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Mississippi | Spring/Summer 2019

Practice Matters: MS – Spring/Summer 2019 Provider Services Center: 800-557-9933

Important information for health care professionals and facilities

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In This Issue...

We hope you enjoy this issue of Practice Matters. In this issue, you can read about support for language services, PreCheck MyScript, access and availability standards, and more.

• Support for Language Services

• Shared Decision Making in Mental Health: Allowing Your Patient’s Participation in the Treatment Planning Process Improves Outcomes

• Vision Problems Following a Head Injury

• Human Papilloma Virus (HPV) Vaccines: Information for Your Patients

• Prior Authorization Update for Dental Procedures: What the PCP Needs to Know

• Non-Physician Payment 5 Percent Reductions for MississippiCAN

• Prior Authorization for Speech-Language Pathology Services

• Claim Edits Help Verify a Care Provider’s Mississippi Medicaid Participation Status

• Hold the Dates for Mississippi Division of Medicaid Workshops

• Your Patients Can Get a 90-Day Supply on Many Medications

• PreCheck MyScript Tool

• Access and Availability Standards

• Medical Records Reviews

• EPSDT Reminder for Pediatric Care Providers

• UnitedHealthcare Dual Complete Plan Benefits Enhanced For 2019

Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-336811



Support for Language ServicesUnitedHealthcare Community Plan serves a diverse group of members who have a variety of cultural and language needs. UnitedHealthcare supports care providers in providing competent cultural and language services to its members in variety of ways.

Here’s what care providers need to know:

• Although the predominant language spoken by Mississippians is English, we have a significant Hispanic population.

• We provide language assistance to help you communicate with our members that includes a telephone language line, in-person interpreters and video services.

• We have tools to promote cultural awareness and assist care providers in recognizing and treating health disparities.

• Resources and tools are available at UHCprovider.com/mscommunityplan

– A Quick Reference Guide – Understanding Cultural Competency and the American with Disabilities Act

– Cross Cultural Health Care Program – Cultural Orientation Resource Center

In addition to spoken languages, we also offer assistance for the hearing impaired.

Shared Decision Making in Mental Health: Allowing Your Patient’s Participation in the Treatment Planning Process Improves Outcomes Recommended by the Institute of Medicine, shared decision-making is an emerging best practice in health care and promotes empowerment, self-determination and recovery. By combining transparent information and a respectful, two-way conversation between patients and care providers, shared decision-making helps balance information about mental health conditions and treatment

options with a patient’s preferences, goals, and cultural values and beliefs. The care provider gathers as much information as possible on the patient and complex care, have an open discussion and include the patient in the treatment plan process.

The U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration recommends four steps of shared decision-making:

1. Establish a partnership – Individualized care decisions are made when patients have the right information and input from others. Care providers can offer the information and support needed throughout the process.

2. Exchange information – Patients should be encouraged to discuss their experiences, history, preferences, values and cultural beliefs. Care providers should be receptive to that information and describe treatment and service options in detail.

3. Weigh the options – Together, patients and care providers evaluate the pros and cons of each option based on preferences, values and cultural beliefs.

4. Make a decision – The process of decision-making is shared, but the final decision rests with the person using the services. However, patients and care providers can review and revise the decision, if needed.

Engaging in the shared decision-making process can result in numerous benefits such as better communication, more effective treatment, greater treatment adherence and fewer missed appointments. Health care is moving more toward including shared decision-making in national quality initiatives (i.e., CAHPS® surveys) that incentivize care providers to adopt this approach as a best practice.

References:1. U.S. Department of Health and Human Services, Substance

Abuse and Mental Health Services Administration. Shared decision making: Making recovery real in mental health.

2. Mental Health America. You’re on the Team: Help for Providers. mentalhealthamerica.net/youre-team-help-providers. Published 2017.

3. National Alliance on Mental Illness. Engagement: A New Standard for Mental Health.

https://www.uhcprovider.com/en/health-plans-by-state/mississippi-health-plans/ms-comm-plan-home.html?cid=none

http://www.mentalhealthamerica.net/youre-team-help-providers




Vision Problems Following a Head InjuryScott A. Edmonds, OD Chief Medical Officer, MARCH Vision Care

A fall on the ice, a collision playing sports or a minor fender bender may result in a direct

blow to the head or a whiplash injury. Care providers need to ask patients or family members about vision-related symptoms after any head injury. These include blurred vision, light sensitivity, double vision, or problems reading or using a cellphone or computer.

Any new vision symptoms following a head injury can signal a concussion or mild traumatic brain injury. These vision symptoms can be delayed and may become chronic as part of post-concussion syndrome.

Children are more vulnerable to these types of injuries because their necks are smaller and less resilient. When children, especially young girls, knock a soccer ball with their head it may create life-long visual symptoms. The brain houses the visual pathway as well as the nerves that control eye movement, eye tracking and coordination. Any violent shake, rattle or hard contact to the head can easily disrupt these connections and result in vision problems.

These problems should be managed early and treated with a comprehensive rehabilitation program that includes a rehab or neuro optometrist. These care providers work as part of a team and use lenses, prisms, filters and vision therapy to re-establish normal visual input. Early diagnosis and proper intervention can reduce and often eliminate vision symptoms and facilitate ongoing learning and development.

Human Papilloma Virus (HPV) Vaccines: Information for Your PatientsMississippi has historically been one of the best performing states for vaccines. However, our state lags at the bottom of vaccine rates for Human Papilloma Virus (HPV). Patients, parents, clinicians and policymakers are seeking to improve these rates.

The American Cancer Society has supplied a list of facts to dispel common misconceptions about the vaccine. The facts come from “HPV VACs: Just the Facts for Providers,” and we encourage you to share them with your patients:

Fact 1: HPV vaccines are safe. They are monitored on a consistent basis, and current studies continue to show that the vaccine is very safe. More than 270 million doses have been distributed worldwide and over 100 million doses in the U.S. The most common side effects with HPV are mild and similar to what is seen with other diseases.

Fact 2: The vaccine does NOT cause fertility issues. There is no data that suggest the vaccine negatively effects future fertility. Receiving the vaccine and protecting against cervical cancer may improve a woman’s ability to get pregnant and have healthy babies.

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Fact 3: The vaccine does NOT contain harmful ingredients. People are exposed to aluminum daily through food and cooking utensils. Vaccines containing aluminum have been used for decades and have been given to more than 1 billion people without problems.

Fact 4: The vaccine is necessary regardless of sexual activity. Vaccinating at age 11 or 12 offers the most HPV cancer prevention. Studies show there is no correlation between the vaccine administration and increased rates of, or earlier engagement in, sexual activity.

Fact 5: The vaccine is strongly recommended for boys and girls. Scientists estimate that 80 percent to 90 percent will be infected with at least one type of HPV in their lifetime.

Fact 6: Studies have shown the vaccine has been proven to prevent infections that can cause multiple HPV cancers.

Fact 7: An effective recommendation from a clinician matters. The American Cancer Society suggests giving a child three vaccines to protect against meningitis, HPV cancers and pertussis.

Fact 8: The effectiveness of the HPV vaccine does not decrease over time. Studies indicate that protection lasts more than 10 years with no signs of the protection weakening.

For more information, visit cancer.org/ content/dam/cancer-org/online-documents/en/pdf/flyers/hpv-vacs-just-the-facts-for-providers.pdf. You can also get more information on vaccine coverage at cdc.gov/hpv/infographics/vacc-coverage.jpg.

For tips on improving rates in rural areas, visit cdc.gov/ruralhealth/vaccines/.

Prior Authorization Update for Dental Procedures: What the PCP Needs to KnowTed Wong, DDS UnitedHealthcare Chief Dental Officer

On March 1, 2019, a new prior authorization process started for dental care services in an operating room or ambulatory surgery center (OR/ASC). This prior authorization form complements the recent Mississippi Division of Medicaid’s revision (eff. 12/1/2018) to the Administrative Code Title 23, Part 204, Rule 1.11: Dental Services Provided in the Hospital or Ambulatory Surgical Center (ASC) Setting, MS Code Ann 43-13-121.

Dentists have been informed of this, but it’s important that you know of the requirement for a medical evaluation prior to services being rendered in an ASC or OR. To substantiate the site of service need, which is usually accompanied by anesthesia, a physician letter or consultation document must validate that the member has a condition that warrants a site of service other than the office setting. When the OR or ASC is requested, we look to see that a patient has a condition that necessitates a higher-level setting. These medically compromising conditions can be behavioral health-oriented, a physical disability, significant behavioral or cognitive impairment, complexity of dental conditions, or any other condition requiring a special accommodation.

Non-Physician Payment 5 Percent Reductions for MississippiCANTo align with Mississippi Medicaid reimbursement amounts, on Jan. 1, 2019, we began following an updated Mississippi Medicaid Coordinated Access Network (MississippiCAN) reimbursement schedule to align with Mississippi Code Ann. § 43-13-117 (2015). As part of our alignment with the state statute, we retroactively applied the new fee schedule to claims with dates of service on or after July 1, 2018.


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https://www.cancer.org/content/dam/cancer-org/online-documents/en/pdf/flyers/hpv-vacs-just-the-facts-for-providers.pdf




https://www.cdc.gov/hpv/infographics/vacc-coverage.jpg

https://www.cdc.gov/ruralhealth/vaccines/




What This Means for YouOn Jan. 1, 2019, we started using the new fee schedule for newly submitted claims and began reprocessing affected paid claims. If your previously paid claims are affected by this fee schedule update when we reprocess those claims, we’ll contact you about recovering any overpaid amounts.

This results in a five percent reduction in reimbursement payments for services including, but not limited to:

• Chiropractic services• Dental services• Emergency and non-emergent ambulance• Free-standing dialysis • Home and community-based services• Home health and private duty nursing• Medical equipment and supplies • Optometry services (including eyeglasses and

screenings)• Prescribed pediatric extended care• Therapy services including audiology, physical,

occupational and speech

Services excluded from the MississippiCAN rate adjustment are:

• Community-based service programs for the elderly and disabled from a planning and development district

• Inpatient hospital services• Outpatient hospital services• Intermediate care facility services• Nursing facility services• Psychiatric residential treatment facility services • Physician (MD/DO) services• Pharmacy services provided under subsection (A) (9)

of Miss Code Ann§ 43-13-117• Services provided by a state agency, a state facility

or a public agency that either provides its own state match through intergovernmental transfer or certification of funds to the division

• Services with a reimbursement methodology and rate set by the federal government

Calculating New RatesFor affected services, multiply your current contracted rate by 0.05. Subtract that from the current rate.

You can find more information on fee schedules at medicaid.ms.gov > Providers > Fee Schedules and Rates.

For more information, call Provider Services at 877-743-8734.

Prior Authorization for Speech-Language Pathology ServicesWe now require prior authorization for speech therapy (CPT 92507). This was implemented to justify medical necessity for services being rendered to MississippiCAN and Mississippi CHIP members.

Evidence-based clinical criteria will be applied to all requests to help validate that services meet medical necessity guidelines. For MSCAN, the review criteria are based on standards established by the Mississippi Division of Medicaid and provided within Administrative Code Part 213 Therapy Services, Chapter 3 Outpatient Speech-Language Pathology (Speech Therapy). For MS CHIP, the review criteria are the UnitedHealthcare Policy



https://medicaid.ms.gov/




for Speech Language Pathology Services, which took effect June 1, 2018.

When processing claims, we’ll validate that authorization was obtained. If the authorization is on file, the claim will be considered for reimbursement. If the authorization is not on file, the claim will be denied with an explanation that the service had not been reviewed and approved.

Rendering care providers should seek prior authorization for CPT 92507. For more information, visit UHCprovider.com/mscommunityplan > Prior Authorization and Notification.

Claim Edits Help Verify a Care Provider’s Mississippi Medicaid Participation Status As a reminder, on Sept. 22, 2018, we made a change to how we process UnitedHealthcare MississippiCAN claims. We use additional claim edits to help ensure that the care providers who submit a claim are also enrolled with the Mississippi Division of Medicaid (DOM). This enrollment is required for participation in the Mississippi Medicaid program and MississippiCAN.

MississippiCAN requires that all care providers listed on a claim be enrolled with DOM and have a valid Medicaid ID. Our claims process will match the care provider National Provider Identifier (NPI) number and Medicaid ID used on a claim and the NPI number, Medicaid ID and taxonomy code in the DOM enrollment database.

If the care provider enrollment information matches, we’ll process the claim as usual.

If the care provider information doesn’t match, we’ll return the claim to the submitter electronically with a 277 claim status response. If a paper claim was submitted, we’ll mail a letter to the submitter with the reasons for the claim return.

If a Claim is ReturnedWhen a claim is returned because the care provider information didn’t match, you’ll have the chance to resubmit the claim within 180 days of the date of service. Before resubmitting, the claim submitter should verify that the NPI numbers listed on a claim will match the Mississippi DOM enrollment information.

Verifying NPI Number and Mississippi DOM Enrollment Information

• If the care provider doesn’t have a valid Medicaid ID, instructions on how to enroll with DOM are at medicaid.ms.gov/providers.

• Care providers enrolled with DOM can verify their enrollment status and NPI number by logging into DOM’s provider portal at medicaid.ms.gov/providers.

• Enrolled care providers can call DOM to verify the registered NPI number at 601-359-6294.

For more information, call Provider Services at 877-743-8734.


https://www.uhcprovider.com/en/health-plans-by-state/mississippi-health-plans/ms-comm-plan-home/ms-cp-prior-auth.html

https://www.uhcprovider.com/en/health-plans-by-state/mississippi-health-plans/ms-comm-plan-home/ms-cp-prior-auth.html




Hold the Dates for Mississippi Division of Medicaid Workshops UnitedHealthcare Community Plan will be in attendance at all workshops hosted by the Mississippi Division of Medicaid this summer. The schedule and agendas are tentatively planned to be:

Date Location Topics of Discussion

July 10, 2019 Gulfport - Courtyard by

Marriott

New ProvidersGeneral Medicaid

IssuesManaged Care

TOP IssuesJuly 16, 2019 Meridian - North

East Conference Center

Rural Health Clinic

Federal Qualified Health Centers

Behavioral HealthJuly 18, 2019 Tupelo -

Bancorp South Arena

Prior Authorization

Claims ReviewRetro Reviews

Hospital ServicesNewborns

July 24, 2019 Natchez - Convention

Center

VisionDurable Medical

EquipmentDental

July 30, 2019 Southaven - Landers Center

Home Health and Waiver Services

Therapy ServicesPhysical

OutpatientSpeech

For more information, visit medicaid.ms.gov/providers/.

Your Patients Can Get a 90-Day Supply on Many MedicationsStarting April 1, 2019, members now are able to get a 90-day supply of select medications from participating retail pharmacies. Members no longer need to return to a retail pharmacy to refill 30-day supplies of their maintenance medication. They can easily fill 90 days’ worth of certain prescriptions in one trip to their pharmacy. This could help them avoid running out of their maintenance medications and reduce early refill rejections that may precede travel plans.

If you believe your patient who is also a UnitedHealthcare Community Plan (MississippiCAN/Medicaid or CHIP) member would benefit from this benefit, you just need to write a prescription for a 90-day supply. Members may also ask their pharmacist about getting a 90-day supply. The pharmacists may contact you directly for new prescriptions or they may encourage the member to talk to you about getting a new prescription.

Beginning July 1, 2019, your UnitedHealthcare MississippiCAN members can increase their prescription benefit from five to six per month. This increase, along with the ability to get 90 days’ supply, should help ease any member and care provider burden associated with


https://medicaid.ms.gov/providers/




prescription denials. CHIP members don’t have a monthly prescription limit.

To see a complete list of medications eligible for a 90-day supply, visit UHCprovider.com or call customer service at 877-743-8734.

PreCheck MyScript ToolThe PreCheck MyScript tool provides real-time, patient-specific prescription data.

You can use the application to:• Find out if a proposed prescription requires prior

authorization or is non-covered or non-preferred• Request prior authorization, if needed, and check the

status of the request• View the current out-of-pocket costs for the

member along with any available lower-cost prescription alternatives

To access PreCheck MyScript, go to UHCprovider.com > Service Links > Link Self-Service Tools > PreCheck MyScript Solution.

If you need assistance with PreCheck MyScript, call the UnitedHealthcare Connectivity Help Desk at 866-842-3278, option 1, Monday through Friday.

Access and Availability StandardsA large percentage of our network care providers are not indicating that they can provide patient availability as outlined in their agreement. As a Medicaid provider who is contracted with a coordinated care organization (CCO), you’re required to meet certain access and availability standards outlined in your agreement with us.

As a reminder, primary care providers (PCPs) and obstetricians who accept MississippiCAN and Mississippi CHIP must be available to members by phone 24 hours a day, 7 days a week, or have arrangements for telephone coverage by another UnitedHealthcare participating PCP or obstetrician. Any coverage arrangements that

deviate from this requirement must be approved by a UnitedHealthcare medical director or physician reviewer.

UnitedHealthcare Community Plan tracks availability through ongoing telephone surveys conducted by Dial America. We’re required to follow up on instances when access standards are not met, and these follow-ups are usually in the form of letters mailed by our chief medical officer. If you have support staff members who accept incoming calls, let them know about these calls because non-participation is considered lack of compliance, which we’re required to report to the Mississippi Division of Medicaid.

To meet the after-hours requirement, our UnitedHealthcare Community Plan members need to be able to reach a care provider by phone after normal business hours. Physicians (PCPs, specialists and behavioral health) are required to provide 24 hour a day, 7 day coverage to members.

Examples of acceptable after-hours responses to our surveys are:

• PCP answering service will verify it will contact the physician on-call for a patient’s emergency.

• PCP’s triage nurse will verify they will speak with the patient for an emergency call, evaluate the nature of the emergency and contact the physician on-call or direct the patient to a hospital emergency room.

• PCP can be reached when called directly.• PCP’s office phone message directs the patient

to call a specific telephone number to reach the PCP’s answering service, who will then contact the physician on-call for an emergency.

• PCP’s office answering machine directs the patient to call a specific telephone number to reach a hospital switchboard and/or hospital emergency room that will reach the physician on-call for emergencies.

Examples of unacceptable after-hours coverage are:• PCP’s answering machine directs the patient to

proceed to the nearest hospital emergency room.• PCP’s office telephone number rings without

an answer.



http://UHCprovider.com

https://www.uhcprovider.com/en/resource-library/link-provider-self-service.html?CID=none




Other standards for access include: • Emergency Care: Immediately upon the member’s

presentation at a service delivery site.• Urgent Care: Symptomatic office visits must be

available from the member’s PCP or another care provider within 24 hours. This would involve the presentation of medical symptoms that require immediate attention but are not life-threatening.

• Routine Office Visits or Non-Urgent, Symptomatic Visits: Available from the PCP or another care provider within seven calendar days. A non-urgent, symptomatic office visit would involve a medical symptom that doesn’t require immediate attention.

• Non-Symptomatic Office Visits: Available from the member’s PCP or another care provider within 30 calendar days. This type of visit could include wellness and preventive care such as physical or annual gynecological exam, child and adult immunizations or other services.

• Specialists and Specialty Clinics: Should arrange appointments within 45 days.

• Dental providers: – Urgent care within 48 hours – Routine visits within 45 days

• Behavioral Health and Substance Abuse Providers:

– Emergency care (non-dangerous to self or others) immediately upon presentation

– Urgent problems within 24 hours of the member’s request

– Post discharge from an acute psychiatric hospital within seven days

– Routine non-urgent issues within 21 days of the member’s request

If you have collaborative ideas on this topic, let us know. We can change the questions we ask in our phone surveys to help ensure your practice is being compliant. You can contact our Clinical Quality Manager at [email protected] or call provider services at 877-743-8734.

Medical Records ReviewsUnitedHealthcare has two different policies that require member medical records, paper and electronic (EHR /EMR), be maintained in a manner that is current, detailed and organized. The records should promote effective and confidential patient care and quality review. Care providers are informed of medical record standards in the Provider Administrative Guide and material that accompanies the provider agreement. The medical record review is completed annually on a randomly selected sample of the UnitedHealthcare network care providers by UnitedHealthcare clinical practice consultants (CPCs).

The annual 2019 Medical Record Reviews began at the beginning of 3rd quarter. Following are the lists of documentation standard elements that the CPCs will be scoring. The assessment items are for care providers who see the UnitedHealthcare member population age 20 and up:

Procedural Elements1. The medical record is legible (*Item is MUST PASS)2. All entries are signed and dated3. Patient name/identification number is located on each page of the record 4. Medical records contain patient demographic information5. Medical record identifies primary language spoken and any cultural or religious preferences if applicable6a. Adults age 18 and older, emancipated minors and minors with children have an executed advance directive in a prominent part of the medical record6b. OR If the answer to the above # 6 is No, then adults age 18 and older, emancipated minors and minors with children are given information about advance directives, which is noted in a prominent part of the medical record7. A problem list includes significant illnesses and active medical conditions.8. A medication list includes prescribed and over-the-counter medications and is reviewed annually9. The presence or absence of allergies or adverse reactions is clearly displayed



mailto:lynn_mitchell%40uhc.com?subject=




History1. Medical and surgical history is present2. The family history includes pertinent history of parents and/or siblings3. The social history minimally includes pertinent information such as occupation, living situation, etc.Preventive Services1. Evidence of current age appropriate immunizations2. Annual comprehensive physical (or more often for newborns)3. Documentation of mental and physical development for children and/or cognitive functioning for adults4. Evidence of depression screening5. Evidence of screening for high-risk behaviors such as drug, alcohol and tobacco use, sexual activity, exercise and nutrition counseling6. Evidence that Medicare patients are screened for functional status and pain7. Evidence of tracking and referral of age and gender appropriate preventive health services8. Use of flow sheets or tools to promote adherence to clinical practice guidelines/preventative screeningsProblem Evaluation and ManagementDocumentation for each visit includes:1. Appropriate vital signs (i.e., weight, height, BMI measurement annually )2. Chief complaint3. Physical assessment4. Diagnosis5. Treatment plan: Treatment plans are consistent with evidence-based care and findings/diagnosis6. Appropriate use of referrals/consults, studies, tests7. X-rays, labs, consultation reports are included in the medical record with evidence of practitioner review8. Time frame for follow-up visit as appropriate9. Follow-up of all abnormal diagnostic tests, procedures, x-rays, consultation reports10. Unresolved issues from the first visit are followed up on subsequent visit

Problem Evaluation and Management (continued)11. There is evidence of coordination of care with behavioral health12. Education, including counseling, is documented

These assessment items are for care providers who see the UnitedHealthcare member population from birth to age 20:

1. HistoryPast History (REQUIRED)Family History (REQUIRED)Interval History (REQUIRED)Developmental /Behavioral Assessment (REQUIRED)Nutritional Assessment (Recommended)Dyslipidemia Screening (Recommended, begin at age 2)Lead Screening Assessment (Recommended from six months to 72 months)2. Comprehensive Unclothed Physical Exam: Unclothed (REQUIRED)Weight (Recommended)Height (Recommended)Body Mass Index (BMI) (Recommended for ages 2 to 21)Blood pressure (Recommended, begin at age 3)Head circumference (Recommended through 24 months)Pelvic exam (provider discretion, recommended if indicated) 3. Laboratory Test (ALL REQUIRED if indicated age appropriate)Newborn blood screening (check 0 through 2 months)Hemoglobin or hematocrit (once at 12 months)Lead blood level screening (perform risk assessment or screening as required at 12 and 24 months)Dyslipidemia screening (required between ages 9-11 and 18-21, with the preferred age at 10 and 20) TB Test (if indicated as high risk)STI/HIV screening (to be performed between ages 16-18, with the preferred age of 17)






4. Health Education (REQUIRED, age appropriate topic/information provided)5. Vision (REQUIRED, ocular alignment between ages 2-6, VA at age 3, 4, 5, 6, 8, 10, 12, 15, 18 or in-between years through age 20 if not done at specified years; subjective at all other visits)6. Hearing (REQUIRED, ABR/AE prior to 1 month, objective at newborn and ages 4, 5, 6, 8, 10, 12, 15 and 18 or in-between years through 18 if not done at specified years; subjective at all other visits)7. Oral Assessment or Dental Referral (Documented)8. Immunizations Up-To-Date

Calls are being made now to schedule times at your offices to review records. If you’re selected to participate, our CPSs can work anywhere in your practice. We appreciate your welcoming us into your office.

EPSDT Reminder for Pediatric Care ProvidersSummer is a great time to reach children to make sure they are current on vaccines and Early and Periodic Screening, Diagnostic and Treatment (EPSDT) screenings. Many children will be coming to you for sports clearances, but you should consider this an opportunity to perform recommended, age-appropriate preventive services. We follow Bright Futures, as endorsed by the American Academy of Pediatrics (brightfutures.aap.org/Pages/default.aspx). Bright Futures has a downloadable periodicity table if you’re not familiar with the timing of these services.

Our outpatient provider incentive programs are centered on these measures, along with the Healthcare Effectiveness Data and Information Set (HEDIS), so your completion of EPSDT services may qualify your office for additional incentive payments. Additionally, we frequently offer member incentives and conduct outreach calls to remind members to receive these services.

If you have any questions or would like to collaborate with us on any EPSDT initiatives, call Provider Services at 877-743-8734 and we will put you in touch with our Mississippi Member Services Director and EPSDT team.

UnitedHealthcare Dual Complete Plan Benefits Enhanced For 2019Mississippi residents enrolled in the UnitedHealthcare Dual Complete plan are getting improved benefits in 2019. They include:

• New Benefit! Meal program – Member meals can be arranged for delivery of up to 28 meals in 14 days following a facility discharge.

• Dental – Members are eligible for an exam and cleaning every six months, with up to $2,500 per year for covered preventive and comprehensive dental services such as fillings, crowns, periodontal services, extractions, dentures and root canals. (Credits increased by $500 from 2018; denture and root canals were added to coverage).

• Health products benefit credits - FirstLine Medical will provide $225 quarterly/$900 annually in over-the-counter product credits. Members will have the option of ordering through the FirstLine Medical Catalog by mail, website or phone. (Increase of $280 annual credits)

• Transportation – National MedTrans will provide up to 36 one-way rides to medical-related appointments annually. (An increase of six one-way trips)

• Vision – Members are eligible for their annual exam and $250 credit every year for eyewear (Credits increased $50 from 2018).

In addition, UnitedHealthcare Dual Complete Plans in Mississippi offer chiropractic, hearing and podiatry benefits beyond what is covered by traditional Medicare. For complete benefit details, visit UHCprovider.com/mscommunityplan.

Members may be eligible for UnitedHealthcare Dual Complete plans if they qualify for both Medicare and Medicaid benefits. They can learn more by calling 844-812-5967 from 8 a.m. – 8 p.m., seven days a week.


https://brightfutures.aap.org/Pages/default.aspx

https://www.uhcprovider.com/en/health-plans-by-state/mississippi-health-plans/ms-comm-plan-home.html?cid=none

795 Woodlands ParkwaySuite 301Ridgeland, MS 39157

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

Community Plan

Mississippi

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