administrative information government programshp/@public/... · o member complaint processes and...
TRANSCRIPT
Administrative Information Page Treatment Cost Calculator 2
Injectable/Immunization Fee Schedule Update
2
Credentialing Web Site 2-3
2013 ClaimCheck Update 3
Changes to Psychiatric CPT Codes 3
COMING SOON: Online Prior Authorization requests
3
ICD-10 3
Important Information Available On Line
4
Clinical Information
Spine Surgery Low Back Pain Office Visits
4
Innovations in Health Care Awards: Winners Announced
5-7
ICSI Guidelines 7-8
ACE/ARB and Diuretics 8
Medical, DME & Medical Dental Coverage Policy Updates
8-9
Pharmacy Updates 9-10
Medical Policy Announcements – Pharmacy
10
New Specialty Pharmacy Partner 11
Government Programs Page REMINDER: PCA Requests and Denials
11-12
Medicare Members and Financial Liability
12
Disclosure of Ownership and Management Statement
12
Minnesota Senior Health Options 13
Mandatory Psychiatric Consultation Services
14
Physician Incentive Plans Disclosure (PIP)
14
PIP Fax Back Form 15
Events Event Calendar 16
NOVEMBER 2012
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ADMINISTRATIVE INFORMATION
Provider Cost Comparison Tool Improvements For HealthPartners’ members interested in the cost of in-network services and procedures, HealthPartners has improved its Provider Cost Comparison Tool. The new tool will better predict health care costs for members by using the provider’s billing patterns from historical claims data. This change will take effect January 1, 2013.
The Provider Cost Comparison Tool provides members with estimated costs for many health care services and procedures from doctors, clinics and hospitals across the country. HealthPartners’ members will now be able to compare costs from one provider to another for more than 230 procedures. The tool also has the capability to use real time benefit integration to produce estimates based on the member’s health plan benefits.
This tool is only available online to HealthPartners members and HealthPartners members must use their authenticated sign on information to use the Provider Cost Comparison Tool.
» If you have any additional questions please contact your Service Specialist or Contract Manager.
Injectable/Immunization Fee Schedule Update As outlined in your market basket fee schedule, the fees for injectables and immunizations are subject to quarterly updates. The next update will be effective November 15, 2012. A list of the updated fees is available on the Provider Portal. Please find the Injectable Fee Schedule link under the HPI Administrative Program for Medical Providers/Fee Schedule Updates or click here Administrative Policies.
National Drug Code (NDC) pricing for not otherwise classified codes (e.g. J3490) can now be found on the Provider Portal. This pricing will be effective January 01, 2013. For additional information on the NDC policy, please refer to the link under the HPI Administrative Program for Medical Providers/Claims Submission Requirements for Drug Codes or click Drug Code Policies.
Credentialing Credentialing Web Site HealthPartners Provider Portal home page has a specific site to answer many of your common credentialing questions. You can access this site through the HealthPartners website at www.healthpartners.com/credentialing (pathway: For Providers/Secured Online Systems/Secured Provider Site Links or Provider/Credentialing and Enrollment).
You will find the following information on the HealthPartners Credentialing Web Site:
• Frequently asked questions—with detailed answers
• Convenient link to the Minnesota Credentialing Collaborative’s web-based credentialing application
• HealthPartners Credentialing Plan, which includes our credentialing criteria for acceptance into the HealthPartners network
• Practitioner’s rights as they pertain to the credentialing process
Credentialing Process HealthPartners uses the Minnesota Credentialing Collaborative’s ApplySmartTM system and is requesting all practitioners use this new, efficient system. Practitioners or clinics can join the MCC and use this web-based credentialing application for submission of the credentialing application to HealthPartners.
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HealthPartners will transition from providing pre-populated recredentialing applications and will ask all practitioners to use ApplySmart for recredentialing. If you do not have an account with the MCC, please Join Now at
http://mncred.org.
If you or your clinic are already a member of the MCC and have an ApplySmartTM account, log into ApplySmartTM to submit your credentialing or recredentialing application to HealthPartners.
If you have questions about the ApplySmart system, contact the Minnesota Credentialing Collaborative, [email protected] e-mail address is being protected from spambots. You need JavaScript enabled to view it or (651) 789-0113.
If you have any additional questions, please contact Credentialing at [email protected] or 952-883-5755.
2013 ClaimCheck Update In the first quarter of 2013, HealthPartners will implement the 2013 NCCI and ClaimCheck Edit updates. This update incorporates the changes in the American Medical Association’s 2013 CPT and 2013 HCPCS Level II code updates.
» If you have any questions regarding specific changes please contact your HealthPartners Service Specialist.
Changes to Psychiatric CPT Codes Effective 1-1-2013 HealthPartners would like to remind providers that the American Medical Association (AMA) has made significant changes to many of the commonly used Mental Health CPT procedure codes effective 1-1-13. Several key codes are being deleted and new codes added. Please reference the 2013 AMA CPT Book or on-line resources for more information on the specific changes. Providers will be required to bill the new codes for dates of service 1-1-13 and after.
» Additional questions, please contact your HealthPartners Service Specialist or Contract Manager
Online Prior Authorization Requests Coming Soon! HealthPartners Provider Portal will soon offer an application allowing providers to submit prior authorization requests online for medical, pharmacy and DME services. This new application will allow providers to: search for diagnosis and procedure codes by description, attach supplemental documentation, answer prompted clinical questions and more. In addition, this new online application will help save paper and also make the prior authorization request process more efficient. Stay tuned for future announcements.
» If you have additional questions, please contact Susan Gunderson at [email protected] or Ken Friday at [email protected]
ICD-10 Information Available to Review from the Webinar held on October 9, 2012 The audio recording of the MN ICD-10 Collaborative Webinar-"The Winding Road to ICD-10 Code Sets" is now available to review if you were unable to participate in the webinar held on Tuesday, October 9, 2012. The audio has been split up into two parts: the presentation itself and the panelist discussion that followed the presentation. You can access either section of the webinar or the PowerPoint slides of the presentation at www.heatlhpartners.com/providers/what’s new/ICD-10 Webinar or click here: Webinar Information
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HealthPartners Programs and Important Information Available On Line Information is available for your review concerning key HealthPartners programs, policies and procedures, as well as important member information you should be aware of. The following information is available on the HealthPartners website at www.healthpartners.com, then click “Provider Website” in the lower right corner.
• Information on our QI programs, including program descriptions and the Annual Evaluation report on meeting our goals
• Clinical Guidelines and Guideline Updates:
• Access Utilization Mgmt Information:
• Access Administrative Policies including:
o Medical Record Standards,
o Utilization Management Criteria
o Contact a Medical Director regarding UM:
o Member Rights & Responsibilities
o Member Complaint Processes and Procedures
• Access Confidentiality/Privacy policies:
• Pharmacy Management Procedures:
» If you would prefer a paper copy of any of the above, please contact your HealthPartners Service Specialist.
CLINICAL INFORMATION
Spine Surgery Low Back Pain Office Visits – Clarification Members are required to have an evaluation at a Designated Medical Spine Center (MSC) by a designated medical spine specialist prior to orthopedic spine and neurosurgeon office visits for specified lumbar spine conditions unless there is an emergent indication for a surgical evaluation (see Spine Surgery-Low Back Pain Office Visit Policy). This policy’s prior authorization requirement does apply to members using a HealthPartners Commercial or Medicaid insurance product. The prior authorization requirement does not apply to members using a HealthPartners Medicare, MN Senior Health Options (MSHO) or Workers Compensation insurance product. See below for specific examples.
The requirement does apply to HealthPartners members when:
• Primary coverage: HPI Medicaid or HPI Commercial insurance product
• Secondary Coverage: HPI Medicaid or HPI Commercial insurance product
• Primary coverage: Non-HPI Medicare insurance product
• Secondary coverage: HPI Commercial or HPI Medicaid insurance product
• Primary coverage: HPI Commercial or HPI Medicaid insurance product
• Secondary coverage: Non-HPI Medicare insurance product
The requirement does not apply to HealthPartners members when: • Primary Coverage: HPI Medicare (i.e. Freedom), MSHO
• Secondary Coverage: HP Medicare (i.e. Freedom), MSHO
» For additional questions, please contact the HealthPartners Member Service Department at 952-883-5000
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2012 Innovation Awards Announcement Five progressive innovative approaches, aimed at improving health, patient experience, and controlling the total cost of care, received HealthPartners’ fifth annual Innovations in Health Care Award.
The Innovation awards, presented at HealthPartners annual Partners in Excellence dinner, had 36 applicants overall and included what has not been seen before - community based initiatives for disadvantaged populations, mental health access, and community initiatives in childhood obesity. The response in this community of care delivery has been innovation, continuous rapid improvement, and a deep commitment to the triple aim of quality outcomes, excellent patient experience and affordability.
We recognize and appreciate on behalf of our members ( your patients), all of the effort each of you is making in achieving this triple aim. Full details on the Innovation winners and all applications will be available soon at www.HealthPartners.com/quality
Fairview Health services, Orthopedic Service Line Pre-operative Pain Consultations Fairview address the variation in post op pain control for medically and behaviorally complex patients who had knee or hip replacements. The group developed a preop pain physician consult for high risk post op pain management patients. It consisted of a comprehensive medical, behavioral, and psychosocial assessment two weeks before surgery at which time a mutually agreed upon pain management plan was developed that extended from the recovery room to ninety-days postoperatively. There were significant improvements in physical therapy compliance, satisfaction with pain control, and a twenty-two percent reduction in hospital costs.
Northwest Metro Alliance - Allina Health and HealthPartners Medical Group Innovative Triple Aim Partnership for a Community These partners formed the Northwest Metro Alliance in which they electronically share health information, develop strategies together, and avoid duplication of resources led by a cross functional clinical and administrative team. They have standardized the care for acute low back pain, reduced emergency department visits, and implemented a pediatric obesity coaching program as well as reduced admissions for heart failure, the use of high-tech imaging, and emergency department visits. They also have opened urgent care centers and have improved mental health services access. In two years, they have saved that population eight million dollars in health care costs.
Fairview Health Services, Orthopedic Service Line Meeting the Needs of Patients with Low Back Pain This group used risk stratification tools and care guidelines to direct patients to the most appropriate provider to begin care for acute low back pain. A nurse triages the patient over the phone to assess the level of risk for the patient. Low risk patients may have a coach and self-manage. If not low risk, the patient is referred to the most appropriate provider who will meet the patient’s needs and values. Ninety percent of the patients have been referred to physical therapy and ten percent are referred to a medical spine specialist. They have demonstrated a fifty-four percent improvement in outcomes, elimination of a physician visit in eighty-eight percent of the patients and reduced MRI use by one third.
Emergency Physicians Professional Association Improved Emergency Department Management of Chronic Pain Patients with chronic pain receive inconsistent and confusing care in the emergency department. This group developed a chronic pain protocol to provide a uniform approach to manage chronic pain patients in the emergency department.
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While reducing the risks associated with prescribing opioids they found no patient complaints, decreased emergency department visits by seventy-seven percent, and had high compliance of patients being followed in their primary care clinic or a pain management clinic.
Fairview Health Services, Orthopedic Service Line Variability in Post-Acute Care for Joint Replacement Patients
This group's joint replacement patients used multiple post-acute care facilities. They developed a seventeen point data analysis on over one thousand of their patients who had post acute care. They then shared this data with each of the facilities. Seventy-five percent of the facilities improved physical therapy outcomes after seeing their comparative data and discharge planning improved. If all patients were referred to the highest value facility, eleven million dollars would have been saved in this population.
Allina Community Pharmacies at Allina Health Medication Outcomes for Employees and Covered Lives
Allina Health Primary Care Cognitive-Behavioral Treatment for Insomnia
Allina Health Breast Cancer Program Across a Large Health System
Diagnostic Evaluation Center Diagnostic Evaluation Center
Bethesda Hospital, Member, HealthEast Decision Support for Care Transitions
CentraCare Health System BLEND: A Community Collaboration to Fight Childhood Obesity
Children’s Hospitals and Clinics of Minnesota Simple Electronic Checklist in the Pediatric ICU
Children's Hospitals and Clinics of Minnesota Bar Code Medication Administration
Chiropractic Care of Minnesota, Inc. Improving Patient Care with Active Care in Chiropractic
HealthPartners Medical Group and Regions Hospital Early Extubation in Adult Cardiac Surgical Patients
HealthPartners Medical Group and Regions Hospital Ultra-low Dose Single Photon Emission Computed Tomography Myocardial Performance Imaging
HealthPartners Medical Group and Regions Hospital Departments of Cardiology, Emergency Medicine and Hospital Medicine Low-Risk Chest Pain Protocol in the Emergency Department
HealthPartners Medical Group; Regions Hospital, Department of Cardiology Safety and Efficacy of Elective Cardioversion by Advanced Practice Providers
HealthPartners Pharmacy Role of the Pharmacist: Enhanced use of the Medical Record
Hennepin County Medical Center Clinics at East Lake Experiential Bilingual Wellness Group
Integrity Health Network
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Care Continuum Initiative
Lakeview Hospital Increasing the Rate of Tdap Vaccinations in the Community
Natalis Counseling & Psychology Solutions Psychology Care Management
North Memorial Human Milk Program
NovaCare Shared-Risk Value-based Purchasing Models of Physical Therapy
OSI Physical Therapy and The Training Room Pre-Diabetic Program
Park Nicollet Health Services Improving Care of Our Patients Living with HIV
Physicians’ Diagnostics & Rehabilitation Cognitive Behavioral Coaching Program
Regions Hospital Reducing Hospital Acquired Pressure Ulcers in the OR
Regions Hospital Care Plans for High-Risk Patients
Regions Hospital In-Patient Mental Health Sensory Integration
Sister Kenny Rehabilitation Institute Work Flow Process for Post-Discharge Follow-Up
St. John’s Hospital/HealthEast Care System Discharge Process Lean Flow
Twin Cities Orthopedics Excel Orthopedic Surgery and Recovery
Western Wisconsin Medical Associates Enhancing the Uninsured Patient Experience
Western Wisconsin Medical Associates Optimal Vascular Care
ICSI Guidelines – New & Revised Guidelines & Order Sets September 2012 Institute for Clinical Systems Improvement (ICSI) health care guidelines represent the most appropriate medical practice for a range of common preventive services, chronic diseases and acute conditions.
A health care protocol is a step-by-step statement of a procedure routinely used in the care of individual patients to assure that the intended effect is reliably achieved.
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Order sets are a standard set of orders for in-patient care for particular conditions.
Health Care Guidelines that have been recently developed or updated:
• Preventive Services for Adults • Preventive Services for Children and Adolescents
Health Care Protocol that has been recently developed or updated:
• Non-OR Procedural Safety Protocol
Our goal in communicating these updates is to promote the use of guidelines/protocols/order sets that are based on the best available evidence. Please review the above list and determine if it is appropriate to implement some or all of them within the clinical practice of your medical group. Complete copies of all ICSI Guidelines, Protocols and Order Sets are available on the ICSI web site at (http://www.icsi.org) or call ICSI at (952) 814-7060 to obtain a hard copy.
» Contact: Bev Norling, Quality Consultant, Quality Measurement and Improvement Department at (952) 883-6184 or [email protected]
Members on ACE/ARB and Diuretics--Annual Monitoring Reminders for November 2012 In November, HealthPartners will send letters to members on ACE/ARBs and/or diuretics who appear to be behind on annual potassium level and kidney function testing. Customized letters will be sent to commercial members on these medications who do not have a claim for these monitoring tests 1/1/12 to 10/31/12. Members are referred to their doctor’s office to make an appointment. The letter is signed by Terry Crowson, M.D., Associate Medical Director. » If you have any questions regarding this initiative, please contact us at [email protected]
Medical, Durable Medical Equipment (DME) & Medical Dental Coverage Policy Updates 11/15/2012
Please read this list of new or revised HealthPartners coverage policies. HealthPartners coverage policies and related lists are available online at HealthPartners – Coverage Criteria Policies. Upon request, a paper version of revised and new policies can be mailed to clinic groups whose staff does not have Internet access. Providers may speak with a HealthPartners Medical Director if they have a question about a utilization management decision.
Medical Coverage Policies Comments / Changes Cryosurgical Radiofrequency Ablation of Hepatic Tumors
Policy has been updated to include coverage of cryosurgical or radiofrequency ablation of neuroendocrine tumors metastatic to the liver, effective 10/1/12.
Epidural Steroid Injections for low back pain
We added ICD-9 code 722.10 – Lumbar intervertebral disc without myelopathy – as another code for which prior authorization is required prior to performing an epidural steroid injection. This will be effective 1/1/13.
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Investigational Services – List of non covered services
This policy has been updated, adding the following services as not covered, effective 1/1/13: • Smart Pill gastrointestinal monitoring (0242T) • LINX reflux management system for gastro-esophageal
reflux disease (43499) • Aneurysm pressure sensor (93982)
Please remember that these codes will deny to either provider or member liability based on use of the GA modifier.
Behavioral Health Coverage Policies Comments / Changes In-Home Mental Health Psychotherapy Services – HealthPartners Care
New policy effective 1/1/13 updating the current process. Claim denials may be seen with failed adherence.
DME Coverage Policies Comments / Changes Breast Pumps- Commercial Correction to Sept Fast Facts entry: Language changed in the
policy to clarify that E0603 is a purchase item only. Coverage criteria have not changed. Effective immediately.
» Contact the Medical Policy Intake line at 952-883-5724 for specific patient inquiries. For general policy
and process questions contact Deb DooherAnderson at 952-883-5798
Pharmacy Updates
Formulary Update, October 2012 A complete list of updates is available at www.healthpartners.com. Updates include:
Rivaroxaban (Xarelto), added with prior authorization.
Rivaroxaban is a new oral anticoagulant, similar to warfarin.
Rivaroxaban is available for FDA-approved indications:
1. Patients with a diagnosis of nonvalvular atrial fibrillation, or
2. Prophylaxis of deep vein thrombosis in patients undergoing knee or hip replacement surgery.
Dabigatran (Pradaxa) remains on formulary with prior authorization, for patients with a diagnosis of nonvalvular atrial fibrillation.
Tdap (tetanus/ diphtheria/ pertussis) vaccine and Zoster vaccine (Zostavax). Coverage has been expanded to allow pharmacists to administer Tdap and Zostavax. Pharmacies are now able to administer Tdap, bill HealthPartners through the pharmacy system, and charge patients using their preventative benefit (usually no co-pay).
Generic Update Recent generic include montelukast (Singulair), valsartan/ HCTZ (Diovan HCT), and methylphenidate CD (Metadate CD). Recent price changes include Avapro and Avalide (now about $25 per month, a typical price erosion, with a significant decrease 6 months after the date of the first generic) and Singulair (now $35 per month, an unusually quick decrease).
The biggest opportunities for cost savings with generic promotion programs are
• Migraines, from Branded triptans such as Maxalt and Relpax, to sumatriptan
• PPIs, from Nexium and Aciphex, to omeprazole and pantoprazole
• Cholesterol, from Crestor to atorvastatin, and from Tricor to fenofibrate
• Nasal steroids, from Nasonex to fluticasone
• NSAIDs, from Celebrex to ibuprofen and naproxen
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Preferred Drug List (Drug Formulary) Drug Formularies are available at www.healthpartners.com/formulary. See these sites to verify formulary status. Drug Formularies are also available for mobile devices through Epocrates. Quarterly Formulary Updates and additional information such as Prior Authorization and Exception Forms, Specialty Pharmacy information, pharmacy newsletters, and Pharmacy and Therapeutics (P&T) Committee policies are available at HealthPartners.com/ Providers/ Pharmacy Services.
Pharmacy Customer Service is available to providers (physicians and pharmacies) 24 hours per day and 365 days per year:
• Fax - 952-853-8700 or 1-888-883-5434. Telephone - 952-883-5813 or 1-800-492-7259. • HealthPartners Pharmacy Services, 8170 33rd Avenue South, PO Box 1309, Mpls, MN 55440.
HealthPartners Customer Service is available from 8 AM - 6 PM Central Time, Monday through Friday. After hours calls are answered by our Pharmacy Benefit Manager.
Medical Policy Announcements – Pharmacy November 2012 Pharmacy Policies
Minimum/Maximum Drug Dosage
New policy. Claims may not be paid for quantities outside these limits. http://www.healthpartners.com/public/coverage-criteria/minimum-maximum-drug-dosage/
This policy provides information about the minimum and maximum billing units allowed per administration for select medications administered by healthcare professionals. Quantities were determined using package labeling or other published clinical evidence.
Claims that do not meet these standards may be denied effective 1/1/13 Hydroxprogesterone Caproate (Makena)
Removed policy. Both compounds and the commercially available product are covered. Previously the commercial formulation, Makena, was not covered.
This policy is effective immediately.
Recently FDA-Approved Medications Coverage Policy
Reminder that select new drugs require prior approval. http://www.healthpartners.com/public/coverage-criteria/fda-approved-medications/
Prior authorization from Pharmacy Administration is required for newly approved, professionally-administered specialty medications. The current list of drugs includes:
• Taliglucerase alfa (Eleyso) • Ziv-aflibercept (Zaltrap) • Vincristine Sulfate (Marqibo)
Preginesatide (Omontys) does NOT require a prior authorization in accordance with our Erythrocyte Stimulating Agents (ESA) policy.
A complete and up-to-date list of drugs impacted by the policy is available on healthpartners.com at the following link. http://www.healthpartners.com/ucm/groups/public/@hp/@public/@cc/documents/
documents/dev_058782.pdf
As drugs are approved for use, Pharmacy Administration will identify impacted drugs. Effective dates of the prior authorization requirement for each drug will be clearly stated. This list of impacted drugs is subject to updates without further notice.
Claims received without prior authorization may be denied effective 1/1/12 as this policy was published in November 2011
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New Specialty Pharmacy Partner Effective 1/1/2013, CVS Caremark will become our specialty pharmacy partner. HealthPartners periodically reviews the market to ensure that our members receive comprehensive service at the most cost-effective price.
Remaining refills will be transferred to CVS Caremark. Impacted members will be contacted by letter and telephone to let them know of this change and facilitate the transition.
You may need to update your Electronic Health Record system or your internal contact document regarding this change. CVS Caremark Specialty Pharmacy information is below.
NCPDP NPI Address Phone # Fax # Caremark Specialty Pharmacy, LLC
3958898 1043382302 105 Mall Boulevard Monroeville, PA 15146
1-800-368-1624 1-800-441-5809
Pulmonary Hypertension Medications Only (no changes)– Caremark Illinois Specialty Pharmacy, LLC
1466033 1134100134 800 Biermann Court, Suite B Mount Prospect, IL 60056
1-877-242-2738 1-877-943-1000
Additionally, CVS Caremark Specialty Pharmacy will:
• Encourage patients to take their medications exactly as prescribed
• Help them to manage medication side effects
• Schedule their next refill and assist them when they need a new prescription filled
• Work with their insurer to coordinate and verify their pharmacy benefits
• Triage members taking limited distribution drugs to the dispensing pharmacy
• Support them with access to a pharmacist 24 hours a day, seven days a week
• Deliver their specialty medication where they want – a prescriber’s office, clinical treatment center, their home or a CVS retail store
These services are available to your patients at no charge. For additional information visit CVSCaremarkSpecialtyRx.com or speak with a member of the CVS Caremark Specialty Pharmacy Care Team at 800-368-1624. Enrollment forms are available at http://cvscaremarkspecialtyrx.com/physicians/enrollment-forms.
» If you have questions or comments for HealthPartners, please contact Christine Strahl, PharmD at 952-883-5022 or at [email protected].
GOVERNMENT INFORMATION
Reminder: Personal Care Assistance (PCA) Requests and Denials A HealthPartners member or other authorized person must request PCA services on behalf of the member. PCA Agencies may no longer request an initial assessment on behalf of a HealthPartners member. An assessment request is considered “initial” any time there is not a current care plan in place. Requests must come from either the member themselves or another authorized person.
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If an inquiry regarding personal care assistance services is made by a PCA agency to HealthPartners:
1. HealthPartners will verify that the member or other authorized requestor contacted HealthPartners to request the service
2. If the initial request was documented in our system, the request for PCA services will be reviewed.
3. If there is no documented request from the member or authorized requestor, a HealthPartners Nurse Navigator will contact the member to verify they have requested PCA services. If the member has requested PCA services, and it is documented in our system, the PCA Agency request will be processed.
If the member did not request a PCA assessment, Quality Utilization and Improvement (QUI) staff will not enter an authorization. Instead, they will contact the PCA provider to educate them on the process for initial assessments.
Also, effective September 1, 2012, HealthPartners began providing a 10-day notice to recipients/responsible parties when a change results in a decrease or reduction in PCA services.
» For additional information, please contact the Medical Policy Triage Line at 952-883-6333.
Medicare Members and Financial Liability: When a HealthPartners Freedom or MSHO member receives an item or service that is covered upon referral or prior-authorization from a contracted provider, the member cannot be financially liable for more than the normal in-plan cost.
If a provider determines a member should receive an item or service and the item or service is not covered, the provider should have the member sign a waiver acknowledging the member is aware the item or service is not covered. The waiver should include the type of item or service, the cost, the member signature and date.
If a claim is submitted and the plan does not have a member signed waiver, the claim will be denied to provider liability.
» If you have additional questions, please contact Trina Dickson (952)883-7315 or [email protected]
Disclosure of Ownership and Management Statement for 2013 is Due From All Contracted Provider Groups The Minnesota Department of Human Services (DHS) and the Centers for Medicare and Medicaid Services (CMS) requires health plans, including HealthPartners, to collect information regarding the ownership and management of their contracted providers on an annual basis.
Please complete the 2013 Disclosure of Ownership, Business Transactions and Exclusions Statement if you have not already done so and return it via the instructions included on the form.
If you have completed this document from another payer, you do not need to fill out a separate form. Simply fax the form you’ve already completed to 952-853-8708.
The form is located on the HealthPartners Provider Portal under Popular Links – Regulatory Requirements or at the following link: Disclosure of Ownership Form
» If you have additional questions, please contact Trina Dickson (952) 883-7315 or [email protected]
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HealthPartners Minnesota Senior Health Options 2013 Supplemental Benefits The MSHO plan provides comprehensive coverage for all seniors covered by Medicare and Medical Assistance. HealthPartners also offers supplemental benefits to MSHO members. These benefits may change each year.
The Supplemental Benefits for 2013 are as follows:
• Second annual visit for cleaning and exam
Dental
• Adult fluoride
• Scaling and root planning
• Full mouth debridement
• Periodontal maintenance
• Root canals on molars
• Denture services
o Relines, rebase and adjustments on dentures
o Complete denture repair
o Partial denture repairs
o Tissue conditioning
• Porcelain crowns, up to $2,000
• Electric toothbrush and replacement heads
• A second pair of eyeglasses
Vision
• Tints and coatings on eyeglasses (applies to both pairs)
• Second pair of orthotics and orthotic shoes
DME
• Safety/falls kits for members living in the community
Health and Wellness
• 10,000 Steps program with pedometer
• Stationary bicycle peddler
• Nutrition education classes
• YumPower nutrition plate
>>If you have additional questions, please contact Riverview Member Services at 952-967-7998
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Mandatory Psychiatric Consultation Services The Minnesota Department of Human Services (DHS) has partnered with the Mental Health Integration and Transformation (MhINT) Coalition to provide the Minnesota Collaborative Psychiatric Consultation Services that were mandated by legislature. Among many things, the MhINT is responsible for reviewing psychotropic prescriptions that exceed predetermined thresholds for children.
To view the Current Medication Thresholds that require a mandatory consultation, visit www.mnpsychconsult.com or click here: current medication thresholds that require a mandatory consultation.
To initiate or continue psychotropic drug therapy in children at dosages exceeding certain thresholds, providers must:
1. Fax a completed Psychiatric Consultation Request Form (DHS-6176) to the Minnesota Collaborative Psychiatric Consultation Service at 1-855-433-4276
2. Call the Consultation Service at 1-855-431-6468 to complete the Consultation
Minnesota’s consultation service is open for calls from pediatricians, family practice physicians and other primary care practitioners (PCPs) Monday – Friday, 7 a.m. – 7 p.m. The state-wide toll‐free number is 1‐855‐431‐6468 (MINT).
» For further information regarding this program, including Psychiatric Consultation Request forms, please visit the DHS website or click here: Mental Health Integration & Transformation Project
Physician Incentive Plans (PIP) Disclosure As part of our contract with the Minnesota Department of Human Services (DHS) and Centers for Medicare and Medicaid Services (CMS), HealthPartners is required to disclose information regarding physician incentive plans that may exist between HealthPartners and our contracted clinics, as well as incentive plans between contracted clinics and individual physicians within the clinic.
We also need to disclose physician incentive plans with “downstream” sub-contracting arrangements with your group. Disclosure is required even if there are no incentive arrangements, or arrangements that have a low level of risk either through referrals or low utilization.
If your clinic’s information has changed since you last submitted these forms, please submit the fax back form to HealthPartners and a Summary Data Form will be sent to you for completion.
Thank you, in advance, for your assistance in keeping physician incentive plan information up to date.
» If you have questions or need more information, please contact your Service Specialist.
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EVENTS
HealthPartners Institute for Education and Research 2012 November/December
Event Calendar
Emergency Medicine and Trauma Update: Beyond the Golden Hour – November 15
33rd Annual Cardiovascular Conference – December 13-14
» For further information, visit the Institute’s website at healthpartnersinstitute.org or contact (952) 883-6225.
If you have questions regarding the content of this newsletter, please contact the person indicated in the article or call your HealthPartners Service Specialist. If you don’t have his/her phone number, please call 952-883-5589 or tool-free at 888-638-6648.
This newsletter is available on-line at healthpartners.com/provider (pathway: Log into the Provider Portal).
Fast Facts Editor:
Kelly Peterson, Hospital & Regional Network Management 952-883-5651 or [email protected]
Fast Facts CoEditor:
Tara Sutherland, Professional Services Network Management 952-883-5657 or [email protected]