practicemattersIowa | Winter 2015

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Call our Provider Services Center at 888-650-3462

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Practice Matters: IA - Winter 2015 Provider Services Center: 888-650-3462

Important information for health care professionals and facilities

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In This Issue...• A Message from our Chief Executive Officer

• Culturally Competent Care

• Medicaid Enrollment Should Be Current

• Enroll in Electronic Payments & Statements

• Where to Check Prior Authorizations, Billing

• Value Added Services

• Behavioral Health Toolkit Available Online

• Iowa Health Link Care Transitions

• Taking Steps toward Quality Improvement

• Where to Get Pharmacy Updates

• Videos and Articles Promote Children’s Health

• Reducing Radiation Exposure in Pediatric Populations

• The Difference in Links

• How to Contact Us

We hope you enjoy the winter edition of Practice Matters. In this issue, you can read about the transition to Iowa Health Link, value added services, quality improvement efforts and much more.

Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33681 Practice Matters: IA - Winter 2015 Provider Services Center: 888-650-34621

Important information for health care professionals and facilities

Training to support culturally competent care is available from the U.S. Department of Human Services Office of Minority Health. Free and accredited continuing education programs are available:

• Physicians – up to nine free CME credits• Nurses – nine CNE credits• Pharmacists – nine contact hours (0.9 CEUs)

(pharmacists)

You can log in from anywhere at any time to complete the courses. CME/CEU certificates are issued after completion of each of the three themes of the course. For more information, visit thinkculturalhealth.hhs.gov.

Medicaid Enrollment Should be CurrentYour Medicaid enrollment needs to be current for you to serve UnitedHealthcare Community Plan members. Long Term Services and Support care providers serving Home and Community-based Services (HCBS) Waivers need to be certified and re-enrolled every four years. Other types of care providers need to re-enroll every five years.

For more information, please contact the Iowa Medicaid Enterprise at 800-338-7909 (option 2) or 515-256-4609 (option 2) in Des Moines, or send an email to IMEProviderEnrollment@dhs.state.ia.us.

Enroll in Electronic Payments & StatementsNow you can use a single tool to access and manage payment information for most UnitedHealthcare health plans. Enroll in electronic payments & statements (EPS) applies to payments from UnitedHealthcare Commercial, UnitedHealthcare Medicare Solutions, UnitedHealthcare Oxford and UnitedHealthcare Community Plan.

EPS is our 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 by 835 ERA files.

A Message from Our Chief Executive OfficerKimberly Foltz, CEOJan. 1, 2016 marks the start of an exciting adventure for the UnitedHealthcare Community Plan of Iowa. We were selected by the Iowa Department of

Human Services for Medicaid services to manage care for the Iowa Medicaid population. We have operated health plans in Iowa since the 1980s, serving a wide range of Iowans, including those who get their coverage through employers, the armed forces and Medicare plans. We have served children in the Iowa hawk-i program since 2000. In addition to hawk-i, we will manage Iowa Wellness, Iowa Marketplace Choice and seven waiver programs.

We are dedicated to promoting health for all Iowans in every stage of their lives, and we value your continued commitment to your patients who are now our members. Please take advantage of our informational webinars designed to help you do business with us or call our Provider Services 888-650-3462 to connect with your assigned provider advocate. As we begin this journey, we thank you for your partnership and working with us in our mission to help people live healthier lives.

Culturally Competent CareMember involvement in their own health care relies on their ability to understand their condition, options and treatment responsibilities. When care instructions are delivered in their own language and their cultural background is taken into account, members respond better. This is necessary for informed consent.

We maintain a telephone translation service available to you to communicate with our members for whom English is a second language or for members who require vision and/or hearing accommodations. To access this service, call Provider Services at 888-650-3462.

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Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33682 Practice Matters: IA - Winter 2015 Provider Services Center: 888-650-34622

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.

Value Added ServicesIn addition to a member’s benefit plan, we offer additional services that are delivered free to members:

• Baby Blocks is a UnitedHealthcare program to improve health outcomes for pregnant and postpartum women, and their babies. The online program uses game interfacing with rewards to encourage members to keep wellness appointments during their pregnancy and into the first 15 months of their baby’s life. Mothers-to-be can select a diaper bag or $20 gift card just by enrolling. The Business Intelligence Group (BIG) awarded Baby Blocks the 2015 BIG Innovation Award. Members can access the program at UHCBabyBlocks.com.

• Weight Watchers consists of 10 annual vouchers to attend Weight Watchers meetings, where skills are taught to improve healthy eating and weight loss measures. Eligible members are over age 12. Members age 16 and younger require a physician-

prescribed weight goal. To refer a member, call Provider Services at 888-650-3462.

• JOIN for ME is a whole-family program intended to fight childhood obesity. The program engages children who struggle with extra weight, along with their parents, in a series of group sessions to achieve healthier weights through healthier family food choices, increased activity and lifestyle improvement tracking. A $50 gift card for work-out gear is awarded after completing the 16-week program. Eligible members are ages 6-17, have a Body Mass Index in the 85th percentile and are in good health. A physician’s signature is necessary on the referral form located at Link or by visiting UHCCommunityPlan.com > For Health Care Professionals > Iowa > Provider Forms. The program can be accessed through case manager care planning, by referral from a primary care provider (PCP) or from a member-initiated request to a PCP. Read more at JOIN for ME.

• Physical for School/Camp/Sports: We support children to go the extra mile by offering a free physical exam once a year to help ensure safe participation in school, camp and sports. This exam is in addition to a member’s annual wellness exam. To deliver this service, a network PCP needs to bill and code ICD-10 code V70.3, “Other Medical Exam for Administrative Purposes,” with one of the following CPT codes:

– 97005 Athletic Training Evaluation – 97006 Athletic Training Re-Evaluation

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Where to Check Prior Authorizations and BillingTo verify that a member is in our plan, request/verify prior authorizations and bill, visit Link or go to UHCCommunityPlan.com > For Health Care Professionals > Iowa > Billing and Reference Guides. You also can request a copy of this information from Provider Services at 888-650-3462.

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Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33683 Practice Matters: IA - Winter 2015 Provider Services Center: 888-650-34623

Important information for health care professionals and facilities

• Medical Transportation: In addition to the covered transportation services for Medicaid members, medical transportation is available for members to get to the physician’s office, dentist or pharmacy. Eligible members are in the Iowa Department of Public Health Family Planning and the Iowa Health and Wellness Plan. Routine visits require 72-hour advance scheduling and can be scheduled up to 30 days in advance. Visits over 75 miles may require prior approval. Hotel accommodations require prior approval for eligible members and are only for trips that require an overnight stay. To refer a member, call Provider Services at 888-650-3462.

• Community Rewards is a point-based incentive program to improve the health of our members. They can earn points for doing healthy activities such as brushing their teeth, completing their initial health risk screening or attending their checkups and screenings. Points can be redeemed through an online catalog with customized incentives at UHCCommunityRewards.com. Members can self-refer themselves to the program on the website.

Behavioral Health Toolkit Available OnlineA Behavioral Health Toolkit with screening tools and referral information is available at Link or UHCCommunityPlan.com > For Health Care Professionals > Iowa > Billing and Reference Guides.

Iowa Health Link Care TransitionsBeginning Jan. 1, 2016, the Iowa Department of Human Services will transition your patients who are UnitedHealthcare Community Plan members to a new managed care program called IA Health Link. Members already in your care at the time of transition will continue receiving services under existing authorizations as follows. This also applies to out-of-network care providers, unless otherwise specified.

Providers and Services Authorization Timeline Care providers 90 days from Jan. 1 to Dec. 31, 2016

Minimum 30 days, effective Jan. 1, 2016

In-patient stays Until the member is discharged from acute care or for 60 days after disenrollment, whichever is less, unless the member is no longer eligible for Medicaid

In-patient psychiatric stays As long as the services continue to be medically necessary

In-patient stay services other than inpatient hospital services (e.g., physician services)

New health plan is responsible for payment at the effective date of disenrollment

Long Term Services and Supports Providers

Until we complete a new service plan and it is agreed on by the member or resolved through the appeals or fair hearing process

• Nursing facility long term care

• Intermediate care facilities for the intellectually-disabled

and

• Support for the member to live in a residential setting controlled by the member or the provider, funded through 1915(i) Habilitation waiver provider or a 1915(c) Home and Community-based Services (HCBS) waiver

Up to one year

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Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33684 Practice Matters: IA - Winter 2015 Provider Services Center: 888-650-34624

Important information for health care professionals and facilities

Providers and Services Authorization Timeline Residential care providers serving members with a dual diagnosis of behavioral health condition and developmental disorder

At least one year

Non-network residential care providers serving members with a dual diagnosis of behavioral health condition and developmental disorder

At least 30 days, maybe more, to allow for continuity of care while transferring to a network provider

Out-patient providers serving members with a dual diagnosis of behavioral health condition and developmental disorder

Minimum of three months as long as the services continue to be medically necessary, unless the care provider is no longer available or when a change in providers is requested in writing by the member or the member’s representative

OB/GYN Members in their second or third trimester at the time of enrollment may stay with their prenatal care provider through delivery, plus 60 days post-delivery, or longer if medically necessary.

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.

For 2015-16, HEDIS performance goals we have targeted 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 primary care provider (PCP), how well they feel PCPs communicate and how informed they perceive their PCP is about care the member received from other physicians.

We will incorporate feedback from the survey results into our efforts to improve the member experience with great customer service by training staff to handle member calls more effectively the first time. We are also improving provider directory search tools.

Where to Get Pharmacy UpdatesPharmacy updates are available at Link or by visiting UHCCommunityPlan.com> For Health Care Professionals > Iowa > Pharmacy Program, where you can 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

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Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33685 Practice Matters: IA - Winter 2015 Provider Services Center: 888-650-34625

Important information for health care professionals and facilities

KidsHealth is an award-winning website with information about health, behavior and development from before birth through the teen years. It is part of the Nemours Foundation, one of the nation’s largest nonprofits devoted to children’s health. KidsHealth resources receive ongoing medical reviews by pediatricians and other specialists to help ensure accuracy.

Reducing Radiation Exposure in Pediatric PopulationsThe effect of radiation on the pediatric population is a growing concern. UnitedHealthcare Military & Veterans recently reviewed the methods used to diagnose acute appendicitis over one year in a pediatric population of 80 TRICARE West Region beneficiaries.

The review found that 51.3 percent of these individuals had computed tomography (CT) scans as the first diagnostic imaging study, 36.2 percent had ultrasounds and 12.5 percent had no imaging study. These numbers show there is an opportunity to find and implement safe strategies to reduce potential radiation exposure in children by reducing CT scans.

When diagnosing acute appendicitis in the pediatric population, we encourage emergency department and radiology care providers to use ultrasounds instead of CT scans, when aligned with medical necessity and appropriate levels of care. Recent literature supports our findings:

• According to the American College of Radiology, ultrasound diagnostic examination of the abdomen is preferred over CT for diagnosing acute appendicitis in children due increased radio-sensitivity to ionizing radiation, smaller body size and less body fat.

• A retrospective study published by the Journal of the American Medical Association (JAMA) evaluated the use of CT for children younger than age 15 from 1996 to 2010. Nationally, four million pediatric CT scans of the head, abdomen/pelvis, chest, or spine performed each year are projected to cause 4,870 future cancers. Implementing readily available dose-reduction strategies, combined with the elimination

Videos and Articles Promote Children’s HealthUnitedHealthcare and KidsHealth have teamed up to provide family-friendly information about children’s health online at UHCCommunityPlan.com/iakids. More than 200 videos and 10,000 articles in English or Spanish are available on a wide range of topics, including:

• Flu• Asthma• Diabetes• Nutrition and Fitness• Stress and Coping• Safety• Pregnancy and Newborns• Caring for Children with Special Needs

Please encourage patients who are UnitedHealthcare Community Plan members to visit the website. Videos and articles are developed for, and searchable by, target audience.

• Parents can find quick advice from a source they can trust.

• Children can have fun with quizzes and games.• Teens can get “straight talk” and personal stories

from other young adults.

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Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33686 Practice Matters: IA - Winter 2015 Provider Services Center: 888-650-34626

Important information for health care professionals and facilities

The Difference in LinksThe Iowa Department of Human Services’ move to managed care is called the Iowa Health Link. Our gateway for care providers to access member eligibility, authorizations, claims management and more is known as Link.

How to Contact UsWe have one phone number to serve care provider business needs. Our Provider Services line is available at 888-650-3462. Operators are available to help you M-F (Except major holidays) from 7:30 a.m. to 6:00 p.m. central time. For your convenience, we’re automated 24 hours a day, 7 days a week.

of unnecessary imaging, could dramatically reduce future radiation-induced cancers from CT use in pediatrics.

• The American College of Emergency Physicians (ACEP) agrees that pediatric populations presenting to the emergency department with abdominal pain and suspected appendicitis should have an ultrasound as the first radiologic study in the diagnostic work-up.

By reducing CT scans for children, UnitedHealthcare Military & Veterans believes the potential radiation exposure — and potential future cancers — also will be reduced. In many cases, increasing the use of ultrasound when diagnosing acute appendicitis may be a viable alternative.

Sources:Smith M.P., Katz D.S., Rosen M.P., Lalani T., Carucci L.R., Cash B.D., Yee J. Expert panel on gastrointestinal imaging. ACR Appropriateness Criteria right lower quadrant pain--suspected appendicitis. [online publication]. Reston (VA): American College of Radiology (ACR); 2013. 10 p. [74 references]; Retrieved from acsearch.acr.org/docs/69357/Narrative.

Migliorett, D., Johnson, E., Williams, A., Greenlee, R., Weinmann, S., Solberg, L., Smith-Bindman, R. The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk. JAMA Pediatrics. 2013; 167 (8): 700-707 doi: 10.1001/jamapediatrics.2013.311; Retrieved from archpedi.jamanetwork.com/article.aspx?articleid=1696279.

Valesky, W., Aponte, E., Secko, M., & Mehta, N. Ultrasound for appendicitis; American College of Emergency Physicians (ACEP) June 1, 201; Retrieved from acepnow.com/article/ultrasound-appendicitis

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practicematters

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

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