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Delaware | Winter 2015

Community Plan

Practice Matters: DE - Winter 2015 Provider Services Center: 800-600-9007

Important information for health care professionals and facilities

In This Issue...• Taking Steps toward Quality Improvement

• Encouraging Members to Get Vaccinated

• A Member’s Right to Culturally Competent Care

• Where to Get Pharmacy Updates

• Enroll in Electronic Payments & Statements

• Special Needs Plan Model of Care Training

• Care Providers Should Seek Opportunities to Provide Wellness Exams

• Primary Care’s Role in Screening for Depression

• Interpreter Services Available for Office Visits

• Access and Availability Standards for Mental Health Practitioners

We hope you enjoy the winter edition of Practice Matters. In this issue, you can read about quality improvement efforts, managing electronic payments, interpreter services and much more.

Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33681 Practice Matters: DE - Winter 2015 Provider Services Center: 800-600-90071

Important information for health care professionals and facilities

Taking Steps toward Quality ImprovementUnitedHealthcare Community Plan continuously looks for ways to help improve access to quality care and services for members. Each year, we use Healthcare Effectiveness Data and Information Set (HEDIS) reporting to measure our health care performance.

In 2014, one of our HEDIS performance goals was to increase the number of diabetic members who had annual HbA1C testing. In 2015, our scores showed an increase nationwide in the number of these members who had this test performed.

For 2015-16, some of the areas we are targeting for improvement include: increasing the number of members who have an annual dental visit; raising the number of women who have a postpartum visit three to eight weeks after delivery; and increasing the appropriate use of corticosteroid therapy for members who have asthma.

We also conduct annual member surveys to see how well we meet member needs. This year we conducted the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey and saw improvements in how members rate their personal physician, how well physicians communicate and how informed a member’s personal physician seemed about the care the member received from other physicians.

We saw improvements in how members rate customer service. We will continue to focus on improving satisfaction in this area. We are working to enhance the member experience by training staff to handle member calls more effectively the first time. We also are working on improving our Provider Directory search tools.

For more information about our Quality Improvement Program, annual goals or progress toward meeting our goals, please call our Customer Service Center at 800-600-9007.

Encouraging Members to Get VaccinatedCare providers play an important role in helping ensure members of all ages get vaccinated as soon as a vaccine becomes available.

The Advisory Committee on Immunization Practices recommends a routine annual flu vaccine for everyone age 6 months and older. All children age 6 months through age 8 who are recommended for two doses should receive their first dose as soon as possible after vaccines become available and the second dose within four weeks. To avoid missed opportunities for vaccination, providers should offer vaccination during routine health-care visits or during hospitalizations whenever vaccine is available.

Pneumonia infections often can be prevented and treated.Most of the hospitalizations and deaths from pneumonia in the United States are in adults rather than in young children. Many of these deaths are preventable through vaccination and appropriate treatment (antibiotics and antivirals).

In the United States, there are several vaccines that prevent infection by bacteria or viruses that may cause pneumonia:

• Haemophilus influenzae type b (Hib)• Influenza (flu)• Measles• Pertussis (whooping cough)• Pneumococcal• Varicella (chickenpox)

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Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33682 Practice Matters: DE - Winter 2015 Provider Services Center: 800-600-90072

Important information for health care professionals and facilities

These vaccines are safe, but side effects can occur. Most side effects are mild or moderate. For more information on vaccines from the Centers for Disease Control and Prevention, visit cdc.gov/vaccines/hcp/vis/index.html.

A Member’s Right to Culturally Competent CareUnitedHealthcare Community Plan’s members have a right to receive care that is culturally competent and respects their cultural and ethnic background and origins. Upon enrollment, information regarding primary language is obtained and members are assisted in choosing a Primary Care Physician who will meet their cultural needs.

UnitedHealthcare Community Plan provides access to a language line for translation of communications between UnitedHealthcare Community Plan staff and non-English speaking members. The language line use is tracked by the Customer Service Center and reported regularly to the health plan so we can be sure we are offering adequate access to practitioners who can help ensure that the cultural, ethnic, racial, and linguistic needs of our members are being met.

Where to Get Pharmacy UpdatesPharmacy updates are available at UHCCommunityPlan.com. Go there to find:

• A list of covered pharmaceuticals, including restrictions and preferences

• Pharmaceutical management procedures• Explanations on limits or quotas• How to submit and support an exception request• Generic substitution, therapeutic interchange and

step-therapy protocols

For more information, call our Customer Service Center at 800-600-9007.

Enroll in Electronic Payments & StatementsNow you can use a single tool to access and manage payment information for most UnitedHealthcare health plans. Enrollment in Electronic Payments & Statements (EPS) applies to payments from UnitedHealthcare Commercial, UnitedHealthcare Medicare Solutions, UnitedHealthcare Oxford and 17 additional UnitedHealthcare Community Plan states that were recently added.

EPS is UnitedHealthcare’s solution for electronic remittance advice (ERA) and electronic funds transfer (EFT). It allows you to receive direct deposit of claim payments into your designated bank account(s) and access explanation of benefits (EOBs)/remittance advice online or via 835 ERA files.

Enrollment in EPS applies to payments from UnitedHealthcare Community Plan in Arizona, Delaware, Florida, Hawaii, Iowa, Kansas, Louisiana, Maryland, Massachusetts, Michigan, Mississippi, Nebraska, New Jersey, New Mexico, New York, Ohio, Pennsylvania, Rhode Island, Tennessee, Texas, Washington and Wisconsin.

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Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33683 Practice Matters: DE - Winter 2015 Provider Services Center: 800-600-90073

Important information for health care professionals and facilities

There’s never been a better time to enroll in EPS. You can learn more by:

• Visiting WelcometoEPS.com• Watching a short video demo • Attending a live 30-minute webinar for an overview

and answers to questions

You can enroll in EPS online or send us a completed enrollment form. If you have questions, please call 866-842-3278, option 5.

Special Needs Plan Model of Care TrainingEach year UnitedHealthcare provides Special Needs Plan Model of Care training to all UnitedHealthcare Special Needs Plan providers, which is a Centers for Medicare & Medicaid Services requirement. This training, which will be available online via WebEx, will assist you in understanding the tools available to support members’ care.

Models of Care are considered integral to helping ensure that the unique needs of each Special Needs Plan member are identified and addressed. A Model of Care is comprised of the following clinical and non-clinical elements:

• Description of the Special Needs Plan population• Care coordination• Special Needs Plan provider network• Model of Care quality measurement and

performance improvement

To access the training, go to UnitedHealthcareOnline.com > Tools & Resources > Training & Education. Scroll down to Medicare & Medicaid Topics. For more information, please call UnitedHealthcare Clinical Services at 855-896-5593.

Care Providers Should Seek Opportunities to Provide Wellness ExamsWe understand our members may be difficult to schedule for an annual wellness exam, but it’s important to help ensure that they receive their annual wellness exam and Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services.

Care providers should not wait until after a member’s birth date or anniversary of the last visit to schedule the annual wellness exam.

The annual wellness visit is covered every year, and UnitedHealthcare will reimburse these visits at the reset of each year. The reimbursement is not triggered by the member’s birth date or the anniversary date of the last visit. Healthcare Effectiveness Data and Information Set (HEDIS) preventive measures count all members in specific age brackets as non-compliant or compliant each calendar year. Members will be considered non-compliant at the beginning of each year, when the HEDIS data reset, until the next visit occurs.

Leverage sick visits to perform comprehensive well-child or well-adult exams, as appropriate.

If a member comes to your office for a sick visit and you determine a comprehensive well-visit exam is needed, we encourage you to perform both services during one visit.

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Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33684 Practice Matters: DE - Winter 2015 Provider Services Center: 800-600-90074

Important information for health care professionals and facilities

The well-visit consists of:• Comprehensive health and developmental history

(i.e., physical health, mental health, development and nutrition)

• Unclothed physical exam with height, weight and head circumference (for children)

• Health education and/or anticipatory guidance

Follow these billing tips to help facilitate reimbursement for your services:

• In addition to the applicable diagnosis for the sick visit, please include the appropriate well- visit diagnosis code on your claim.

• Include the applicable Evaluation & Management (E&M) code for both the sick visit and the well-visit. Modifier 25 is required when the sick visit is significant enough to necessitate a problem-oriented evaluation and management service.

If you have any questions, please call Provider Services at 877-842-3210.

Primary Care’s Role in Screening for DepressionAn estimated one in 10 adults in our country reports suffering from depression. Primary care providers play a vital role in identifying and treating depression. The care for a member diagnosed with depression may involve collaboration among the PCP and behavioral health practitioners, and may consist of referring members for psychotherapy, prescribing antidepressants or doing both.

The Patient Health Questionnaire (PHQ-9) is one tool that PCPs can use to screen for depression. The questionnaire, developed through an education grant from Pfizer Inc., can be completed by a member in minutes and rates the frequency of depressive symptoms. A non-scored follow-up question on the PHQ-9 assesses the degree to which the member’s depression has affected their level of function. The treating care provider can score the results rapidly and administer the PHQ-9 multiple times during treatment to monitor improvement or worsening of depressive symptoms.

For more information, you can visit see the Depression Management Tool Kit from the MacArthur Foundation Initiative on Depression and Primary Care. You will find resources, including the PHQ-9 tool, to assist in diagnosing depression and monitoring treatment.

Members can call the Member Services number on their insurance card and get assistance finding a behavioral health clinician close to their home. For more complex behavioral health issues, the Member Services coordinator can transfer the call to a Behavioral Health Care Advocate, who is a licensed social worker. The Care Advocate can help the member choose the right provider and answer any other behavioral services questions.

Interpreter Services Available for Office VisitsAll UnitedHealthcare Community Plan network care providers must coordinate and provide in-office interpretation services for members who speak languages other than the provider’s language. Care providers who need help locating an interpreter, call 877-844-8844. We also provide signers for the deaf. For an American Sign Language interpreter, call 877-901-5523 (TTY 711).

If UnitedHealthcare Community Plan provides an interpreter, either via a conference call or in-person, we will pay the associated costs. However, the health care professional or facility must pay costs for any interpreter not provided by UnitedHealthcare Community Plan.

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Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33685 Practice Matters: DE - Winter 2015 Provider Services Center: 800-600-90075

Important information for health care professionals and facilities

Access and Availability Standards for Mental Health PractitionersWe provide behavioral health benefits to all of our Medicaid members in our service area. The state of Delaware has established access standards for care providers of these services as follows. Please feel free to post this reminder where you do your appointment scheduling.

Type of Appointment Access Standard

Life-Threatening Emergencies Examples: threat of suicide, homicide or self-injury that needs immediate medical attention

Immediately

Care For Non-Life-Threatening Emergencies Examples: when symptoms first develop, but are not life-threatening, like suicidal ideation without a plan to implement or the member is starting to show signs of a mania or psychosis

Within 6 Hours

Urgent Care Examples: member is out of or does not have enough antipsychotic medication to wait for a routine visit or has medication concerns

Within 48 Hours

Routine Office Visit Examples: routine counseling or is member seeing practitioner for a follow-up visit after a hospitalization

Within 7 days

4051 Ogletown RoadSuite 200Iron Hill Corporate CenterNewark, DE 19713Doc#: PCA19037_20151123 © 2015 UnitedHealth Group, Inc. All Rights Reserved.

Practice Matters is a quarterly publication for physicians and other health care professionals and facilities in the UnitedHealthcare network.

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