Maryland, and Indiana counties. Click here for a link to the counties and facilities.

CSNP. The CommuniCare Advantage CSNP covers individuals with diabetes mellitus, chronic heart failure, or cardiovascular disease who live in Baltimore City County, Maryland; Cuyahoga County or Hamilton County, Ohio; or Marion County, Indiana.

Note: To become a participating provider, at least one of your practice locations or facilities must serve members in one of our service areas as defined by the CMS access standard.

How CommuniCare Advantage Can Benefit Providers

CommuniCare Advantage is an HMO Medicare Advantage ISNP and CSNP. We contract with a network of healthcare providers in select counties in Indiana, Maryland, and Ohio. Our Plan offers providers several benefits:

  • To have the support of case managers to help coordinate and ensure delivery of high-quality, customized care in our nursing facilities
  • To be a part of a team of medical professionals that believes in keeping members healthy through the use of care coordination and personalized patient care
  • Medicare Fee Schedule reimbursement
  • A partnership with local, community-based leaders who understand your challenges because we are providers, too.

CommuniCare Advantage’s Model of Care is proactive and facilitates early evaluation and risk assessment through the following:

  • Health risk assessment and health risk stratification
  • The support of an interdisciplinary care team
  • An individualized care plan that addresses the unique goals, preferences, and clinical needs of the member
  • Proactive care coordination for ISNP members at a cadence appropriate to the member’s health needs
  • Care coordination and care transition coaching as needed for CSNP members to ensure understanding and adherence to treatment plans and reduce need for rehospitalization after an acute episode of care
  • Care transition management
  • Advance care planning
  • Active engagement with the member for all decision making and planning

Last modified: 01/04/2022

Discover the benefits of CommuniCare Advantage.
Call (855)-969-5869 to learn more.
CommuniCare residents call (855)-969-5861.