Community Plan

practicemattersIowa | Summer 2016

For More Information

Call our Provider Services Center at 888-650-3462

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Practice Matters: IA - Summer 2016 Provider Services Center: 888-650-3462

Important information for health care professionals and facilities

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In This Issue...• Self-Service Tools Available Online for Providers

• Many Home Health Services No Longer Require Prior Authorization

• Reminder to Review All Current Requirements for Prior Authorizations

• Value-Added Benefits for Members

• Five Areas of the Early Periodic Screening, Diagnosis and Treatment Exam

• HEDIS and the Clinical Practice Consultant Program

• Communication Between PCPs and Specialists Is Key to Well-Coordinated Care

• Videos and Articles Promote Children’s Health

• Tell Us about Your Service Experience

We hope you enjoy the summer edition of Practice Matters. In this issue, you can read home health services, coordination of care and much more. Happy summer!

Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33681 Practice Matters: IA - Summer 2016 Provider Services Center: 888-650-34621

Important information for health care professionals and facilities

available for download at UHCCommunityPlan.com > For Health Care Professionals > Iowa > Provider Forms. These forms follow rules required by the state and UnitedHealthcare Community Plan of Iowa.

• Complete training on our programs and processes. – Visit UHCCommunityPlan.com > For Health Care Professionals > Iowa > Provider Training.

• View announcements on system and process updates through news bulletins.

– Bulletins are available at UHCCommunityPlan.com > For Health Care Professionals > Iowa > Bulletins. These announcements may also be distributed electronically, faxed, mailed or sent through other methods.

If you can’t find what you’re looking for online, please call Provider Services at 888-650-3462 or contact your Provider Advocate. You can find your local advocate online at UHCCommunityPlan.com > For Health Care Professionals > Iowa > Provider Information > Provider Advocate Look Up.

Many Home Health Services No Longer Require Prior AuthorizationUnitedHealthcare Community Plan of Iowa is pleased to announce that we no longer require prior authorization for some home health services. This will be retroactive for dates of service from April 1, 2016 going forward. Care providers should ensure Medicaid medical necessity criteria are met. Some services will still require prior authorization.

Home health services no longer requiring authorizations:

• Skilled nursing care - Revenue Code 0551• Home health aide services - Revenue Code 0571• Occupational therapy - Revenue Code 0431• Physical therapy - Revenue Code 0421

Self-Service Tools Available Online for ProvidersAs a reminder, UnitedHealthcare Community Plan of Iowa offers several tools online for care providers to self-serve and expedite many processes. These tools are updated on a regular basis, so it’s best to check the site frequently. You can use our online tools to:

• Determine member eligibility, request prior authorizations, submit claims, check claim status, submit claim reconsiderations, register informational changes and take continuing education courses.

– Go to UnitedHealthcareOnline.com and sign in to Link with your Optum ID. If you aren’t registered, select “New User” to register.

• Check the latest updates of rules and program guidance for doing business with UnitedHealthcare Community Plan.

– The provider manual is updated to fit the needs of our care providers and answer your questions. Go to UHCCommunityPlan.com > For Health Care Professionals > Iowa > Provider Administrative Manual.

• Download the latest required forms. – Prior authorization forms, sterilization consent forms, critical incident forms, claim forms, Health Risk Assessments (HRAs) and claim reconsideration forms are among the forms

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Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33682 Practice Matters: IA - Summer 2016 Provider Services Center: 888-650-34622

Important information for health care professionals and facilities

• Speech therapy - Revenue Code 0441• Medical social services - Revenue Code 0561

Services that continue to require prior authorization:

• Private duty nursing - Revenue Code 0589 with HCPCS Code T1000

• Personal care services - Revenue Code 0572 with HCPCS Code S9122

• Waiver services (authorized through the member’s service plan)

• Medical day services/Child care medical services (T1024 UC)

UnitedHealthcare Community Plan’s prior authorization list available at UHCCommunityPlan.com > For Health Care Professionals > Iowa > Prior Authorization will be updated to remove the applicable HCPCS/CPT codes G0151–G0153, G0155-G0164, G0299, G0300, S9123, S9124, S9127-S9129, S9131, and S9474.

Please continue to submit claims following the contracted codes per service category:

Service Category Payment Method

Nursing Services- Skilled Nursing Per visit

Home Health Aide Per visit

Occupational Therapy Per visit

Physical Therapy Per visit

Speech Therapy Per visit

Medical Social Services Per visit

Private Duty Nursing Per unit (for each 15-minute increment)

Personal Care ServicesPer unit (for each

one-hour increment)1 unit = 1 hour

Waiver Services Per service plan

Submitting Medicare Non-Covered Home Health Services ClaimsIf a claim with the XA-XD code in any other field was submitted and rejected, please resubmit the claim following these instructions:

• For electronic submissions, put “Not Homebound” in the 2300 loop – billing or claim note

• For paper submissions, put “Not Homebound” in box 80 – remarks

Out-of-Network Services

• All out-of-network services will continue to require prior authorization.

• For more information, go to UHCCommunityPlan.com > For Health Care Professionals > Iowa > Prior Authorization.

If you have questions regarding specific claims and how they’ll be processed, please contact Provider Services 888-650-3462 or your Provider Advocate.

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Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33683 Practice Matters: IA - Summer 2016 Provider Services Center: 888-650-34623

Important information for health care professionals and facilities

Reminder to Review All Current Requirements for Prior AuthorizationsAs a reminder, all current inpatient and outpatient prior authorization requirements for UnitedHealthcare Community Plan of Iowa are outlined in our Prior Authorization Requirements document available at UHCCommunityPlan.com > For Health Care Professionals > Iowa > Prior Authorization. All services from out-of-network physicians, facilities and other health care providers require prior authorization. Please submit prior authorization requests online, by phone or by fax for all services except radiology, cardiology and behavioral health*:

• Online: Submit prior authorization requests using Link by signing in to UnitedHealthcareOnline.com and using your Optum ID. You’ll be redirected to Link after sign-in. If you don’t have an Optum ID or need help remembering your ID or password, the Link sign-in screens will guide you through the process.

• Phone: 888-650-3462• Fax: 888-899-1680

– Prior Authorization Request Form available at UHCCommunityPlan.com > For Health Care Professionals > Iowa > Provider Forms; or

– Pharmacy Prior Authorization Forms available at UHCCommunityPlan.com > For Health Care Professionals > Iowa > Pharmacy Program.

*Behavioral health requests: Submit online at UnitedHealthcareOnline.com or by phone at 888-650-3462. *Radiology and cardiology prior authorization requests: Follow the instructions on UnitedHealthcareOnline.com > Link > UnitedHealthcare Community Plan > For Health Care Professionals > Iowa > Radiology or Cardiology.

If you have questions, please call Provider Services at 888-650-3462.

Value-Added Benefits for MembersAs a reminder to care providers, value-added benefits for members address member needs and experiences to help them live healthier lives. Members are informed of these services through their UnitedHealthcare Community Plan of Iowa welcome packet. Care providers can help members learn about these benefits by going to UHCCommunityPlan.com > For Health Care Professionals > Billing and Reference Guides > Value-Added Member Benefits.

Here are some highlights of our value-added benefits: – No Copay: There’s no copay for our members, excluding non-emergent ER visits.

– Baby Blocks: This program helps keep members healthy during pregnancy and their baby’s first 15 months of life.

– Community Rewards: Members earn rewards points for completing healthy activities.

– School/Camp/Sports Physicals: One sports/school/camp physical is offered every 12 months.

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Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33684 Practice Matters: IA - Summer 2016 Provider Services Center: 888-650-34624

Important information for health care professionals and facilities

– Non-Emergent Transportation: Provides needed rides to and from health care locations when transportation services aren’t covered by their plan. This includes trips to the doctor or therapy visits.

– Healthy First Steps: Supports members during pregnancy such as providing advice on nutrition.

– Care Management: Members with a disability or complex health issues receive personal help with coordinating doctor appointments, keeping track of medical records and making sure they have support at home.

– Disease Management: Members with chronic or high-risk illnesses receive extra support.

– NurseLine: Nurses are available 24 hours a day, 7 days a week to offer self-care tips, help with care questions, and advise when to schedule a doctor visit or visit an urgent care center.

– MyHealthLine: Members receive a free phone and 350 minutes per month, unlimited text messages and free calls to UnitedHealthcare Member Services.

– Text4Baby: New and pregnant moms get three text messages each week to help keep themselves and their babies healthy.

Five Areas of the Early Periodic Screening, Diagnosis and Treatment ExamThe Early Periodic Screening, Diagnosis and Treatment (EPSDT) exam for Iowa’s Medicaid program for children includes five areas:

• Comprehensive health and developmental history• An unclothed physical exam• Immunizations as recommended by age• Appropriate laboratory tests• Anticipatory guidance

In addition, the EPSDT program provides hearing, vision and dental screenings. The areas required for each member are based on age and can be determined using EPSDT Care for Kids Health Maintenance Recommendations, also known as the Periodicity Schedule, which is available at UHCCommunityPlan.com > For Health Care Professionals > Iowa > Provider Training. This benefit isn’t available to hawk-i members.

As a reminder to care providers, documentation of EPSDT screenings is a federal requirement and all areas need to be adequately documented in the member’s chart. Specific information is necessary in the charting of the screenings, such as all age appropriate guidance provided. Age-specific Iowa Child Health and Development Record Forms are available at iowaepsdt.org under the “resources” section. The forms aren’t required, but are a useful resource for helping to ensure that all areas of the EPSDT screening have been completed and charted.

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Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33685 Practice Matters: IA - Summer 2016 Provider Services Center: 888-650-34625

Important information for health care professionals and facilities

HEDIS and the Clinical Practice Consultant ProgramThank you for participating in our annual data collection for Healthcare Effectiveness Data and Information Set (HEDIS) 2016! We’re in the process of winding down our HEDIS project and results will be available later in the summer. HEDIS is a widely used set of performance measures mandated by the National Committee for Quality Assurance (NCQA). Health plans across the nation use HEDIS to gauge performance on an extensive range of care and services. HEDIS 2016 consists of 88 measures across several domains of care:

• Effectiveness of care• Access/availability of care• Experience of care • Utilization and risk adjusted utilization • Relative resource use• Health plan descriptive information• Measures collected using electronic clinical data

systems

UnitedHealthcare conducts an annual HEDIS medical record review each spring to try and meet/exceed established benchmarks for these measures. Evaluation of the HEDIS results are analyzed and used to set new goals, improve processes and encourage better care for our members.

In addition, UnitedHealthcare Community Plan of Iowa implemented a Clinical Practice Consultant (CPC) Program in the fall of 2015. The program supports care provider efforts to help members overcome health care barriers. As part of this initiative, consultants work with care provider offices and staff to help manage the clinical requirements involved with meeting HEDIS and other quality measures. The consultant:

• Delivers care provider scorecards and care opportunity reports, which identify members in need of preventive and/or ongoing disease management services.

• Helps care providers identify potential barriers and interventions to close member care opportunities.

• Highlights opportunities to improve documentation and claim submissions to meet HEDIS and other quality measures.

To find your local Clinical Practice Consultant, please visit UHCCommunityPlan.com > For Health Care Professionals > Iowa > Provider Information > Clinical Practice Consultant (CPC) Lookup.

Communication Between PCPs and Specialists Is Key to Well-Coordinated CarePrimary care physicians (PCPs) and specialists have shared responsibility for coordinating care and communicating essential patient information to each other. Lack of communication can negatively affect quality patient care.

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Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33686 Practice Matters: IA - Summer 2016 Provider Services Center: 888-650-34626

Important information for health care professionals and facilities

Relevant information from the PCP to the specialist should include the patient’s history, diagnostic tests and results and the reason for referring the member to the specialist for a consultation. The specialist is responsible for timely communication of the results of consultations to the PCP, and ongoing recommendations and treatment plans.

Well-coordinated care starts with a regular exchange of information between health care providers to give the patient the highest quality care and care management.

Videos and Articles Promote Children’s HealthUnitedHealthcare and KidsHealth have teamed up to provide online family-friendly information about children’s health at UHCCommunityPlan.com/IAkids. Please help us in encouraging members to visit the website to access more than 200 videos and 10,000 articles in English or Spanish on a wide range of topics including:

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

Videos and articles are developed for and searchable by target audience:

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

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

from other young adults.

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

Tell Us about Your Service ExperienceEach year, we ask for your participation in our Physician Satisfaction Survey. The survey provides insights about your experiences working with us and gives us the information we need to identify opportunities to enhance our services to align with your practice’s needs.

Survey invitations will be sent in early September by fax to a random sample of physicians. Please complete the survey if you receive a request. Your feedback is important to us. Thank you.

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practicematters

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

Community Plan

Iowa

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