NEWS—July 2015

Clinical Practice & Preventive Health GuidelinesMolina Healthcare of Illinois (Molina) adopts Clinical Practiceand Preventive Health guidelines to ensure Providers haveup-to-date information to deliver quality, cost-effective andevidence-based care to Members. These guidelines are basedupon recommendations by nationally recognized organizationsand are used to assist practitioners in determining what iscovered by Molina.

Clinical Practice Guidelines: http://www.molinahealthcare.com/providers/il/medicaid/resource/Pages/clinical.aspx

Preventive Health Guidelines: http://www.molinahealthcare.com/providers/il/medicaid/resource/Pages/prevent.aspx

Community Outreach EventsMolina hosts and participates in health education and preven-tive care-focused events to improve the health outcomes ofMolina Members, potential Members, and the communitiesMolina serves. Molina Community Outreach and Care Man-agement staff partner with Providers and community-basedorganizations to ensure consumers can make informed deci-sions concerning their health care and health care for theirfamily members. To partner with Molina in hosting one of theseevents, please contact your Provider Services Representative.

Upcoming events include: Healthy Living Expo (Seniors and Families)—

Bloomington—July 2 Molina Health & Resource Fair (Seniors and Families)—

East St. Louis—July 8 Molina Community Health and Wellness Fair (Seniors and

Families)—Springfield—July 9 4th Annual Mammogram-A-Thon (Women)—Peoria—July

17 Older Adult Health Council Summer Health Fair (Seniors)

—Granite City—July 22 Community Child Care Connection Health Fair (Families)—

Springfield—July 24 Senior Lifestyle Event (Seniors)—East Peoria—July 25 Belleville Chamber Back 2 School Event (Families)—

Belleville—July 28

Provider Satisfaction Survey

Earlier this year, Molina conducted aProvider Satisfaction Survey to remainwell-informed about Provider needs.The survey concentrated on a variety ofsubjects, including: customer service,Provider relations, Provider network,continuity/coordination of care, utiliza-tion/case management, claims, phar-macy and drug benefits, and overallsatisfaction and loyalty. Molina will useresults to develop new Provider initia-tives.

HCC Pearls

Molina’s HCC Pearls program focuseson the coding and documentation rules(Hierarchical Condition Category —HCC) applied by the Centers for Medi-care and Medicaid Services (CMS).HCC Pearls are concise tips for effec-tively and easily identifying, coding, anddocumenting the health status of yourpatients. Included in this month’spacket are:

Chronic Respiratory Failure

Dialysis

Additional HCC Pearls can be found at:

http://www.molinahealthcare.com/providers/il/duals/comm/Pages/hcc-pearls.aspx

No Balance Billing

As a reminder, Providers are prohibited,per Illinois Department of Healthcareand Family Services (HFS) guidelines,from balance billing Molina Membersfor covered services. If you havequestions as it relates to Molina, pleasecontact your Provider ServicesRepresentative.

July National Health Observances

Cord Blood Awareness Month

Juvenile Arthritis Awareness Month

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HEDIS® HintsHealth Plan Effectiveness Data and Information Set (HEDIS®): Set of standardized measuresdeveloped by NCQA©Molina will educate Providers monthly on new HEDIS measures, and July’s focus is on Adult Access toPreventive/Ambulatory Health Services (AAP). The AAP table below provides the Primary Care Physician(PCP) with the appropriate billing codes to use when seeing patients 20 years and older who had an Ambu-latory or Preventive Care visit during the measurement year. These codes ensure that Providers capturethe correct data for the AAP HEDIS measure.

Value Set Description CPT ICD-9-CMDiagnosis

UB Revenue

Ambulatory Visits

Office or otheroutpatient services

99201-99205,99211-99215,99241-99245

051x, 0520-0523,0526-0529, 0982,0983

Home services 99341-99345,99347-99350

Preventivemedicine

99385-99387,99395-99397,99401-99404,99411, 99412,99420, 99429

General medicalexamination

V70.0, V70.3,V70.5, V70.6,V70.8, V70.9

Other AmbulatoryVisits

Domiciliary, resthome or custodialcare services

99324-99328,99334-99337

How to Improve HEDIS ScoresHEDIS results are the measurement standard for many of Molina’s clinical quality improvement activitiesand health improvement programs. Improving these scores means improving clinical outcomes for MolinaMembers.

Use appropriate billing codes as referenced above.

Educate patients on the importance of having at least one Ambulatory or Preventive Care visit duringeach calendar year.

Contact patients on the missing services list who have not had a Preventive or Ambulatory health visit.

Look into offering expanded office hours to increase access to care.

Make reminder calls to patients who have appointments to decrease no-show rates.

Pregnancy Notification FormMolina has revised its Pregnancy Notification Form (PNF), which provides Molina with valuableinformation in identifying pregnant Members. Attached are the PNF and corresponding memo.

For additional information, please contact your Provider Services Representativeor call (855) 866-5462.

Updated Pregnancy Notification Form

Molina Healthcare of Illinois (Molina) has revised its Pregnancy Notification Form (PNF). The PNFprovides Molina with valuable information to assist in identifying pregnant Members and ensuringthey receive the timely prenatal and postpartum care needed.

Providers should complete the form for all pregnant Molina Members and fax to Molina’sQuality Improvement Department. A copy of the attached PNF is also available on Molina’s Pro-vider website at: http://www.molinahealthcare.com/providers/il/medicaid/forms/pages/fuf.aspx.

PNF Submission Process

Complete all Member information. Complete the Provider Information section with the name of the OB/GYN to whom the

Member was referred for prenatal care. Fax the PNF to Molina’s Quality Improvement Department at (866) 617- 4969.

If you have any questions, please contact Provider Services at (855) 866-5462. Representativesare available Monday through Friday, 8 a.m. to 5 p.m. You may also visit our website atwww.MolinaHealthcare.com to learn more about Molina Healthcare.

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Provider Memorandum

Pregnancy Notification FormMolina Healthcare of Illinois Today’s Date: ________________

Urgent - Time SensitiveUpon confirmation of a positive pregnancy test, please complete the form and fax toll free to (866) 617-4969. If you have questions or need assistance, please call (855) 866-5462.

Member InformationMember’s Name: ___________________________________ Member ID: _____________________________

Member’s DOB: ___________________________________ Preferred Language: __________________________

Phone #: ( ) ___________________________________ Alternate Phone #: ( ) _____________________

Address: _____________________________________ City: ________________ State:________ Zip: ________

Last Menstrual Period (LMP): ___________________________ Estimated Date of Confinement (EDC): _____________

IPA Name: ________________________________________________________________________________

High Risk Condition(s)Current Pregnancyq Hypertension q Pre-term laborq Diabetes q Multiple Gestationq Smoking q Excessive Nausea & Vomitingq No problems with current pregnancyq Other: __________________________________

Past Pregnancyq N/A q Hypertensionq Diabetesq Pre-term laborq Pre-term deliveryq No problems with past pregnancyq Other: _____________________________________

Provider InformationPractitioner’s Name: __________________________________________________________________________

Practitioner’s Address: ________________________________________________________________________

Practitioner’s Phone Number: ___________________________________________________________________

Date of First Prenatal Appointment Scheduled/Completed: _______________________________________________

Referred to OB/GYN Practitioner: _________________________________________________________________

Referred OB/GYN Practitioner Phone #: ( ) _______________________________________________________

Molina Healthcare of Illinois • 1520 Kensington Road - Suite 212 • Oak Brook, IL 605232505706IL0515

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