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Texas | Winter 2015

PCA19042_20151210

Practice Matters: TX - Winter 2015 Customer Service: 888-887-9003

Important information for health care professionals and facilities

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In This Issue...• A Word from Our Chief Medical Officer

• Reducing Radiation Exposure in Pediatric Populations

• Medication Therapy Management

• Network Referrals

• Important Updates for THSteps

• Introducing Link ‒ a New Site for UnitedHealthcareOnline.com and Optum Cloud Dashboard Users

• Culturally Competent Care

• Where to Find Updates Online

• Taking Steps toward Quality Improvement

• Special Needs Plan Model of Care Training

• 2016 Training Opportunities

• Caring for Members with Intellectual and Developmental Disabilities

• Medicaid Re-enrollment is Required to Continue Serving Members

• Long Term Service and Support ICD-10 Codes

• Provider Manual Coming Soon

We hope you enjoy the winter edition of Practice Matters. In this issue, you can read about quality improvement efforts, updates for THSteps, Medicaid re-enrollment and much more.

PCA19042_20151210

Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33681 Practice Matters: TX - Winter 2015 Customer Service: 888-887-90031


A Word from Our Chief Medical Officer — Salil Deshpande, MD Medicaid managed care can involve rapidly changing policies and procedures. In this edition, we’re highlighting training opportunities for primary care physicians and support staff, along with several updates to THSteps, ICD-10 and our provider portal.

One the most significant changes that I want to highlight is the need to regularly re-attest as a Texas Medicaid provider so that you can continue to care for and deliver services to UnitedHealthcare Community Plan members. If you were enrolled prior to Jan. 1, 2013, visit the Texas Medicaid & Healthcare Partnership (TMHP) to re-enroll today so that you can continue to serve our members into 2016. Thank you for joining us in our mission to help people live healthier lives.

http://www.tmhp.com/Pages/default.aspx



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 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

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

http://www.acepnow.com/article/ultrasound-appendicitis/



Medication Therapy ManagementOur members are invited to meet with a pharmacist for a review of their prescribed medications. For convenience or necessity, this also can be done by phone.

During the review, the member receives patient education specific to their prescriptions. The pharmacist assesses for possible under/over drug utilization patterns. Possible drug-to-drug interactions are explored. As a result, the pharmacist may contact the prescriber to address concerns. In some instances, the pharmacist may follow up in six months to check on the member and their prescriptions when there is a concern for safety and/or compliance.

This service is offered at no cost to eligible members who have a complicated medication regime consisting of at least seven drugs and have two or more chronic health conditions. The service is considered in the development of the member care plan, or a pharmacist may contact a member on our request, based on quality reviews.

For more information or to refer a member to this service, please call Customer Service at 888-887-9003.

Network ReferralsOur members are able to self-refer to any participating network specialists so a referral from their primary care provider is not necessary. Members can find a network specialist by visiting UHCCommunityPlan.com. When they enter their zip code and basic information to pull up their plan, they can select “Choice of Doctor” to do a “Doctor Look Up.”

Important Updates for THStepsTexas Health Steps (THSteps) has several updates for you to implement in wellness care for STAR and STAR+PLUS members through age 20.

On Oct. 1, 2015, the ICD-10 codes Z00.129 and Z00.121 replaced ICD-9 for medical checkups, exception to periodicity checkups and follow-up visits. On Nov. 1, 2015, Z00.00 and Z00.001 were added as new medical checkups, exception to periodicity checkups and follow-up visits for members age 18-20.

ICD-10 Code DescriptorZ00.129 Encounter for routine child

health examination without abnormal findings

Z00.121 Encounter for routine child health examination with abnormal findings

Z00.00 Encounter for general adult health examination without abnormal findings

Z00.001 Encounter for general adult health examination without abnormal findings

On Nov. 1, the THSteps Medical Checkup Periodicity Schedule for infants, children and adolescents birth through age 20 was revised to reflect policy changes.

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http://www.uhccommunityplan.com/health-professionals/tx/provider-bulletins.html



Screenings• Anemia screening: This is no longer a mandatory

screening for all members who are 18 months of age and for females age 12. Now, it is only mandatory for members who are 12 months of age.

• Human Immunodeficiency Virus (HIV) screening: One additional mandatory screening for members age 16-18, regardless of risk. This is in addition to the current risk-based screening for members age 11-20.

• Dyslipidemia Screening, previously hyperlipidemia screening: One additional mandatory screening for members age 9-11, and again for members age 18-20, regardless of risk. These are in addition to the current risk-based screening for members age 24 months to 20 years.

Autism ScreeningThe Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) screening tool for autism in toddlers may be used to complete the required autism screening at 18 and 24 months of age.

Dyslipidemia ScreeningAdditional testing may be completed based on an identified risk or at the care provider’s discretion.

Mental Health ScreeningMental health screenings are required once for all members age 12-18 and use one of the following validated, standardized mental health screening tools recognized by THSteps:

• Pediatric Symptom Checklist (PSC-35)• Pediatric Symptom Checklist for Youth (Y-PSC)• Patient Health Questionnaire (PHQ-9)• Car, Relax, Alone, Forget, Family and Trouble

Checklist (CRAFFT)

Procedure code 99420 will be a benefit for members age 12-18 when services are provided by THSteps medical and federally qualified health center providers in the office setting. Procedure code 99420 must be submitted for mental health screenings when one of the validated, standardized mental health screening tools recognized by THSteps is used. Procedure code 99420 must be

submitted on the same date of service by the same provider as procedure code 99384, 99385, 99394 or 99395 and will be limited to once per lifetime.

Mental health screening at other checkups does not require the use of a validated, standardized mental health screening tool. The member’s medical record must include documentation that identifies which tool was used, the screening results and any referrals.

Newborn ScreeningState-mandated newborn screening for critical congenital heart disease is offered by and performed in a birth facility in accordance with Health and Safety Code (HSC), Chapter 33, §§ 33.011, and the Texas Administrative Code, Title 25, Part 1, Chapter 37, Subchapter E, §§ 37.75 - 37.79.

For more information, visit THSteps online.

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http://www.dshs.state.tx.us/thsteps/providers.shtm



Introducing Link ‒ a New Site for UnitedHealthcareOnline.com and Optum Cloud Dashboard UsersCare providers and their administrative staff have told us they want a better way to get the information they need to check benefits and eligibility, determine claim status, submit claims reconsideration and more.

That’s why we introduced Link ‒ your new gateway to UnitedHealthcare’s online tools. Link replaces Optum Cloud Dashboard.

• Link includes many of the same applications as Optum Cloud Dashboard, but with a new interface that can help make your work measurably faster and easier.*

• Quickly move between apps and UnitedHealthcare websites, and even customize your screen to put your most common tasks just one click away.

• Next-generation technology will allow enhanced features and new applications.

Applications on Link include:• Eligibility & Benefits: Check member eligibility and

review detailed benefits information, including prior authorization/advance notification requirements and cost share amounts.

• Claims Management: Get the status of your claims quickly and accurately.

• Claims Reconsideration: Quickly look up processed claims, flag claims for reconsideration and submit reconsideration requests with supporting documents. You will receive a tracking number and can check the status of the submission online.

You can also access UHCCommunityPlan.com and UnitedHealthcareOnline.com using the applications on Link.

How to Access LinkTo access Link, sign in to UnitedHealthcareOnline.com using your Optum ID. You will be redirected to Link after sign-in. If you don’t have an Optum ID or need help remembering your ID or password, don’t worry ‒ the

UnitedHealthcareOnline.com sign-in screens will help guide you through the process.

If you have questions about using Link, please call the Optum Support Center at 855-819-5909.

* Based on ongoing usability studies using keystroke-level modeling when comparing Link to UnitedHealthcareOnline.com and Optum Cloud Dashboard.

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. During enrollment, we obtain information about a member’s primary language and may assist the member with choosing a Primary Care Physician who will meet their cultural needs.

Member involvement in their own health care relies on their ability to understand their condition, options and treatment responsibilities. Members respond better when care instructions are delivered in their own language and their cultural background is taken into account. 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


https://www.unitedhealthcareonline.com/b2c/CmaAction.do?viewKey=PreLoginMain&forwardToken=PreLoginMain



and/or hearing accommodations. To access this service, call Customer Service at 888-887-9003.

With growing concerns about health inequities and the need for health care systems to reach increasingly diverse patient populations, cultural competence has become more of a national concern. Practical training to support culturally competent care is available from the U.S. Department of Human Services Office of Minority Health. Think Cultural Health is an educational program dedicated to advancing health equity at every point of contact and promoting culturally and linguistically appropriate services. 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 CEU’s)

(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.

Where to Find Updates OnlinePlease review Bulletin Updates on Reimbursement Policy, Medical Policy and Coverage Determination Guidelines and other alerts by visiting the UnitedHealthcare Community Plan app at Link. Pharmacy updates include:

• 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 the Prescriber Help Desk at 800-310-6826.

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 they feel physicians communicate and how informed they perceive their personal physician is about care the member received from other physicians.



https://www.thinkculturalhealth.hhs.gov/content/continuinged.asp

https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/C&S/UHC%20Community%20Plan_MP%20and%20CDG%20Disclaimer%20Page.pdf




https://provider.linkhealth.com/content/odin/en/provider-dashboard/public/home.html



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.

For more information about our Quality Improvement Program, please call 888-887-9003.

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 is available online by WebEx and will cover 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. 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.

2016 Training OpportunitiesPre-register for one of our 2016 care provider education offerings that are facilitator-led, informational webinars tailored to network providers. Topics include:

• Long Term Services and Support• Employment services• Value-added services• Well baby care• UnitedHealthcare Connected (Medicare-Medicaid Plan)

Training sessions remain posted after the webinar date so you can access the information at your convenience. Visit us through Link > UnitedHealthcare CommunityPlan app > For Health Care Professionals > Texas > Provider Training.

Caring for Members with Intellectual and Developmental DisabilitiesOur STAR+PLUS program includes members who have intellectual and developmental disabilities. The Vanderbilt Kennedy Center for Excellence in Developmental Disabilities offers a primary care provider toolkit that includes medical and behavioral health resources. You can access the toolkit through Link or go to vkc.mc.vanderbilt.edu/etoolkit.

Continuing education is available online. Appropriate Use of Psychotropic Medications for People with IDD: Helping Individuals Get the Best Behavioral Health Care is one course that:

• Equips physicians and other prescribers to better understand and accurately diagnose underlying mental health conditions in individuals with IDD



https://www.unitedhealthcareonline.com/b2c/CmaAction.do?channelId=8c6592752e071110VgnVCM100000c520720a____


http://www.uhccommunityplan.com/health-professionals/tx/provider-training.html

http://www.uhccommunityplan.com/health-professionals/tx/provider-training.html


http://vkc.mc.vanderbilt.edu/etoolkit/



• Offers information for non-pharmacologic interventions that may better address problem behaviors, and identifies when psychotropic medications are appropriate

• Helps promote prescriptions of psychotropic medications that are prescribed in a safe manner and are closely monitored

The training accommodates the busy schedules of practicing professionals by offering 90 minutes of training in eight 10-15 minute modules, which can be completed independently at CME.MC.Vanderbilt.edu.

Satisfactory completion of all modules, including competency checks, is required to receive free Continuing Medical Education credits for the training:

• 1.5 hours American Academy of Family Physicians (AAFP)

• 1.5 American Medical Association Physician Recognition Award (AMA PRA), Category 1 credits for physicians and advanced practice nurses with prescription authority

• 1.5 hours American Psychological Association (APA) Continuing Education credits

Medicaid Re-enrollment is Required to Continue Serving MembersRemember that acute care providers need to re-enroll or re-attest every three years to maintain enrollment as a Texas Medicaid Provider for UnitedHealthcare Community Plan members. Care providers of non-skilled Long Term Services and Support need to re-enroll every five years.

If you enrolled in Medicaid prior to Jan. 1, 2013, your enrollment application needs to be completed and approved by Sept. 25, 2016, to continue serving Medicaid members. If you have not already re-enrolled, please go online to the Texas Medicaid & Healthcare Partnership at TMHP.com > Providers > Provider Enrollmlent > Current and Former Medicaid Providers.

The re-enrollment process requires time to complete and if your re-enrollment is not completed by the deadline

established by the Texas Health and Human Services Commission, we will be forced to reassign members to another network provider who is an active Texas Medicaid provider.

If you have any questions, please call Customer Service at 888-887-9003.

Long Term Service and Support ICD-10 CodesIn accordance with 45 Code of Federal Regulations, Part 162, ICD-10 diagnosis codes must be included on all claims for services provided on or after October 1, 2015.

If a member does not have an ICD-10 code specific to his or her primary diagnosis for services provided from Oct. 1, 2015 through Sept. 30, 2016, you can use the ICD-10 code Z76.89, “Persons encountering health services in other specified circumstances.” To view the information, go to dads.state.tx.us/providers/communications/2015/letters/IL2015-59.pdf.

As a convenience for our LTSS providers, we updated all authorizations for long term services prior to the ICD change on Oct. 1, 2015 and were authorized to continue after Oct. 1, 2015. You can check member authorizations through Link. For more information, call LTSS Provider Services at 888-787-4107.

Provider Manual Coming SoonWe’re updating the CHIP, STAR and STAR+PLUS program in our provider administrative manual. The manual supplements your participating network Agreement and the Texas Medicaid Procedures Provider Manual.

The provider administrative manual contains information on programs, benefits, claims processing, complaints, appeals and more. You can request a CD or paper copy by calling Customer Service at 888-887-9003 or go online to Link > UnitedHealthcare CommunityPlan app > For Health Care Professionals > Texas > Provider Administrative Manual.


https://cme.mc.vanderbilt.edu/content/appropriate-use-psychotropic-medications-people-idd-helping-individuals-get-best-behavioral

http://www.tmhp.com/Homepage%20File%20Library/NetscapeAgreement.aspx?http://www.tmhp.com/Pages/ProviderEnrollment/PE_TX_Medicaid_Current.aspx

http://www.tmhp.com/Homepage%20File%20Library/NetscapeAgreement.aspx?http://www.tmhp.com/Pages/ProviderEnrollment/PE_TX_Medicaid_Current.aspx

http://www.dads.state.tx.us/providers/communications/2015/letters/IL2015-59.pdf

http://www.dads.state.tx.us/providers/communications/2015/letters/IL2015-59.pdf



practicematters

Doc#: PCA19042_20151210 © 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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Texas

UnitedHealthcare Community Plan is the trade name of United Healthcare Insurance Company in the Texas Health and Human Services Commission’s STAR+PLUS Central and Northeast Medicaid Rural Service Areas. UnitedHealthcare Community Plan is the trade name of UnitedHealthcare Community Plan of Texas L.L.C. in the following service delivery areas: Jefferson, Harris, Hidalgo, Nueces and Travis.

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