washington | winter 2019 – 2020 practicematters€¦ · • education and training opportunities...
TRANSCRIPT
practicematters
For More Information
Call our Provider Services Center at 877-542-9231
Visit UHCCommunityPlancom
Washington | Winter 2019 ndash 2020
For the latest on COVID-19 visit the Centers for Disease Control at CDCgovFor UnitedHealthcare benefits information and resources related to COVID-19 visit UHCprovidercomcovid19
The Mississippi Division of Medicaid has COVID-19 news and resources at medicaidmsgovcoronavirus-updates
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33682 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-9231
Important information for health care professionals and facilities
Policy drug and Protocol changes contained herein are effective and enforceable as of the dates indicated pending notice from UnitedHealthcare to the contrary Changes to these effective dates or updates to our business practices and policies as a result of COVID-19 will prevail and be posted on our care provider website as quickly as possible As with any public health issue we are working with and following guidance and protocols issued by federal state and local health authorities
You can find the latest UnitedHealthcare COVID-19 related resources at UHCprovidercomcovid19
Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-9231
Important information for health care professionals and facilities
In This Issuebull Encourage Members to Get an Annual Flu Shot
bull Remind Members to Renew Their Benefits
bull UHCprovidercom ndash Your Source for Tools and Information
bull Covered Services for Apple Health Enrollees
bull Quality Improvement Program
bull Patient Review and Coordination Program
bull Utilization Management Guidelines
bull Billing and Claims Submission
bull Health Home Program
bull Long-Term Services and Supports
bull Increasing Education and Awareness of Opioids
bull Hepatitits A Update
bull Education and Training Opportunities for Integrated Managed Care
bull Tips to Raise the Rate of Well-Care Visits in Primary Care Clinics
bull Benefit Enhancements for Washington Dual Special Needs Plan
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33681 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92311
Important information for health care professionals and facilities
Encourage Members to Get an Annual Flu ShotPlease encourage members ages six months and older who do not have a contraindication to get their annual flu shot We also encourage you to implement the following practices
bull Establish standing orders for the vaccine For more information on implementing standing orders go to immunizeorg gt For Health Professionals gt Handouts for Patients amp Staff gt Standing Orders Templates Vaccine information statements are also available online at immunizeorg gt For Health Professionals gt Vaccine Information Statements
bull Tell members why itrsquos important to receive the vaccine and address any barriers Remind your staff about the importance of vaccination and encourage them to get vaccinated as well
bull Establish a walk-in policy for flu vaccinations or flu vaccine clinic hours
Wersquoll support your efforts by reminding members about the flu vaccine through recorded voice messages postcards and online notices If you have any questions contact your local Physician Advocate
Remind Members to Renew Their Benefits You may have Washington Apple Health (Medicaid) members who need to renew their coverage Please remind them to act quickly if they receive a Medicaid renewal notice from the Washington Health Benefits Exchange Together we can help members avoid lapses in coverage
For members to maintain coverage many must report their income to the Health Care Authority (HCA) every 12 months In an effort to help members avoid a loss in eligibility as a result of failing to complete the renewal steps or making other mistakes at wahealthplanfinderorg wersquore increasing awareness of the renewal process
If you discover members who need to renew coverage please advise them on how to renew Washington Apple Health (Medicaid) members can renew by contacting the Washington Health Benefits Exchange and UnitedHealthcare Community Plan members can also call us directly for renewal assistance at 866-686-9323 TTY 711
To renew with the Washington Health Benefit Exchange
bull By phone Call 855-923-4633 (TTYTTD 855-627-9604) Language assistance and disability accommodations are provided at no cost
bull Online Visit wahealthplanfinderorg and click on the Current Customer link
bull By mail Update renewal documents received in the mail by signing and returning them to Washington Health Benefit Exchange PO Box 946 Olympia WA 98507
bull In Person To receive renewal assistance go to wahealthplanfinderorg and search for a Navigator through the Customer Support link
We recommend checking a memberrsquos Medicaid eligibility at the time of service by calling Provider Services at 877-542-9231 or checking UHCprovidercom
If UnitedHealthcare Community Plan members have questions they can always call us at 866-686-9323 TTY 711 for renewal assistance
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33682 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92312
Important information for health care professionals and facilities
bull Develops clinical guidelines and service standards bull Monitors and assesses the quality and
appropriateness of services given to our members based on the guidelines and public health goals
bull Promotes wellness and preventive health as well as chronic condition self-management
bull Maintains a network of practitioners and care providers to deliver medical and behavioral health services
bull Strives for improvement of member health care and services
bull Develops implements and monitors key aspects of patient safety identifying opportunities and developing programs to promoting safe patient care
bull Tracks member and care provider satisfaction taking actions as appropriate
bull Identifies and analyzes existence of significant health care disparities in clinical areas
bull Conducts patient-focused interventions with culturally competent outreach materials that focus on specific risks related to raceethnicitylanguage
As a participating care provider you may offer input through representation on our Quality Improvement committees and your Provider Services representativeProvider AdvocateClinical Practice Consultant
Every year UnitedHealthcare Community Plan conducts care provider satisfaction assessments as part of our quality improvement efforts We assess and promote your satisfaction through
bull Annual care provider satisfaction surveys bull Regular visitsbull Town hall meetings
Our chief concern with the survey is objectivity Thatrsquos why UnitedHealthcare Community Plan engages the independent market research firm Center for the Study of Services (CSS) to analyze and report findings
UHCprovidercom mdash Your Source for Tools and InformationBe sure to check out UHCprovidercom our care provider website to find everything from UnitedHealthcare Community Plan reports and administrative guides to policies and Link self-service tools Your Link dashboard contains your capitation eligibility and patient management reports and online transactions so yoursquore able to verify eligibility check the status of a claim and submit or check the status of a prior authorization
Covered Services for Apple Health EnrolleesUnitedHealthcare Community Plan only pays for medically necessary services Medically necessary health care services or supplies are considered medically appropriate when they are
bull Necessary to meet a memberrsquos basic health needs bull Cost-efficient and appropriate for the covered
services
The UnitedHealthcare Community Plan doesnrsquot have a deductible or copayments Do not bill members for covered services View member benefit coverage information at UHCcommunityplancomwa gt View Plan Details gt Member Resources gt Member Handbook
Quality Improvement ProgramUnitedHealthcare Community Planrsquos comprehensive Quality Improvement Program is designed to objectively monitor systematically evaluate and effectively improve the quality and safety of clinical care and quality of services provided to all members A copy of our Quality Improvement program is available upon request
The Quality Improvement Program
bull Identifies the scope of care and services given
(continued on next page)
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33683 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92313
Important information for health care professionals and facilities
Survey results are reported to our Quality Management Committee who compares the results year over year as well as to other UnitedHealthcare Community Plan plans across the country The survey results include key strengths and improvement areas which we help carry out as needed
Patient Review and Coordination Program The Patient Review and Coordination (PRC) program is for all Apple Health Programs The Washington HCA program helps control over-utilization and inappropriate use of clinical services It restricts members to certain care providers including Primary Care Providers (PCPs) pharmacies and hospitals Washington Administrative Code (WAC182-501- 0135) established the guidelines for the PRC program and allows us to perform this function
PRC focuses on the health and safety of members who
bull Are often seen by several different prescribers bull Have a high number of duplicate medications bull Use several different pharmacies bull Have a high amount of emergency room (ER) usage
Based on a clinical review of the utilization findings these members may be placed into the PRC program for at least two years
The PCP plays a critical role in managing membersrsquo health care When a member is restricted within the program the PCP must approve any non-emergent care that the member receives from other practitioners This may include prescriptions for scheduled drugs class (Cll-CV)
The primary pharmacy is a critical player in managing the memberrsquos prescriptions The pharmacist alerts the memberrsquos PCP the plan PRC staff or HCA PRC staff of any misuse or potential concerns with the memberrsquos prescriptions All standard pharmacy policies remain in effect However if the member goes to a non-assigned pharmacy for scheduled drugs (Cll-CV) the claim will be rejected and the medication may not be dispensed
The pharmacist may refer the member back to their assigned pharmacy or choose to fill the prescription and ask the member to pay cash We may not reimburse the member depending on a review of the pertinent clinic situation
ER staff members are key players in helping the PCP manage the memberrsquos care to avoid clinically unnecessary ER visits If the ER is aware of the PRC restriction the hospital can coordinate care by referring the member back to their PCP andor pharmacy whether emergency services are provided or not
To refer a member to the PRC program call 877-542-8997
Utilization Management GuidelinesUtilization Management (UM) is based on a memberrsquos medical condition and is not influenced by monetary incentives UnitedHealthcare Community Plan pays its in-network PCPs and specialists on a fee-for-service basis as well as in-network hospitals and other types of care providers in the UnitedHealthcare Community Plan network on a fee-for-service basis The planrsquos UM staff works with care providers to help ensure members receive the most appropriate care in the place best suited for the needed services Our staff encourages appropriate use mdash and discourages underuse mdash and doesnrsquot receive incentives for UM decisions
(continued from previous page)
(continued on next page)
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33684 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92314
Important information for health care professionals and facilities
Reimbursements also depend on the fee schedule and the procedure performed Refer to your bulletins for correct coding Use the appropriate modifier codes on your claim form The modifier must be used based on the date of service
For claims billing and payment questions go to UHCprovidercomenclaims-payments-billinghtml
Health Home ProgramOur Health Home program is managed in partnership with the Washington state HCA Health Home provides community-based intensive care coordination and comprehensive care management to improve health outcomes and reduce service costs for some of Washingtonrsquos highest-need individuals
The Health Home program provides services beyond those typically offered by care providers including but not limited to
bull Comprehensive care management bull Care coordination and health promotion bull Individual and family support bull Referral to community services
Health Home also strives to increase an individualrsquos participation in their own care This program helps reduce Medicaid inpatient hospital admissions avoidable emergency room visits inpatient psychiatric admissions and the need for nursing home admissions It also works with area hospitals to provide transitional care services to members who are enrolled in the program
Hospitals and care providers may refer members to us for potential Health Home enrollment however Health Home-eligibility is determined by the HCA For more information about Health Home call 888-702-2053
UM Appeals These appeals contest the decisions made by UnitedHealthcare Community Planrsquos UM program They are appeals of UnitedHealthcare Community Planrsquos admission extension of stay level of care or other health care services determination These appeals typically state that it isnrsquot medically necessary or is considered experimental or investigational It may also contest any admission extension of stay or other health care service due to late notification or lack of complete or accurate information Any member their designee or care provider who is dissatisfied with a UnitedHealthcare Community Plan UM decision may file a UM appeal Adverse benefit determination decisions may include UnitedHealthcare Community Planrsquos decision to deny a service authorization request or to authorize a service in an amount duration or scope less than requested
Call 866-815-5334 to discuss the guidelines and utilization management
Billing and Claims SubmissionUnitedHealthcare Community Plan follows the same claims process as UnitedHealthcare Your clean claims must include your National Provider Identification (NPI) number and federal tax ID number Also include the Unique Care Provider Identification number (UPIN) for laboratory claims
We only consider reimbursing claims if you meet billing and coverage requirements Submitting a referral does not guarantee that wersquoll pay you Payment depends on the memberrsquos coverage on the date(s) of service medical necessity plan rules about limitations and exclusions and UnitedHealthcare Community Plan policies We donrsquot reimburse excessive inappropriate or non-covered charges To comply with applicable standards policies and laws we may adjust previous payments for services and audit claims We may also seek reimbursement for overpayments or offset future payments as allowed by law
(continued from previous page)
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33685 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92315
Important information for health care professionals and facilities
Long-Term Services and Supports Aging and Long-Term Support Administration (ALTSA) mdashHome and Community Services (HCS) mdash provides long-term care services for members who are older or have disabilities in their own homes which includes community residential settings or an in-home caregiver HCS also provides services to assist family caregivers or people who are transitioning from nursing homes
These services are not provided by UnitedHealthcare Community Plan To get more information about long-term care services visit dshswagovaltsalong-term-care-services-information You can also visit Community Living Connections or call 855-587-0252
Increasing Education and Awareness of Opioids Itrsquos critical that you are up-to-date on research and evidence-based clinical practice guidelines of opioid use We offer opioid use disorders (OUD)-related training and resources available on our care provider website to help ensure you have the information you need
For example state-specific Behavioral Health Toolkits are developed to provide access to clinical practice guidelines free substance use disordersOUD assessments and screening resources and other important state-specific resources Additionally Pain Management Toolkits are available and provide resources to help you identify members who present with chronic physical pain and who may need behavioral health services to address the psychological aspects of pain Continuing education is available and includes webinars such as ldquoThe Role of the Health Care Team in Solving the Opioid Epidemicrdquo and ldquoThe Fight Against the Prescription Opioid Abuse Epidemicrdquo
While resources are available we also work to help ensure you have the educational resources you need For example our Drug Utilization Review Provider Newsletter includes opioid trends prescribing and key resources
Access these resources by visiting UHCprovidercom gt Drug Lists and Pharmacy gt Resource Library
Prescribing Opioids Go to our Prescription Drug List (PDL) to learn more about which opioids require prior authorization and if there are prescription limits
Hepatitits A Update The Washington State Department of Health (DOH) announced an outbreak of hepatitis A (HAV) within Washington state on July 30 2019 Multiple states across the country have reported outbreaks of HAV primarily among people experiencing homelessness and people using drugs
People experiencing homelessness andor users of injection and non-injection drugs are at increased risk of infection during an outbreak due to lack of access to sanitation and should be offered a vaccine if susceptible People who have frequent ongoing contact with the above populations are also recommended for the hepatitis A vaccination People with chronic liver conditions such as hepatitis B or C should get the hepatitis A vaccine because of an increased risk for severe disease
Additional recommendations by the Advisory Committee on Immunization Practices (ACIP) for hepatitis A can be found at cdcgovvaccineshcpacip-recsvacc-specifichepahtml For questions about the hepatitis A vaccine or vaccine recommendations email DOH at oicpdohwagov
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33686 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92316
Important information for health care professionals and facilities
Education and Training Opportunities for Integrated Managed Care In 2020 UnitedHealthcare Community Plan of Washington is implementing the Integrated Managed Care (IMC) clinical care model also known as whole-person care This means that Apple Health (Medicaid) will integrate behavioral health benefits into the Apple Health managed care program so members have access to both medical and behavioral health services through a single plan
UnitedHealthcare will provide support to network care providers as they incorporate the IMC clinical model into their practices There are several educational and training opportunities available at UHCprovidercomwa-comm-training If you have any questions about the Integrated Managed Care contact Andrea Ray Senior Clinical Practice Performance Consultant at 763-361-3659 or andrearayuhccom
Tips to Raise the Rate of Well-Care Visits in Primary Care ClinicsHere is some guidance to increase the rate of well-care visits to primary care practices
bull Offer well-care appointments outside standard business hours one or two nights a week mdash or on a weekend day by allowing a care provider to flex their hours to cover these This allows parents to come in during non-work hours and students to be present for school and afterschool activities
bull Consider what well-care visits are called by clinic staff The term ldquowell-childrdquo visit is offensive to adolescents
bull Parents report that clinic reminders get attention while a reminder from a health plan may not receive the attention merited
bull Many parents prefer a text message reminder from the clinic Clinics report that including a link or phone number in a text or email to contact scheduling is highly successful
bull Compare the Medicaid lists of patients attributed to the clinic against the electronic medical record list of clinic patients Medicaid MCOs post a list of each clinic online Patients who are not established at the clinic offer an opportunity to increase well-care visit rates and build new relationships
bull Having difficulty reaching an unestablished patient If the patient is age 6 or younger check the Immunization Information System (IIS) IIS maintains their contact information through frequent mailings Community health workers may offer another strategy to locate parentspatients
bull Informal research suggests that reminders sent out three weeks in advance with reminders three days and three hours in advance are effective in getting appointments rescheduled and reducing missed appointments
bull Schedule the next well-care visit when the patient checks in for any appointment
(continued on next page)
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33687 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92317
Important information for health care professionals and facilities
bull Allow parentspatient to schedule the next annual checkup at this yearrsquos checkup
bull When reminding parents or patients to schedule a well-care visit mention
ndash Apple Health appointments are based on the calendar year (Note Medicaid provides one free well-care appointment (Early and Periodic Screening Diagnostic and Treatment (EPSDT) each calendar year)
ndash Immunization benefits will be offered at the appointment in plain English (eg cancer immunization for those who are age 12 flu vaccine for all kids or particularly children with asthma Note that the flu vaccine may prevent sick days for kids and parents)
bull Perform a well-care visit while the patient is at the clinic for a problem visit mdash when time permits
bull EPSDT and treated health problems can be completed and billed on the same day
bull Give schedulers and receptionists the ability to tell parentspatients when a well-care visit is needed If a well-care visit is needed it can be scheduled at check-in while the parent is fresh and children are cooperative
bull Most parents prefer to be reminded about needed preventive care by the clinic rather than the managed care organization and are more likely to read or listen to the reminder as well
Benefit Enhancements for Washington Dual Special Needs Plan The UnitedHealthcare Dual Completereg plan is available for members who qualify for both Medicare and Medicaid The plan has enhanced several benefits for qualified plan participants in 2020
New or enhanced member benefits in 2020
bull Dental An annual exam and $3000 in credits for dental care including dentures root canals bridges and more This is an increase of $1000 in credits
bull Over-the-Counter (OTC) Debit Card UnitedHealthcare will provide $275 quarterly$1100 annually in OTC product credits Members will have the option of using a debit card at their local Walgreens online at healthproductscardcom or by phone This is an increase of $420 in credits per year
bull Hearing An annual exam and $2000 in credits every two years for hearing devices This is an increase of $400 in credits every two years
bull Virtual Medical Visits Available to members 24 hours a day seven days a week through live video chat with a doctor via computer tablet or smartphone New benefit
Members also have the following additional benefits
bull Routine acupuncture and chiropractic carebull Fitness benefit bull Foot carebull NurseLinebull Personal emergency response systembull Transportationbull Vision
If you would like to learn more about the UnitedHealthcare Dual Complete Plan visit UHCprovidercomWAcommunityplan or contact your Provider Advocate
Where can members get more informationProspective DSNP members can call 855-332-0756 TTY 711 8 am to 8 pm seven days a week
Current members can call 844-368-6883 TTY 711 8 am to 8 pm seven days a week
Members can also visit the UnitedHealthcare Community Plan of Washington Dual Complete Plan for more information
(continued from previous page)
1111 3rd Ave Suite 1100 Seattle WA 98101
Practice Matters is a quarterly publication for physicians and other health care professionals and facilities in the UnitedHealthcare network
Washington
practicematters
copy2020 United HealthCare Services IncPCA-1-19-01276-CampS-Multi-04242020
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33682 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-9231
Important information for health care professionals and facilities
Policy drug and Protocol changes contained herein are effective and enforceable as of the dates indicated pending notice from UnitedHealthcare to the contrary Changes to these effective dates or updates to our business practices and policies as a result of COVID-19 will prevail and be posted on our care provider website as quickly as possible As with any public health issue we are working with and following guidance and protocols issued by federal state and local health authorities
You can find the latest UnitedHealthcare COVID-19 related resources at UHCprovidercomcovid19
Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-9231
Important information for health care professionals and facilities
In This Issuebull Encourage Members to Get an Annual Flu Shot
bull Remind Members to Renew Their Benefits
bull UHCprovidercom ndash Your Source for Tools and Information
bull Covered Services for Apple Health Enrollees
bull Quality Improvement Program
bull Patient Review and Coordination Program
bull Utilization Management Guidelines
bull Billing and Claims Submission
bull Health Home Program
bull Long-Term Services and Supports
bull Increasing Education and Awareness of Opioids
bull Hepatitits A Update
bull Education and Training Opportunities for Integrated Managed Care
bull Tips to Raise the Rate of Well-Care Visits in Primary Care Clinics
bull Benefit Enhancements for Washington Dual Special Needs Plan
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33681 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92311
Important information for health care professionals and facilities
Encourage Members to Get an Annual Flu ShotPlease encourage members ages six months and older who do not have a contraindication to get their annual flu shot We also encourage you to implement the following practices
bull Establish standing orders for the vaccine For more information on implementing standing orders go to immunizeorg gt For Health Professionals gt Handouts for Patients amp Staff gt Standing Orders Templates Vaccine information statements are also available online at immunizeorg gt For Health Professionals gt Vaccine Information Statements
bull Tell members why itrsquos important to receive the vaccine and address any barriers Remind your staff about the importance of vaccination and encourage them to get vaccinated as well
bull Establish a walk-in policy for flu vaccinations or flu vaccine clinic hours
Wersquoll support your efforts by reminding members about the flu vaccine through recorded voice messages postcards and online notices If you have any questions contact your local Physician Advocate
Remind Members to Renew Their Benefits You may have Washington Apple Health (Medicaid) members who need to renew their coverage Please remind them to act quickly if they receive a Medicaid renewal notice from the Washington Health Benefits Exchange Together we can help members avoid lapses in coverage
For members to maintain coverage many must report their income to the Health Care Authority (HCA) every 12 months In an effort to help members avoid a loss in eligibility as a result of failing to complete the renewal steps or making other mistakes at wahealthplanfinderorg wersquore increasing awareness of the renewal process
If you discover members who need to renew coverage please advise them on how to renew Washington Apple Health (Medicaid) members can renew by contacting the Washington Health Benefits Exchange and UnitedHealthcare Community Plan members can also call us directly for renewal assistance at 866-686-9323 TTY 711
To renew with the Washington Health Benefit Exchange
bull By phone Call 855-923-4633 (TTYTTD 855-627-9604) Language assistance and disability accommodations are provided at no cost
bull Online Visit wahealthplanfinderorg and click on the Current Customer link
bull By mail Update renewal documents received in the mail by signing and returning them to Washington Health Benefit Exchange PO Box 946 Olympia WA 98507
bull In Person To receive renewal assistance go to wahealthplanfinderorg and search for a Navigator through the Customer Support link
We recommend checking a memberrsquos Medicaid eligibility at the time of service by calling Provider Services at 877-542-9231 or checking UHCprovidercom
If UnitedHealthcare Community Plan members have questions they can always call us at 866-686-9323 TTY 711 for renewal assistance
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33682 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92312
Important information for health care professionals and facilities
bull Develops clinical guidelines and service standards bull Monitors and assesses the quality and
appropriateness of services given to our members based on the guidelines and public health goals
bull Promotes wellness and preventive health as well as chronic condition self-management
bull Maintains a network of practitioners and care providers to deliver medical and behavioral health services
bull Strives for improvement of member health care and services
bull Develops implements and monitors key aspects of patient safety identifying opportunities and developing programs to promoting safe patient care
bull Tracks member and care provider satisfaction taking actions as appropriate
bull Identifies and analyzes existence of significant health care disparities in clinical areas
bull Conducts patient-focused interventions with culturally competent outreach materials that focus on specific risks related to raceethnicitylanguage
As a participating care provider you may offer input through representation on our Quality Improvement committees and your Provider Services representativeProvider AdvocateClinical Practice Consultant
Every year UnitedHealthcare Community Plan conducts care provider satisfaction assessments as part of our quality improvement efforts We assess and promote your satisfaction through
bull Annual care provider satisfaction surveys bull Regular visitsbull Town hall meetings
Our chief concern with the survey is objectivity Thatrsquos why UnitedHealthcare Community Plan engages the independent market research firm Center for the Study of Services (CSS) to analyze and report findings
UHCprovidercom mdash Your Source for Tools and InformationBe sure to check out UHCprovidercom our care provider website to find everything from UnitedHealthcare Community Plan reports and administrative guides to policies and Link self-service tools Your Link dashboard contains your capitation eligibility and patient management reports and online transactions so yoursquore able to verify eligibility check the status of a claim and submit or check the status of a prior authorization
Covered Services for Apple Health EnrolleesUnitedHealthcare Community Plan only pays for medically necessary services Medically necessary health care services or supplies are considered medically appropriate when they are
bull Necessary to meet a memberrsquos basic health needs bull Cost-efficient and appropriate for the covered
services
The UnitedHealthcare Community Plan doesnrsquot have a deductible or copayments Do not bill members for covered services View member benefit coverage information at UHCcommunityplancomwa gt View Plan Details gt Member Resources gt Member Handbook
Quality Improvement ProgramUnitedHealthcare Community Planrsquos comprehensive Quality Improvement Program is designed to objectively monitor systematically evaluate and effectively improve the quality and safety of clinical care and quality of services provided to all members A copy of our Quality Improvement program is available upon request
The Quality Improvement Program
bull Identifies the scope of care and services given
(continued on next page)
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33683 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92313
Important information for health care professionals and facilities
Survey results are reported to our Quality Management Committee who compares the results year over year as well as to other UnitedHealthcare Community Plan plans across the country The survey results include key strengths and improvement areas which we help carry out as needed
Patient Review and Coordination Program The Patient Review and Coordination (PRC) program is for all Apple Health Programs The Washington HCA program helps control over-utilization and inappropriate use of clinical services It restricts members to certain care providers including Primary Care Providers (PCPs) pharmacies and hospitals Washington Administrative Code (WAC182-501- 0135) established the guidelines for the PRC program and allows us to perform this function
PRC focuses on the health and safety of members who
bull Are often seen by several different prescribers bull Have a high number of duplicate medications bull Use several different pharmacies bull Have a high amount of emergency room (ER) usage
Based on a clinical review of the utilization findings these members may be placed into the PRC program for at least two years
The PCP plays a critical role in managing membersrsquo health care When a member is restricted within the program the PCP must approve any non-emergent care that the member receives from other practitioners This may include prescriptions for scheduled drugs class (Cll-CV)
The primary pharmacy is a critical player in managing the memberrsquos prescriptions The pharmacist alerts the memberrsquos PCP the plan PRC staff or HCA PRC staff of any misuse or potential concerns with the memberrsquos prescriptions All standard pharmacy policies remain in effect However if the member goes to a non-assigned pharmacy for scheduled drugs (Cll-CV) the claim will be rejected and the medication may not be dispensed
The pharmacist may refer the member back to their assigned pharmacy or choose to fill the prescription and ask the member to pay cash We may not reimburse the member depending on a review of the pertinent clinic situation
ER staff members are key players in helping the PCP manage the memberrsquos care to avoid clinically unnecessary ER visits If the ER is aware of the PRC restriction the hospital can coordinate care by referring the member back to their PCP andor pharmacy whether emergency services are provided or not
To refer a member to the PRC program call 877-542-8997
Utilization Management GuidelinesUtilization Management (UM) is based on a memberrsquos medical condition and is not influenced by monetary incentives UnitedHealthcare Community Plan pays its in-network PCPs and specialists on a fee-for-service basis as well as in-network hospitals and other types of care providers in the UnitedHealthcare Community Plan network on a fee-for-service basis The planrsquos UM staff works with care providers to help ensure members receive the most appropriate care in the place best suited for the needed services Our staff encourages appropriate use mdash and discourages underuse mdash and doesnrsquot receive incentives for UM decisions
(continued from previous page)
(continued on next page)
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33684 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92314
Important information for health care professionals and facilities
Reimbursements also depend on the fee schedule and the procedure performed Refer to your bulletins for correct coding Use the appropriate modifier codes on your claim form The modifier must be used based on the date of service
For claims billing and payment questions go to UHCprovidercomenclaims-payments-billinghtml
Health Home ProgramOur Health Home program is managed in partnership with the Washington state HCA Health Home provides community-based intensive care coordination and comprehensive care management to improve health outcomes and reduce service costs for some of Washingtonrsquos highest-need individuals
The Health Home program provides services beyond those typically offered by care providers including but not limited to
bull Comprehensive care management bull Care coordination and health promotion bull Individual and family support bull Referral to community services
Health Home also strives to increase an individualrsquos participation in their own care This program helps reduce Medicaid inpatient hospital admissions avoidable emergency room visits inpatient psychiatric admissions and the need for nursing home admissions It also works with area hospitals to provide transitional care services to members who are enrolled in the program
Hospitals and care providers may refer members to us for potential Health Home enrollment however Health Home-eligibility is determined by the HCA For more information about Health Home call 888-702-2053
UM Appeals These appeals contest the decisions made by UnitedHealthcare Community Planrsquos UM program They are appeals of UnitedHealthcare Community Planrsquos admission extension of stay level of care or other health care services determination These appeals typically state that it isnrsquot medically necessary or is considered experimental or investigational It may also contest any admission extension of stay or other health care service due to late notification or lack of complete or accurate information Any member their designee or care provider who is dissatisfied with a UnitedHealthcare Community Plan UM decision may file a UM appeal Adverse benefit determination decisions may include UnitedHealthcare Community Planrsquos decision to deny a service authorization request or to authorize a service in an amount duration or scope less than requested
Call 866-815-5334 to discuss the guidelines and utilization management
Billing and Claims SubmissionUnitedHealthcare Community Plan follows the same claims process as UnitedHealthcare Your clean claims must include your National Provider Identification (NPI) number and federal tax ID number Also include the Unique Care Provider Identification number (UPIN) for laboratory claims
We only consider reimbursing claims if you meet billing and coverage requirements Submitting a referral does not guarantee that wersquoll pay you Payment depends on the memberrsquos coverage on the date(s) of service medical necessity plan rules about limitations and exclusions and UnitedHealthcare Community Plan policies We donrsquot reimburse excessive inappropriate or non-covered charges To comply with applicable standards policies and laws we may adjust previous payments for services and audit claims We may also seek reimbursement for overpayments or offset future payments as allowed by law
(continued from previous page)
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33685 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92315
Important information for health care professionals and facilities
Long-Term Services and Supports Aging and Long-Term Support Administration (ALTSA) mdashHome and Community Services (HCS) mdash provides long-term care services for members who are older or have disabilities in their own homes which includes community residential settings or an in-home caregiver HCS also provides services to assist family caregivers or people who are transitioning from nursing homes
These services are not provided by UnitedHealthcare Community Plan To get more information about long-term care services visit dshswagovaltsalong-term-care-services-information You can also visit Community Living Connections or call 855-587-0252
Increasing Education and Awareness of Opioids Itrsquos critical that you are up-to-date on research and evidence-based clinical practice guidelines of opioid use We offer opioid use disorders (OUD)-related training and resources available on our care provider website to help ensure you have the information you need
For example state-specific Behavioral Health Toolkits are developed to provide access to clinical practice guidelines free substance use disordersOUD assessments and screening resources and other important state-specific resources Additionally Pain Management Toolkits are available and provide resources to help you identify members who present with chronic physical pain and who may need behavioral health services to address the psychological aspects of pain Continuing education is available and includes webinars such as ldquoThe Role of the Health Care Team in Solving the Opioid Epidemicrdquo and ldquoThe Fight Against the Prescription Opioid Abuse Epidemicrdquo
While resources are available we also work to help ensure you have the educational resources you need For example our Drug Utilization Review Provider Newsletter includes opioid trends prescribing and key resources
Access these resources by visiting UHCprovidercom gt Drug Lists and Pharmacy gt Resource Library
Prescribing Opioids Go to our Prescription Drug List (PDL) to learn more about which opioids require prior authorization and if there are prescription limits
Hepatitits A Update The Washington State Department of Health (DOH) announced an outbreak of hepatitis A (HAV) within Washington state on July 30 2019 Multiple states across the country have reported outbreaks of HAV primarily among people experiencing homelessness and people using drugs
People experiencing homelessness andor users of injection and non-injection drugs are at increased risk of infection during an outbreak due to lack of access to sanitation and should be offered a vaccine if susceptible People who have frequent ongoing contact with the above populations are also recommended for the hepatitis A vaccination People with chronic liver conditions such as hepatitis B or C should get the hepatitis A vaccine because of an increased risk for severe disease
Additional recommendations by the Advisory Committee on Immunization Practices (ACIP) for hepatitis A can be found at cdcgovvaccineshcpacip-recsvacc-specifichepahtml For questions about the hepatitis A vaccine or vaccine recommendations email DOH at oicpdohwagov
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33686 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92316
Important information for health care professionals and facilities
Education and Training Opportunities for Integrated Managed Care In 2020 UnitedHealthcare Community Plan of Washington is implementing the Integrated Managed Care (IMC) clinical care model also known as whole-person care This means that Apple Health (Medicaid) will integrate behavioral health benefits into the Apple Health managed care program so members have access to both medical and behavioral health services through a single plan
UnitedHealthcare will provide support to network care providers as they incorporate the IMC clinical model into their practices There are several educational and training opportunities available at UHCprovidercomwa-comm-training If you have any questions about the Integrated Managed Care contact Andrea Ray Senior Clinical Practice Performance Consultant at 763-361-3659 or andrearayuhccom
Tips to Raise the Rate of Well-Care Visits in Primary Care ClinicsHere is some guidance to increase the rate of well-care visits to primary care practices
bull Offer well-care appointments outside standard business hours one or two nights a week mdash or on a weekend day by allowing a care provider to flex their hours to cover these This allows parents to come in during non-work hours and students to be present for school and afterschool activities
bull Consider what well-care visits are called by clinic staff The term ldquowell-childrdquo visit is offensive to adolescents
bull Parents report that clinic reminders get attention while a reminder from a health plan may not receive the attention merited
bull Many parents prefer a text message reminder from the clinic Clinics report that including a link or phone number in a text or email to contact scheduling is highly successful
bull Compare the Medicaid lists of patients attributed to the clinic against the electronic medical record list of clinic patients Medicaid MCOs post a list of each clinic online Patients who are not established at the clinic offer an opportunity to increase well-care visit rates and build new relationships
bull Having difficulty reaching an unestablished patient If the patient is age 6 or younger check the Immunization Information System (IIS) IIS maintains their contact information through frequent mailings Community health workers may offer another strategy to locate parentspatients
bull Informal research suggests that reminders sent out three weeks in advance with reminders three days and three hours in advance are effective in getting appointments rescheduled and reducing missed appointments
bull Schedule the next well-care visit when the patient checks in for any appointment
(continued on next page)
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33687 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92317
Important information for health care professionals and facilities
bull Allow parentspatient to schedule the next annual checkup at this yearrsquos checkup
bull When reminding parents or patients to schedule a well-care visit mention
ndash Apple Health appointments are based on the calendar year (Note Medicaid provides one free well-care appointment (Early and Periodic Screening Diagnostic and Treatment (EPSDT) each calendar year)
ndash Immunization benefits will be offered at the appointment in plain English (eg cancer immunization for those who are age 12 flu vaccine for all kids or particularly children with asthma Note that the flu vaccine may prevent sick days for kids and parents)
bull Perform a well-care visit while the patient is at the clinic for a problem visit mdash when time permits
bull EPSDT and treated health problems can be completed and billed on the same day
bull Give schedulers and receptionists the ability to tell parentspatients when a well-care visit is needed If a well-care visit is needed it can be scheduled at check-in while the parent is fresh and children are cooperative
bull Most parents prefer to be reminded about needed preventive care by the clinic rather than the managed care organization and are more likely to read or listen to the reminder as well
Benefit Enhancements for Washington Dual Special Needs Plan The UnitedHealthcare Dual Completereg plan is available for members who qualify for both Medicare and Medicaid The plan has enhanced several benefits for qualified plan participants in 2020
New or enhanced member benefits in 2020
bull Dental An annual exam and $3000 in credits for dental care including dentures root canals bridges and more This is an increase of $1000 in credits
bull Over-the-Counter (OTC) Debit Card UnitedHealthcare will provide $275 quarterly$1100 annually in OTC product credits Members will have the option of using a debit card at their local Walgreens online at healthproductscardcom or by phone This is an increase of $420 in credits per year
bull Hearing An annual exam and $2000 in credits every two years for hearing devices This is an increase of $400 in credits every two years
bull Virtual Medical Visits Available to members 24 hours a day seven days a week through live video chat with a doctor via computer tablet or smartphone New benefit
Members also have the following additional benefits
bull Routine acupuncture and chiropractic carebull Fitness benefit bull Foot carebull NurseLinebull Personal emergency response systembull Transportationbull Vision
If you would like to learn more about the UnitedHealthcare Dual Complete Plan visit UHCprovidercomWAcommunityplan or contact your Provider Advocate
Where can members get more informationProspective DSNP members can call 855-332-0756 TTY 711 8 am to 8 pm seven days a week
Current members can call 844-368-6883 TTY 711 8 am to 8 pm seven days a week
Members can also visit the UnitedHealthcare Community Plan of Washington Dual Complete Plan for more information
(continued from previous page)
1111 3rd Ave Suite 1100 Seattle WA 98101
Practice Matters is a quarterly publication for physicians and other health care professionals and facilities in the UnitedHealthcare network
Washington
practicematters
copy2020 United HealthCare Services IncPCA-1-19-01276-CampS-Multi-04242020
Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-9231
Important information for health care professionals and facilities
In This Issuebull Encourage Members to Get an Annual Flu Shot
bull Remind Members to Renew Their Benefits
bull UHCprovidercom ndash Your Source for Tools and Information
bull Covered Services for Apple Health Enrollees
bull Quality Improvement Program
bull Patient Review and Coordination Program
bull Utilization Management Guidelines
bull Billing and Claims Submission
bull Health Home Program
bull Long-Term Services and Supports
bull Increasing Education and Awareness of Opioids
bull Hepatitits A Update
bull Education and Training Opportunities for Integrated Managed Care
bull Tips to Raise the Rate of Well-Care Visits in Primary Care Clinics
bull Benefit Enhancements for Washington Dual Special Needs Plan
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33681 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92311
Important information for health care professionals and facilities
Encourage Members to Get an Annual Flu ShotPlease encourage members ages six months and older who do not have a contraindication to get their annual flu shot We also encourage you to implement the following practices
bull Establish standing orders for the vaccine For more information on implementing standing orders go to immunizeorg gt For Health Professionals gt Handouts for Patients amp Staff gt Standing Orders Templates Vaccine information statements are also available online at immunizeorg gt For Health Professionals gt Vaccine Information Statements
bull Tell members why itrsquos important to receive the vaccine and address any barriers Remind your staff about the importance of vaccination and encourage them to get vaccinated as well
bull Establish a walk-in policy for flu vaccinations or flu vaccine clinic hours
Wersquoll support your efforts by reminding members about the flu vaccine through recorded voice messages postcards and online notices If you have any questions contact your local Physician Advocate
Remind Members to Renew Their Benefits You may have Washington Apple Health (Medicaid) members who need to renew their coverage Please remind them to act quickly if they receive a Medicaid renewal notice from the Washington Health Benefits Exchange Together we can help members avoid lapses in coverage
For members to maintain coverage many must report their income to the Health Care Authority (HCA) every 12 months In an effort to help members avoid a loss in eligibility as a result of failing to complete the renewal steps or making other mistakes at wahealthplanfinderorg wersquore increasing awareness of the renewal process
If you discover members who need to renew coverage please advise them on how to renew Washington Apple Health (Medicaid) members can renew by contacting the Washington Health Benefits Exchange and UnitedHealthcare Community Plan members can also call us directly for renewal assistance at 866-686-9323 TTY 711
To renew with the Washington Health Benefit Exchange
bull By phone Call 855-923-4633 (TTYTTD 855-627-9604) Language assistance and disability accommodations are provided at no cost
bull Online Visit wahealthplanfinderorg and click on the Current Customer link
bull By mail Update renewal documents received in the mail by signing and returning them to Washington Health Benefit Exchange PO Box 946 Olympia WA 98507
bull In Person To receive renewal assistance go to wahealthplanfinderorg and search for a Navigator through the Customer Support link
We recommend checking a memberrsquos Medicaid eligibility at the time of service by calling Provider Services at 877-542-9231 or checking UHCprovidercom
If UnitedHealthcare Community Plan members have questions they can always call us at 866-686-9323 TTY 711 for renewal assistance
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33682 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92312
Important information for health care professionals and facilities
bull Develops clinical guidelines and service standards bull Monitors and assesses the quality and
appropriateness of services given to our members based on the guidelines and public health goals
bull Promotes wellness and preventive health as well as chronic condition self-management
bull Maintains a network of practitioners and care providers to deliver medical and behavioral health services
bull Strives for improvement of member health care and services
bull Develops implements and monitors key aspects of patient safety identifying opportunities and developing programs to promoting safe patient care
bull Tracks member and care provider satisfaction taking actions as appropriate
bull Identifies and analyzes existence of significant health care disparities in clinical areas
bull Conducts patient-focused interventions with culturally competent outreach materials that focus on specific risks related to raceethnicitylanguage
As a participating care provider you may offer input through representation on our Quality Improvement committees and your Provider Services representativeProvider AdvocateClinical Practice Consultant
Every year UnitedHealthcare Community Plan conducts care provider satisfaction assessments as part of our quality improvement efforts We assess and promote your satisfaction through
bull Annual care provider satisfaction surveys bull Regular visitsbull Town hall meetings
Our chief concern with the survey is objectivity Thatrsquos why UnitedHealthcare Community Plan engages the independent market research firm Center for the Study of Services (CSS) to analyze and report findings
UHCprovidercom mdash Your Source for Tools and InformationBe sure to check out UHCprovidercom our care provider website to find everything from UnitedHealthcare Community Plan reports and administrative guides to policies and Link self-service tools Your Link dashboard contains your capitation eligibility and patient management reports and online transactions so yoursquore able to verify eligibility check the status of a claim and submit or check the status of a prior authorization
Covered Services for Apple Health EnrolleesUnitedHealthcare Community Plan only pays for medically necessary services Medically necessary health care services or supplies are considered medically appropriate when they are
bull Necessary to meet a memberrsquos basic health needs bull Cost-efficient and appropriate for the covered
services
The UnitedHealthcare Community Plan doesnrsquot have a deductible or copayments Do not bill members for covered services View member benefit coverage information at UHCcommunityplancomwa gt View Plan Details gt Member Resources gt Member Handbook
Quality Improvement ProgramUnitedHealthcare Community Planrsquos comprehensive Quality Improvement Program is designed to objectively monitor systematically evaluate and effectively improve the quality and safety of clinical care and quality of services provided to all members A copy of our Quality Improvement program is available upon request
The Quality Improvement Program
bull Identifies the scope of care and services given
(continued on next page)
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33683 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92313
Important information for health care professionals and facilities
Survey results are reported to our Quality Management Committee who compares the results year over year as well as to other UnitedHealthcare Community Plan plans across the country The survey results include key strengths and improvement areas which we help carry out as needed
Patient Review and Coordination Program The Patient Review and Coordination (PRC) program is for all Apple Health Programs The Washington HCA program helps control over-utilization and inappropriate use of clinical services It restricts members to certain care providers including Primary Care Providers (PCPs) pharmacies and hospitals Washington Administrative Code (WAC182-501- 0135) established the guidelines for the PRC program and allows us to perform this function
PRC focuses on the health and safety of members who
bull Are often seen by several different prescribers bull Have a high number of duplicate medications bull Use several different pharmacies bull Have a high amount of emergency room (ER) usage
Based on a clinical review of the utilization findings these members may be placed into the PRC program for at least two years
The PCP plays a critical role in managing membersrsquo health care When a member is restricted within the program the PCP must approve any non-emergent care that the member receives from other practitioners This may include prescriptions for scheduled drugs class (Cll-CV)
The primary pharmacy is a critical player in managing the memberrsquos prescriptions The pharmacist alerts the memberrsquos PCP the plan PRC staff or HCA PRC staff of any misuse or potential concerns with the memberrsquos prescriptions All standard pharmacy policies remain in effect However if the member goes to a non-assigned pharmacy for scheduled drugs (Cll-CV) the claim will be rejected and the medication may not be dispensed
The pharmacist may refer the member back to their assigned pharmacy or choose to fill the prescription and ask the member to pay cash We may not reimburse the member depending on a review of the pertinent clinic situation
ER staff members are key players in helping the PCP manage the memberrsquos care to avoid clinically unnecessary ER visits If the ER is aware of the PRC restriction the hospital can coordinate care by referring the member back to their PCP andor pharmacy whether emergency services are provided or not
To refer a member to the PRC program call 877-542-8997
Utilization Management GuidelinesUtilization Management (UM) is based on a memberrsquos medical condition and is not influenced by monetary incentives UnitedHealthcare Community Plan pays its in-network PCPs and specialists on a fee-for-service basis as well as in-network hospitals and other types of care providers in the UnitedHealthcare Community Plan network on a fee-for-service basis The planrsquos UM staff works with care providers to help ensure members receive the most appropriate care in the place best suited for the needed services Our staff encourages appropriate use mdash and discourages underuse mdash and doesnrsquot receive incentives for UM decisions
(continued from previous page)
(continued on next page)
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33684 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92314
Important information for health care professionals and facilities
Reimbursements also depend on the fee schedule and the procedure performed Refer to your bulletins for correct coding Use the appropriate modifier codes on your claim form The modifier must be used based on the date of service
For claims billing and payment questions go to UHCprovidercomenclaims-payments-billinghtml
Health Home ProgramOur Health Home program is managed in partnership with the Washington state HCA Health Home provides community-based intensive care coordination and comprehensive care management to improve health outcomes and reduce service costs for some of Washingtonrsquos highest-need individuals
The Health Home program provides services beyond those typically offered by care providers including but not limited to
bull Comprehensive care management bull Care coordination and health promotion bull Individual and family support bull Referral to community services
Health Home also strives to increase an individualrsquos participation in their own care This program helps reduce Medicaid inpatient hospital admissions avoidable emergency room visits inpatient psychiatric admissions and the need for nursing home admissions It also works with area hospitals to provide transitional care services to members who are enrolled in the program
Hospitals and care providers may refer members to us for potential Health Home enrollment however Health Home-eligibility is determined by the HCA For more information about Health Home call 888-702-2053
UM Appeals These appeals contest the decisions made by UnitedHealthcare Community Planrsquos UM program They are appeals of UnitedHealthcare Community Planrsquos admission extension of stay level of care or other health care services determination These appeals typically state that it isnrsquot medically necessary or is considered experimental or investigational It may also contest any admission extension of stay or other health care service due to late notification or lack of complete or accurate information Any member their designee or care provider who is dissatisfied with a UnitedHealthcare Community Plan UM decision may file a UM appeal Adverse benefit determination decisions may include UnitedHealthcare Community Planrsquos decision to deny a service authorization request or to authorize a service in an amount duration or scope less than requested
Call 866-815-5334 to discuss the guidelines and utilization management
Billing and Claims SubmissionUnitedHealthcare Community Plan follows the same claims process as UnitedHealthcare Your clean claims must include your National Provider Identification (NPI) number and federal tax ID number Also include the Unique Care Provider Identification number (UPIN) for laboratory claims
We only consider reimbursing claims if you meet billing and coverage requirements Submitting a referral does not guarantee that wersquoll pay you Payment depends on the memberrsquos coverage on the date(s) of service medical necessity plan rules about limitations and exclusions and UnitedHealthcare Community Plan policies We donrsquot reimburse excessive inappropriate or non-covered charges To comply with applicable standards policies and laws we may adjust previous payments for services and audit claims We may also seek reimbursement for overpayments or offset future payments as allowed by law
(continued from previous page)
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33685 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92315
Important information for health care professionals and facilities
Long-Term Services and Supports Aging and Long-Term Support Administration (ALTSA) mdashHome and Community Services (HCS) mdash provides long-term care services for members who are older or have disabilities in their own homes which includes community residential settings or an in-home caregiver HCS also provides services to assist family caregivers or people who are transitioning from nursing homes
These services are not provided by UnitedHealthcare Community Plan To get more information about long-term care services visit dshswagovaltsalong-term-care-services-information You can also visit Community Living Connections or call 855-587-0252
Increasing Education and Awareness of Opioids Itrsquos critical that you are up-to-date on research and evidence-based clinical practice guidelines of opioid use We offer opioid use disorders (OUD)-related training and resources available on our care provider website to help ensure you have the information you need
For example state-specific Behavioral Health Toolkits are developed to provide access to clinical practice guidelines free substance use disordersOUD assessments and screening resources and other important state-specific resources Additionally Pain Management Toolkits are available and provide resources to help you identify members who present with chronic physical pain and who may need behavioral health services to address the psychological aspects of pain Continuing education is available and includes webinars such as ldquoThe Role of the Health Care Team in Solving the Opioid Epidemicrdquo and ldquoThe Fight Against the Prescription Opioid Abuse Epidemicrdquo
While resources are available we also work to help ensure you have the educational resources you need For example our Drug Utilization Review Provider Newsletter includes opioid trends prescribing and key resources
Access these resources by visiting UHCprovidercom gt Drug Lists and Pharmacy gt Resource Library
Prescribing Opioids Go to our Prescription Drug List (PDL) to learn more about which opioids require prior authorization and if there are prescription limits
Hepatitits A Update The Washington State Department of Health (DOH) announced an outbreak of hepatitis A (HAV) within Washington state on July 30 2019 Multiple states across the country have reported outbreaks of HAV primarily among people experiencing homelessness and people using drugs
People experiencing homelessness andor users of injection and non-injection drugs are at increased risk of infection during an outbreak due to lack of access to sanitation and should be offered a vaccine if susceptible People who have frequent ongoing contact with the above populations are also recommended for the hepatitis A vaccination People with chronic liver conditions such as hepatitis B or C should get the hepatitis A vaccine because of an increased risk for severe disease
Additional recommendations by the Advisory Committee on Immunization Practices (ACIP) for hepatitis A can be found at cdcgovvaccineshcpacip-recsvacc-specifichepahtml For questions about the hepatitis A vaccine or vaccine recommendations email DOH at oicpdohwagov
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33686 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92316
Important information for health care professionals and facilities
Education and Training Opportunities for Integrated Managed Care In 2020 UnitedHealthcare Community Plan of Washington is implementing the Integrated Managed Care (IMC) clinical care model also known as whole-person care This means that Apple Health (Medicaid) will integrate behavioral health benefits into the Apple Health managed care program so members have access to both medical and behavioral health services through a single plan
UnitedHealthcare will provide support to network care providers as they incorporate the IMC clinical model into their practices There are several educational and training opportunities available at UHCprovidercomwa-comm-training If you have any questions about the Integrated Managed Care contact Andrea Ray Senior Clinical Practice Performance Consultant at 763-361-3659 or andrearayuhccom
Tips to Raise the Rate of Well-Care Visits in Primary Care ClinicsHere is some guidance to increase the rate of well-care visits to primary care practices
bull Offer well-care appointments outside standard business hours one or two nights a week mdash or on a weekend day by allowing a care provider to flex their hours to cover these This allows parents to come in during non-work hours and students to be present for school and afterschool activities
bull Consider what well-care visits are called by clinic staff The term ldquowell-childrdquo visit is offensive to adolescents
bull Parents report that clinic reminders get attention while a reminder from a health plan may not receive the attention merited
bull Many parents prefer a text message reminder from the clinic Clinics report that including a link or phone number in a text or email to contact scheduling is highly successful
bull Compare the Medicaid lists of patients attributed to the clinic against the electronic medical record list of clinic patients Medicaid MCOs post a list of each clinic online Patients who are not established at the clinic offer an opportunity to increase well-care visit rates and build new relationships
bull Having difficulty reaching an unestablished patient If the patient is age 6 or younger check the Immunization Information System (IIS) IIS maintains their contact information through frequent mailings Community health workers may offer another strategy to locate parentspatients
bull Informal research suggests that reminders sent out three weeks in advance with reminders three days and three hours in advance are effective in getting appointments rescheduled and reducing missed appointments
bull Schedule the next well-care visit when the patient checks in for any appointment
(continued on next page)
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33687 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92317
Important information for health care professionals and facilities
bull Allow parentspatient to schedule the next annual checkup at this yearrsquos checkup
bull When reminding parents or patients to schedule a well-care visit mention
ndash Apple Health appointments are based on the calendar year (Note Medicaid provides one free well-care appointment (Early and Periodic Screening Diagnostic and Treatment (EPSDT) each calendar year)
ndash Immunization benefits will be offered at the appointment in plain English (eg cancer immunization for those who are age 12 flu vaccine for all kids or particularly children with asthma Note that the flu vaccine may prevent sick days for kids and parents)
bull Perform a well-care visit while the patient is at the clinic for a problem visit mdash when time permits
bull EPSDT and treated health problems can be completed and billed on the same day
bull Give schedulers and receptionists the ability to tell parentspatients when a well-care visit is needed If a well-care visit is needed it can be scheduled at check-in while the parent is fresh and children are cooperative
bull Most parents prefer to be reminded about needed preventive care by the clinic rather than the managed care organization and are more likely to read or listen to the reminder as well
Benefit Enhancements for Washington Dual Special Needs Plan The UnitedHealthcare Dual Completereg plan is available for members who qualify for both Medicare and Medicaid The plan has enhanced several benefits for qualified plan participants in 2020
New or enhanced member benefits in 2020
bull Dental An annual exam and $3000 in credits for dental care including dentures root canals bridges and more This is an increase of $1000 in credits
bull Over-the-Counter (OTC) Debit Card UnitedHealthcare will provide $275 quarterly$1100 annually in OTC product credits Members will have the option of using a debit card at their local Walgreens online at healthproductscardcom or by phone This is an increase of $420 in credits per year
bull Hearing An annual exam and $2000 in credits every two years for hearing devices This is an increase of $400 in credits every two years
bull Virtual Medical Visits Available to members 24 hours a day seven days a week through live video chat with a doctor via computer tablet or smartphone New benefit
Members also have the following additional benefits
bull Routine acupuncture and chiropractic carebull Fitness benefit bull Foot carebull NurseLinebull Personal emergency response systembull Transportationbull Vision
If you would like to learn more about the UnitedHealthcare Dual Complete Plan visit UHCprovidercomWAcommunityplan or contact your Provider Advocate
Where can members get more informationProspective DSNP members can call 855-332-0756 TTY 711 8 am to 8 pm seven days a week
Current members can call 844-368-6883 TTY 711 8 am to 8 pm seven days a week
Members can also visit the UnitedHealthcare Community Plan of Washington Dual Complete Plan for more information
(continued from previous page)
1111 3rd Ave Suite 1100 Seattle WA 98101
Practice Matters is a quarterly publication for physicians and other health care professionals and facilities in the UnitedHealthcare network
Washington
practicematters
copy2020 United HealthCare Services IncPCA-1-19-01276-CampS-Multi-04242020
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33681 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92311
Important information for health care professionals and facilities
Encourage Members to Get an Annual Flu ShotPlease encourage members ages six months and older who do not have a contraindication to get their annual flu shot We also encourage you to implement the following practices
bull Establish standing orders for the vaccine For more information on implementing standing orders go to immunizeorg gt For Health Professionals gt Handouts for Patients amp Staff gt Standing Orders Templates Vaccine information statements are also available online at immunizeorg gt For Health Professionals gt Vaccine Information Statements
bull Tell members why itrsquos important to receive the vaccine and address any barriers Remind your staff about the importance of vaccination and encourage them to get vaccinated as well
bull Establish a walk-in policy for flu vaccinations or flu vaccine clinic hours
Wersquoll support your efforts by reminding members about the flu vaccine through recorded voice messages postcards and online notices If you have any questions contact your local Physician Advocate
Remind Members to Renew Their Benefits You may have Washington Apple Health (Medicaid) members who need to renew their coverage Please remind them to act quickly if they receive a Medicaid renewal notice from the Washington Health Benefits Exchange Together we can help members avoid lapses in coverage
For members to maintain coverage many must report their income to the Health Care Authority (HCA) every 12 months In an effort to help members avoid a loss in eligibility as a result of failing to complete the renewal steps or making other mistakes at wahealthplanfinderorg wersquore increasing awareness of the renewal process
If you discover members who need to renew coverage please advise them on how to renew Washington Apple Health (Medicaid) members can renew by contacting the Washington Health Benefits Exchange and UnitedHealthcare Community Plan members can also call us directly for renewal assistance at 866-686-9323 TTY 711
To renew with the Washington Health Benefit Exchange
bull By phone Call 855-923-4633 (TTYTTD 855-627-9604) Language assistance and disability accommodations are provided at no cost
bull Online Visit wahealthplanfinderorg and click on the Current Customer link
bull By mail Update renewal documents received in the mail by signing and returning them to Washington Health Benefit Exchange PO Box 946 Olympia WA 98507
bull In Person To receive renewal assistance go to wahealthplanfinderorg and search for a Navigator through the Customer Support link
We recommend checking a memberrsquos Medicaid eligibility at the time of service by calling Provider Services at 877-542-9231 or checking UHCprovidercom
If UnitedHealthcare Community Plan members have questions they can always call us at 866-686-9323 TTY 711 for renewal assistance
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33682 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92312
Important information for health care professionals and facilities
bull Develops clinical guidelines and service standards bull Monitors and assesses the quality and
appropriateness of services given to our members based on the guidelines and public health goals
bull Promotes wellness and preventive health as well as chronic condition self-management
bull Maintains a network of practitioners and care providers to deliver medical and behavioral health services
bull Strives for improvement of member health care and services
bull Develops implements and monitors key aspects of patient safety identifying opportunities and developing programs to promoting safe patient care
bull Tracks member and care provider satisfaction taking actions as appropriate
bull Identifies and analyzes existence of significant health care disparities in clinical areas
bull Conducts patient-focused interventions with culturally competent outreach materials that focus on specific risks related to raceethnicitylanguage
As a participating care provider you may offer input through representation on our Quality Improvement committees and your Provider Services representativeProvider AdvocateClinical Practice Consultant
Every year UnitedHealthcare Community Plan conducts care provider satisfaction assessments as part of our quality improvement efforts We assess and promote your satisfaction through
bull Annual care provider satisfaction surveys bull Regular visitsbull Town hall meetings
Our chief concern with the survey is objectivity Thatrsquos why UnitedHealthcare Community Plan engages the independent market research firm Center for the Study of Services (CSS) to analyze and report findings
UHCprovidercom mdash Your Source for Tools and InformationBe sure to check out UHCprovidercom our care provider website to find everything from UnitedHealthcare Community Plan reports and administrative guides to policies and Link self-service tools Your Link dashboard contains your capitation eligibility and patient management reports and online transactions so yoursquore able to verify eligibility check the status of a claim and submit or check the status of a prior authorization
Covered Services for Apple Health EnrolleesUnitedHealthcare Community Plan only pays for medically necessary services Medically necessary health care services or supplies are considered medically appropriate when they are
bull Necessary to meet a memberrsquos basic health needs bull Cost-efficient and appropriate for the covered
services
The UnitedHealthcare Community Plan doesnrsquot have a deductible or copayments Do not bill members for covered services View member benefit coverage information at UHCcommunityplancomwa gt View Plan Details gt Member Resources gt Member Handbook
Quality Improvement ProgramUnitedHealthcare Community Planrsquos comprehensive Quality Improvement Program is designed to objectively monitor systematically evaluate and effectively improve the quality and safety of clinical care and quality of services provided to all members A copy of our Quality Improvement program is available upon request
The Quality Improvement Program
bull Identifies the scope of care and services given
(continued on next page)
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33683 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92313
Important information for health care professionals and facilities
Survey results are reported to our Quality Management Committee who compares the results year over year as well as to other UnitedHealthcare Community Plan plans across the country The survey results include key strengths and improvement areas which we help carry out as needed
Patient Review and Coordination Program The Patient Review and Coordination (PRC) program is for all Apple Health Programs The Washington HCA program helps control over-utilization and inappropriate use of clinical services It restricts members to certain care providers including Primary Care Providers (PCPs) pharmacies and hospitals Washington Administrative Code (WAC182-501- 0135) established the guidelines for the PRC program and allows us to perform this function
PRC focuses on the health and safety of members who
bull Are often seen by several different prescribers bull Have a high number of duplicate medications bull Use several different pharmacies bull Have a high amount of emergency room (ER) usage
Based on a clinical review of the utilization findings these members may be placed into the PRC program for at least two years
The PCP plays a critical role in managing membersrsquo health care When a member is restricted within the program the PCP must approve any non-emergent care that the member receives from other practitioners This may include prescriptions for scheduled drugs class (Cll-CV)
The primary pharmacy is a critical player in managing the memberrsquos prescriptions The pharmacist alerts the memberrsquos PCP the plan PRC staff or HCA PRC staff of any misuse or potential concerns with the memberrsquos prescriptions All standard pharmacy policies remain in effect However if the member goes to a non-assigned pharmacy for scheduled drugs (Cll-CV) the claim will be rejected and the medication may not be dispensed
The pharmacist may refer the member back to their assigned pharmacy or choose to fill the prescription and ask the member to pay cash We may not reimburse the member depending on a review of the pertinent clinic situation
ER staff members are key players in helping the PCP manage the memberrsquos care to avoid clinically unnecessary ER visits If the ER is aware of the PRC restriction the hospital can coordinate care by referring the member back to their PCP andor pharmacy whether emergency services are provided or not
To refer a member to the PRC program call 877-542-8997
Utilization Management GuidelinesUtilization Management (UM) is based on a memberrsquos medical condition and is not influenced by monetary incentives UnitedHealthcare Community Plan pays its in-network PCPs and specialists on a fee-for-service basis as well as in-network hospitals and other types of care providers in the UnitedHealthcare Community Plan network on a fee-for-service basis The planrsquos UM staff works with care providers to help ensure members receive the most appropriate care in the place best suited for the needed services Our staff encourages appropriate use mdash and discourages underuse mdash and doesnrsquot receive incentives for UM decisions
(continued from previous page)
(continued on next page)
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33684 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92314
Important information for health care professionals and facilities
Reimbursements also depend on the fee schedule and the procedure performed Refer to your bulletins for correct coding Use the appropriate modifier codes on your claim form The modifier must be used based on the date of service
For claims billing and payment questions go to UHCprovidercomenclaims-payments-billinghtml
Health Home ProgramOur Health Home program is managed in partnership with the Washington state HCA Health Home provides community-based intensive care coordination and comprehensive care management to improve health outcomes and reduce service costs for some of Washingtonrsquos highest-need individuals
The Health Home program provides services beyond those typically offered by care providers including but not limited to
bull Comprehensive care management bull Care coordination and health promotion bull Individual and family support bull Referral to community services
Health Home also strives to increase an individualrsquos participation in their own care This program helps reduce Medicaid inpatient hospital admissions avoidable emergency room visits inpatient psychiatric admissions and the need for nursing home admissions It also works with area hospitals to provide transitional care services to members who are enrolled in the program
Hospitals and care providers may refer members to us for potential Health Home enrollment however Health Home-eligibility is determined by the HCA For more information about Health Home call 888-702-2053
UM Appeals These appeals contest the decisions made by UnitedHealthcare Community Planrsquos UM program They are appeals of UnitedHealthcare Community Planrsquos admission extension of stay level of care or other health care services determination These appeals typically state that it isnrsquot medically necessary or is considered experimental or investigational It may also contest any admission extension of stay or other health care service due to late notification or lack of complete or accurate information Any member their designee or care provider who is dissatisfied with a UnitedHealthcare Community Plan UM decision may file a UM appeal Adverse benefit determination decisions may include UnitedHealthcare Community Planrsquos decision to deny a service authorization request or to authorize a service in an amount duration or scope less than requested
Call 866-815-5334 to discuss the guidelines and utilization management
Billing and Claims SubmissionUnitedHealthcare Community Plan follows the same claims process as UnitedHealthcare Your clean claims must include your National Provider Identification (NPI) number and federal tax ID number Also include the Unique Care Provider Identification number (UPIN) for laboratory claims
We only consider reimbursing claims if you meet billing and coverage requirements Submitting a referral does not guarantee that wersquoll pay you Payment depends on the memberrsquos coverage on the date(s) of service medical necessity plan rules about limitations and exclusions and UnitedHealthcare Community Plan policies We donrsquot reimburse excessive inappropriate or non-covered charges To comply with applicable standards policies and laws we may adjust previous payments for services and audit claims We may also seek reimbursement for overpayments or offset future payments as allowed by law
(continued from previous page)
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33685 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92315
Important information for health care professionals and facilities
Long-Term Services and Supports Aging and Long-Term Support Administration (ALTSA) mdashHome and Community Services (HCS) mdash provides long-term care services for members who are older or have disabilities in their own homes which includes community residential settings or an in-home caregiver HCS also provides services to assist family caregivers or people who are transitioning from nursing homes
These services are not provided by UnitedHealthcare Community Plan To get more information about long-term care services visit dshswagovaltsalong-term-care-services-information You can also visit Community Living Connections or call 855-587-0252
Increasing Education and Awareness of Opioids Itrsquos critical that you are up-to-date on research and evidence-based clinical practice guidelines of opioid use We offer opioid use disorders (OUD)-related training and resources available on our care provider website to help ensure you have the information you need
For example state-specific Behavioral Health Toolkits are developed to provide access to clinical practice guidelines free substance use disordersOUD assessments and screening resources and other important state-specific resources Additionally Pain Management Toolkits are available and provide resources to help you identify members who present with chronic physical pain and who may need behavioral health services to address the psychological aspects of pain Continuing education is available and includes webinars such as ldquoThe Role of the Health Care Team in Solving the Opioid Epidemicrdquo and ldquoThe Fight Against the Prescription Opioid Abuse Epidemicrdquo
While resources are available we also work to help ensure you have the educational resources you need For example our Drug Utilization Review Provider Newsletter includes opioid trends prescribing and key resources
Access these resources by visiting UHCprovidercom gt Drug Lists and Pharmacy gt Resource Library
Prescribing Opioids Go to our Prescription Drug List (PDL) to learn more about which opioids require prior authorization and if there are prescription limits
Hepatitits A Update The Washington State Department of Health (DOH) announced an outbreak of hepatitis A (HAV) within Washington state on July 30 2019 Multiple states across the country have reported outbreaks of HAV primarily among people experiencing homelessness and people using drugs
People experiencing homelessness andor users of injection and non-injection drugs are at increased risk of infection during an outbreak due to lack of access to sanitation and should be offered a vaccine if susceptible People who have frequent ongoing contact with the above populations are also recommended for the hepatitis A vaccination People with chronic liver conditions such as hepatitis B or C should get the hepatitis A vaccine because of an increased risk for severe disease
Additional recommendations by the Advisory Committee on Immunization Practices (ACIP) for hepatitis A can be found at cdcgovvaccineshcpacip-recsvacc-specifichepahtml For questions about the hepatitis A vaccine or vaccine recommendations email DOH at oicpdohwagov
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33686 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92316
Important information for health care professionals and facilities
Education and Training Opportunities for Integrated Managed Care In 2020 UnitedHealthcare Community Plan of Washington is implementing the Integrated Managed Care (IMC) clinical care model also known as whole-person care This means that Apple Health (Medicaid) will integrate behavioral health benefits into the Apple Health managed care program so members have access to both medical and behavioral health services through a single plan
UnitedHealthcare will provide support to network care providers as they incorporate the IMC clinical model into their practices There are several educational and training opportunities available at UHCprovidercomwa-comm-training If you have any questions about the Integrated Managed Care contact Andrea Ray Senior Clinical Practice Performance Consultant at 763-361-3659 or andrearayuhccom
Tips to Raise the Rate of Well-Care Visits in Primary Care ClinicsHere is some guidance to increase the rate of well-care visits to primary care practices
bull Offer well-care appointments outside standard business hours one or two nights a week mdash or on a weekend day by allowing a care provider to flex their hours to cover these This allows parents to come in during non-work hours and students to be present for school and afterschool activities
bull Consider what well-care visits are called by clinic staff The term ldquowell-childrdquo visit is offensive to adolescents
bull Parents report that clinic reminders get attention while a reminder from a health plan may not receive the attention merited
bull Many parents prefer a text message reminder from the clinic Clinics report that including a link or phone number in a text or email to contact scheduling is highly successful
bull Compare the Medicaid lists of patients attributed to the clinic against the electronic medical record list of clinic patients Medicaid MCOs post a list of each clinic online Patients who are not established at the clinic offer an opportunity to increase well-care visit rates and build new relationships
bull Having difficulty reaching an unestablished patient If the patient is age 6 or younger check the Immunization Information System (IIS) IIS maintains their contact information through frequent mailings Community health workers may offer another strategy to locate parentspatients
bull Informal research suggests that reminders sent out three weeks in advance with reminders three days and three hours in advance are effective in getting appointments rescheduled and reducing missed appointments
bull Schedule the next well-care visit when the patient checks in for any appointment
(continued on next page)
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33687 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92317
Important information for health care professionals and facilities
bull Allow parentspatient to schedule the next annual checkup at this yearrsquos checkup
bull When reminding parents or patients to schedule a well-care visit mention
ndash Apple Health appointments are based on the calendar year (Note Medicaid provides one free well-care appointment (Early and Periodic Screening Diagnostic and Treatment (EPSDT) each calendar year)
ndash Immunization benefits will be offered at the appointment in plain English (eg cancer immunization for those who are age 12 flu vaccine for all kids or particularly children with asthma Note that the flu vaccine may prevent sick days for kids and parents)
bull Perform a well-care visit while the patient is at the clinic for a problem visit mdash when time permits
bull EPSDT and treated health problems can be completed and billed on the same day
bull Give schedulers and receptionists the ability to tell parentspatients when a well-care visit is needed If a well-care visit is needed it can be scheduled at check-in while the parent is fresh and children are cooperative
bull Most parents prefer to be reminded about needed preventive care by the clinic rather than the managed care organization and are more likely to read or listen to the reminder as well
Benefit Enhancements for Washington Dual Special Needs Plan The UnitedHealthcare Dual Completereg plan is available for members who qualify for both Medicare and Medicaid The plan has enhanced several benefits for qualified plan participants in 2020
New or enhanced member benefits in 2020
bull Dental An annual exam and $3000 in credits for dental care including dentures root canals bridges and more This is an increase of $1000 in credits
bull Over-the-Counter (OTC) Debit Card UnitedHealthcare will provide $275 quarterly$1100 annually in OTC product credits Members will have the option of using a debit card at their local Walgreens online at healthproductscardcom or by phone This is an increase of $420 in credits per year
bull Hearing An annual exam and $2000 in credits every two years for hearing devices This is an increase of $400 in credits every two years
bull Virtual Medical Visits Available to members 24 hours a day seven days a week through live video chat with a doctor via computer tablet or smartphone New benefit
Members also have the following additional benefits
bull Routine acupuncture and chiropractic carebull Fitness benefit bull Foot carebull NurseLinebull Personal emergency response systembull Transportationbull Vision
If you would like to learn more about the UnitedHealthcare Dual Complete Plan visit UHCprovidercomWAcommunityplan or contact your Provider Advocate
Where can members get more informationProspective DSNP members can call 855-332-0756 TTY 711 8 am to 8 pm seven days a week
Current members can call 844-368-6883 TTY 711 8 am to 8 pm seven days a week
Members can also visit the UnitedHealthcare Community Plan of Washington Dual Complete Plan for more information
(continued from previous page)
1111 3rd Ave Suite 1100 Seattle WA 98101
Practice Matters is a quarterly publication for physicians and other health care professionals and facilities in the UnitedHealthcare network
Washington
practicematters
copy2020 United HealthCare Services IncPCA-1-19-01276-CampS-Multi-04242020
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33682 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92312
Important information for health care professionals and facilities
bull Develops clinical guidelines and service standards bull Monitors and assesses the quality and
appropriateness of services given to our members based on the guidelines and public health goals
bull Promotes wellness and preventive health as well as chronic condition self-management
bull Maintains a network of practitioners and care providers to deliver medical and behavioral health services
bull Strives for improvement of member health care and services
bull Develops implements and monitors key aspects of patient safety identifying opportunities and developing programs to promoting safe patient care
bull Tracks member and care provider satisfaction taking actions as appropriate
bull Identifies and analyzes existence of significant health care disparities in clinical areas
bull Conducts patient-focused interventions with culturally competent outreach materials that focus on specific risks related to raceethnicitylanguage
As a participating care provider you may offer input through representation on our Quality Improvement committees and your Provider Services representativeProvider AdvocateClinical Practice Consultant
Every year UnitedHealthcare Community Plan conducts care provider satisfaction assessments as part of our quality improvement efforts We assess and promote your satisfaction through
bull Annual care provider satisfaction surveys bull Regular visitsbull Town hall meetings
Our chief concern with the survey is objectivity Thatrsquos why UnitedHealthcare Community Plan engages the independent market research firm Center for the Study of Services (CSS) to analyze and report findings
UHCprovidercom mdash Your Source for Tools and InformationBe sure to check out UHCprovidercom our care provider website to find everything from UnitedHealthcare Community Plan reports and administrative guides to policies and Link self-service tools Your Link dashboard contains your capitation eligibility and patient management reports and online transactions so yoursquore able to verify eligibility check the status of a claim and submit or check the status of a prior authorization
Covered Services for Apple Health EnrolleesUnitedHealthcare Community Plan only pays for medically necessary services Medically necessary health care services or supplies are considered medically appropriate when they are
bull Necessary to meet a memberrsquos basic health needs bull Cost-efficient and appropriate for the covered
services
The UnitedHealthcare Community Plan doesnrsquot have a deductible or copayments Do not bill members for covered services View member benefit coverage information at UHCcommunityplancomwa gt View Plan Details gt Member Resources gt Member Handbook
Quality Improvement ProgramUnitedHealthcare Community Planrsquos comprehensive Quality Improvement Program is designed to objectively monitor systematically evaluate and effectively improve the quality and safety of clinical care and quality of services provided to all members A copy of our Quality Improvement program is available upon request
The Quality Improvement Program
bull Identifies the scope of care and services given
(continued on next page)
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33683 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92313
Important information for health care professionals and facilities
Survey results are reported to our Quality Management Committee who compares the results year over year as well as to other UnitedHealthcare Community Plan plans across the country The survey results include key strengths and improvement areas which we help carry out as needed
Patient Review and Coordination Program The Patient Review and Coordination (PRC) program is for all Apple Health Programs The Washington HCA program helps control over-utilization and inappropriate use of clinical services It restricts members to certain care providers including Primary Care Providers (PCPs) pharmacies and hospitals Washington Administrative Code (WAC182-501- 0135) established the guidelines for the PRC program and allows us to perform this function
PRC focuses on the health and safety of members who
bull Are often seen by several different prescribers bull Have a high number of duplicate medications bull Use several different pharmacies bull Have a high amount of emergency room (ER) usage
Based on a clinical review of the utilization findings these members may be placed into the PRC program for at least two years
The PCP plays a critical role in managing membersrsquo health care When a member is restricted within the program the PCP must approve any non-emergent care that the member receives from other practitioners This may include prescriptions for scheduled drugs class (Cll-CV)
The primary pharmacy is a critical player in managing the memberrsquos prescriptions The pharmacist alerts the memberrsquos PCP the plan PRC staff or HCA PRC staff of any misuse or potential concerns with the memberrsquos prescriptions All standard pharmacy policies remain in effect However if the member goes to a non-assigned pharmacy for scheduled drugs (Cll-CV) the claim will be rejected and the medication may not be dispensed
The pharmacist may refer the member back to their assigned pharmacy or choose to fill the prescription and ask the member to pay cash We may not reimburse the member depending on a review of the pertinent clinic situation
ER staff members are key players in helping the PCP manage the memberrsquos care to avoid clinically unnecessary ER visits If the ER is aware of the PRC restriction the hospital can coordinate care by referring the member back to their PCP andor pharmacy whether emergency services are provided or not
To refer a member to the PRC program call 877-542-8997
Utilization Management GuidelinesUtilization Management (UM) is based on a memberrsquos medical condition and is not influenced by monetary incentives UnitedHealthcare Community Plan pays its in-network PCPs and specialists on a fee-for-service basis as well as in-network hospitals and other types of care providers in the UnitedHealthcare Community Plan network on a fee-for-service basis The planrsquos UM staff works with care providers to help ensure members receive the most appropriate care in the place best suited for the needed services Our staff encourages appropriate use mdash and discourages underuse mdash and doesnrsquot receive incentives for UM decisions
(continued from previous page)
(continued on next page)
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33684 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92314
Important information for health care professionals and facilities
Reimbursements also depend on the fee schedule and the procedure performed Refer to your bulletins for correct coding Use the appropriate modifier codes on your claim form The modifier must be used based on the date of service
For claims billing and payment questions go to UHCprovidercomenclaims-payments-billinghtml
Health Home ProgramOur Health Home program is managed in partnership with the Washington state HCA Health Home provides community-based intensive care coordination and comprehensive care management to improve health outcomes and reduce service costs for some of Washingtonrsquos highest-need individuals
The Health Home program provides services beyond those typically offered by care providers including but not limited to
bull Comprehensive care management bull Care coordination and health promotion bull Individual and family support bull Referral to community services
Health Home also strives to increase an individualrsquos participation in their own care This program helps reduce Medicaid inpatient hospital admissions avoidable emergency room visits inpatient psychiatric admissions and the need for nursing home admissions It also works with area hospitals to provide transitional care services to members who are enrolled in the program
Hospitals and care providers may refer members to us for potential Health Home enrollment however Health Home-eligibility is determined by the HCA For more information about Health Home call 888-702-2053
UM Appeals These appeals contest the decisions made by UnitedHealthcare Community Planrsquos UM program They are appeals of UnitedHealthcare Community Planrsquos admission extension of stay level of care or other health care services determination These appeals typically state that it isnrsquot medically necessary or is considered experimental or investigational It may also contest any admission extension of stay or other health care service due to late notification or lack of complete or accurate information Any member their designee or care provider who is dissatisfied with a UnitedHealthcare Community Plan UM decision may file a UM appeal Adverse benefit determination decisions may include UnitedHealthcare Community Planrsquos decision to deny a service authorization request or to authorize a service in an amount duration or scope less than requested
Call 866-815-5334 to discuss the guidelines and utilization management
Billing and Claims SubmissionUnitedHealthcare Community Plan follows the same claims process as UnitedHealthcare Your clean claims must include your National Provider Identification (NPI) number and federal tax ID number Also include the Unique Care Provider Identification number (UPIN) for laboratory claims
We only consider reimbursing claims if you meet billing and coverage requirements Submitting a referral does not guarantee that wersquoll pay you Payment depends on the memberrsquos coverage on the date(s) of service medical necessity plan rules about limitations and exclusions and UnitedHealthcare Community Plan policies We donrsquot reimburse excessive inappropriate or non-covered charges To comply with applicable standards policies and laws we may adjust previous payments for services and audit claims We may also seek reimbursement for overpayments or offset future payments as allowed by law
(continued from previous page)
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33685 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92315
Important information for health care professionals and facilities
Long-Term Services and Supports Aging and Long-Term Support Administration (ALTSA) mdashHome and Community Services (HCS) mdash provides long-term care services for members who are older or have disabilities in their own homes which includes community residential settings or an in-home caregiver HCS also provides services to assist family caregivers or people who are transitioning from nursing homes
These services are not provided by UnitedHealthcare Community Plan To get more information about long-term care services visit dshswagovaltsalong-term-care-services-information You can also visit Community Living Connections or call 855-587-0252
Increasing Education and Awareness of Opioids Itrsquos critical that you are up-to-date on research and evidence-based clinical practice guidelines of opioid use We offer opioid use disorders (OUD)-related training and resources available on our care provider website to help ensure you have the information you need
For example state-specific Behavioral Health Toolkits are developed to provide access to clinical practice guidelines free substance use disordersOUD assessments and screening resources and other important state-specific resources Additionally Pain Management Toolkits are available and provide resources to help you identify members who present with chronic physical pain and who may need behavioral health services to address the psychological aspects of pain Continuing education is available and includes webinars such as ldquoThe Role of the Health Care Team in Solving the Opioid Epidemicrdquo and ldquoThe Fight Against the Prescription Opioid Abuse Epidemicrdquo
While resources are available we also work to help ensure you have the educational resources you need For example our Drug Utilization Review Provider Newsletter includes opioid trends prescribing and key resources
Access these resources by visiting UHCprovidercom gt Drug Lists and Pharmacy gt Resource Library
Prescribing Opioids Go to our Prescription Drug List (PDL) to learn more about which opioids require prior authorization and if there are prescription limits
Hepatitits A Update The Washington State Department of Health (DOH) announced an outbreak of hepatitis A (HAV) within Washington state on July 30 2019 Multiple states across the country have reported outbreaks of HAV primarily among people experiencing homelessness and people using drugs
People experiencing homelessness andor users of injection and non-injection drugs are at increased risk of infection during an outbreak due to lack of access to sanitation and should be offered a vaccine if susceptible People who have frequent ongoing contact with the above populations are also recommended for the hepatitis A vaccination People with chronic liver conditions such as hepatitis B or C should get the hepatitis A vaccine because of an increased risk for severe disease
Additional recommendations by the Advisory Committee on Immunization Practices (ACIP) for hepatitis A can be found at cdcgovvaccineshcpacip-recsvacc-specifichepahtml For questions about the hepatitis A vaccine or vaccine recommendations email DOH at oicpdohwagov
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33686 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92316
Important information for health care professionals and facilities
Education and Training Opportunities for Integrated Managed Care In 2020 UnitedHealthcare Community Plan of Washington is implementing the Integrated Managed Care (IMC) clinical care model also known as whole-person care This means that Apple Health (Medicaid) will integrate behavioral health benefits into the Apple Health managed care program so members have access to both medical and behavioral health services through a single plan
UnitedHealthcare will provide support to network care providers as they incorporate the IMC clinical model into their practices There are several educational and training opportunities available at UHCprovidercomwa-comm-training If you have any questions about the Integrated Managed Care contact Andrea Ray Senior Clinical Practice Performance Consultant at 763-361-3659 or andrearayuhccom
Tips to Raise the Rate of Well-Care Visits in Primary Care ClinicsHere is some guidance to increase the rate of well-care visits to primary care practices
bull Offer well-care appointments outside standard business hours one or two nights a week mdash or on a weekend day by allowing a care provider to flex their hours to cover these This allows parents to come in during non-work hours and students to be present for school and afterschool activities
bull Consider what well-care visits are called by clinic staff The term ldquowell-childrdquo visit is offensive to adolescents
bull Parents report that clinic reminders get attention while a reminder from a health plan may not receive the attention merited
bull Many parents prefer a text message reminder from the clinic Clinics report that including a link or phone number in a text or email to contact scheduling is highly successful
bull Compare the Medicaid lists of patients attributed to the clinic against the electronic medical record list of clinic patients Medicaid MCOs post a list of each clinic online Patients who are not established at the clinic offer an opportunity to increase well-care visit rates and build new relationships
bull Having difficulty reaching an unestablished patient If the patient is age 6 or younger check the Immunization Information System (IIS) IIS maintains their contact information through frequent mailings Community health workers may offer another strategy to locate parentspatients
bull Informal research suggests that reminders sent out three weeks in advance with reminders three days and three hours in advance are effective in getting appointments rescheduled and reducing missed appointments
bull Schedule the next well-care visit when the patient checks in for any appointment
(continued on next page)
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33687 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92317
Important information for health care professionals and facilities
bull Allow parentspatient to schedule the next annual checkup at this yearrsquos checkup
bull When reminding parents or patients to schedule a well-care visit mention
ndash Apple Health appointments are based on the calendar year (Note Medicaid provides one free well-care appointment (Early and Periodic Screening Diagnostic and Treatment (EPSDT) each calendar year)
ndash Immunization benefits will be offered at the appointment in plain English (eg cancer immunization for those who are age 12 flu vaccine for all kids or particularly children with asthma Note that the flu vaccine may prevent sick days for kids and parents)
bull Perform a well-care visit while the patient is at the clinic for a problem visit mdash when time permits
bull EPSDT and treated health problems can be completed and billed on the same day
bull Give schedulers and receptionists the ability to tell parentspatients when a well-care visit is needed If a well-care visit is needed it can be scheduled at check-in while the parent is fresh and children are cooperative
bull Most parents prefer to be reminded about needed preventive care by the clinic rather than the managed care organization and are more likely to read or listen to the reminder as well
Benefit Enhancements for Washington Dual Special Needs Plan The UnitedHealthcare Dual Completereg plan is available for members who qualify for both Medicare and Medicaid The plan has enhanced several benefits for qualified plan participants in 2020
New or enhanced member benefits in 2020
bull Dental An annual exam and $3000 in credits for dental care including dentures root canals bridges and more This is an increase of $1000 in credits
bull Over-the-Counter (OTC) Debit Card UnitedHealthcare will provide $275 quarterly$1100 annually in OTC product credits Members will have the option of using a debit card at their local Walgreens online at healthproductscardcom or by phone This is an increase of $420 in credits per year
bull Hearing An annual exam and $2000 in credits every two years for hearing devices This is an increase of $400 in credits every two years
bull Virtual Medical Visits Available to members 24 hours a day seven days a week through live video chat with a doctor via computer tablet or smartphone New benefit
Members also have the following additional benefits
bull Routine acupuncture and chiropractic carebull Fitness benefit bull Foot carebull NurseLinebull Personal emergency response systembull Transportationbull Vision
If you would like to learn more about the UnitedHealthcare Dual Complete Plan visit UHCprovidercomWAcommunityplan or contact your Provider Advocate
Where can members get more informationProspective DSNP members can call 855-332-0756 TTY 711 8 am to 8 pm seven days a week
Current members can call 844-368-6883 TTY 711 8 am to 8 pm seven days a week
Members can also visit the UnitedHealthcare Community Plan of Washington Dual Complete Plan for more information
(continued from previous page)
1111 3rd Ave Suite 1100 Seattle WA 98101
Practice Matters is a quarterly publication for physicians and other health care professionals and facilities in the UnitedHealthcare network
Washington
practicematters
copy2020 United HealthCare Services IncPCA-1-19-01276-CampS-Multi-04242020
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33683 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92313
Important information for health care professionals and facilities
Survey results are reported to our Quality Management Committee who compares the results year over year as well as to other UnitedHealthcare Community Plan plans across the country The survey results include key strengths and improvement areas which we help carry out as needed
Patient Review and Coordination Program The Patient Review and Coordination (PRC) program is for all Apple Health Programs The Washington HCA program helps control over-utilization and inappropriate use of clinical services It restricts members to certain care providers including Primary Care Providers (PCPs) pharmacies and hospitals Washington Administrative Code (WAC182-501- 0135) established the guidelines for the PRC program and allows us to perform this function
PRC focuses on the health and safety of members who
bull Are often seen by several different prescribers bull Have a high number of duplicate medications bull Use several different pharmacies bull Have a high amount of emergency room (ER) usage
Based on a clinical review of the utilization findings these members may be placed into the PRC program for at least two years
The PCP plays a critical role in managing membersrsquo health care When a member is restricted within the program the PCP must approve any non-emergent care that the member receives from other practitioners This may include prescriptions for scheduled drugs class (Cll-CV)
The primary pharmacy is a critical player in managing the memberrsquos prescriptions The pharmacist alerts the memberrsquos PCP the plan PRC staff or HCA PRC staff of any misuse or potential concerns with the memberrsquos prescriptions All standard pharmacy policies remain in effect However if the member goes to a non-assigned pharmacy for scheduled drugs (Cll-CV) the claim will be rejected and the medication may not be dispensed
The pharmacist may refer the member back to their assigned pharmacy or choose to fill the prescription and ask the member to pay cash We may not reimburse the member depending on a review of the pertinent clinic situation
ER staff members are key players in helping the PCP manage the memberrsquos care to avoid clinically unnecessary ER visits If the ER is aware of the PRC restriction the hospital can coordinate care by referring the member back to their PCP andor pharmacy whether emergency services are provided or not
To refer a member to the PRC program call 877-542-8997
Utilization Management GuidelinesUtilization Management (UM) is based on a memberrsquos medical condition and is not influenced by monetary incentives UnitedHealthcare Community Plan pays its in-network PCPs and specialists on a fee-for-service basis as well as in-network hospitals and other types of care providers in the UnitedHealthcare Community Plan network on a fee-for-service basis The planrsquos UM staff works with care providers to help ensure members receive the most appropriate care in the place best suited for the needed services Our staff encourages appropriate use mdash and discourages underuse mdash and doesnrsquot receive incentives for UM decisions
(continued from previous page)
(continued on next page)
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33684 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92314
Important information for health care professionals and facilities
Reimbursements also depend on the fee schedule and the procedure performed Refer to your bulletins for correct coding Use the appropriate modifier codes on your claim form The modifier must be used based on the date of service
For claims billing and payment questions go to UHCprovidercomenclaims-payments-billinghtml
Health Home ProgramOur Health Home program is managed in partnership with the Washington state HCA Health Home provides community-based intensive care coordination and comprehensive care management to improve health outcomes and reduce service costs for some of Washingtonrsquos highest-need individuals
The Health Home program provides services beyond those typically offered by care providers including but not limited to
bull Comprehensive care management bull Care coordination and health promotion bull Individual and family support bull Referral to community services
Health Home also strives to increase an individualrsquos participation in their own care This program helps reduce Medicaid inpatient hospital admissions avoidable emergency room visits inpatient psychiatric admissions and the need for nursing home admissions It also works with area hospitals to provide transitional care services to members who are enrolled in the program
Hospitals and care providers may refer members to us for potential Health Home enrollment however Health Home-eligibility is determined by the HCA For more information about Health Home call 888-702-2053
UM Appeals These appeals contest the decisions made by UnitedHealthcare Community Planrsquos UM program They are appeals of UnitedHealthcare Community Planrsquos admission extension of stay level of care or other health care services determination These appeals typically state that it isnrsquot medically necessary or is considered experimental or investigational It may also contest any admission extension of stay or other health care service due to late notification or lack of complete or accurate information Any member their designee or care provider who is dissatisfied with a UnitedHealthcare Community Plan UM decision may file a UM appeal Adverse benefit determination decisions may include UnitedHealthcare Community Planrsquos decision to deny a service authorization request or to authorize a service in an amount duration or scope less than requested
Call 866-815-5334 to discuss the guidelines and utilization management
Billing and Claims SubmissionUnitedHealthcare Community Plan follows the same claims process as UnitedHealthcare Your clean claims must include your National Provider Identification (NPI) number and federal tax ID number Also include the Unique Care Provider Identification number (UPIN) for laboratory claims
We only consider reimbursing claims if you meet billing and coverage requirements Submitting a referral does not guarantee that wersquoll pay you Payment depends on the memberrsquos coverage on the date(s) of service medical necessity plan rules about limitations and exclusions and UnitedHealthcare Community Plan policies We donrsquot reimburse excessive inappropriate or non-covered charges To comply with applicable standards policies and laws we may adjust previous payments for services and audit claims We may also seek reimbursement for overpayments or offset future payments as allowed by law
(continued from previous page)
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33685 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92315
Important information for health care professionals and facilities
Long-Term Services and Supports Aging and Long-Term Support Administration (ALTSA) mdashHome and Community Services (HCS) mdash provides long-term care services for members who are older or have disabilities in their own homes which includes community residential settings or an in-home caregiver HCS also provides services to assist family caregivers or people who are transitioning from nursing homes
These services are not provided by UnitedHealthcare Community Plan To get more information about long-term care services visit dshswagovaltsalong-term-care-services-information You can also visit Community Living Connections or call 855-587-0252
Increasing Education and Awareness of Opioids Itrsquos critical that you are up-to-date on research and evidence-based clinical practice guidelines of opioid use We offer opioid use disorders (OUD)-related training and resources available on our care provider website to help ensure you have the information you need
For example state-specific Behavioral Health Toolkits are developed to provide access to clinical practice guidelines free substance use disordersOUD assessments and screening resources and other important state-specific resources Additionally Pain Management Toolkits are available and provide resources to help you identify members who present with chronic physical pain and who may need behavioral health services to address the psychological aspects of pain Continuing education is available and includes webinars such as ldquoThe Role of the Health Care Team in Solving the Opioid Epidemicrdquo and ldquoThe Fight Against the Prescription Opioid Abuse Epidemicrdquo
While resources are available we also work to help ensure you have the educational resources you need For example our Drug Utilization Review Provider Newsletter includes opioid trends prescribing and key resources
Access these resources by visiting UHCprovidercom gt Drug Lists and Pharmacy gt Resource Library
Prescribing Opioids Go to our Prescription Drug List (PDL) to learn more about which opioids require prior authorization and if there are prescription limits
Hepatitits A Update The Washington State Department of Health (DOH) announced an outbreak of hepatitis A (HAV) within Washington state on July 30 2019 Multiple states across the country have reported outbreaks of HAV primarily among people experiencing homelessness and people using drugs
People experiencing homelessness andor users of injection and non-injection drugs are at increased risk of infection during an outbreak due to lack of access to sanitation and should be offered a vaccine if susceptible People who have frequent ongoing contact with the above populations are also recommended for the hepatitis A vaccination People with chronic liver conditions such as hepatitis B or C should get the hepatitis A vaccine because of an increased risk for severe disease
Additional recommendations by the Advisory Committee on Immunization Practices (ACIP) for hepatitis A can be found at cdcgovvaccineshcpacip-recsvacc-specifichepahtml For questions about the hepatitis A vaccine or vaccine recommendations email DOH at oicpdohwagov
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33686 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92316
Important information for health care professionals and facilities
Education and Training Opportunities for Integrated Managed Care In 2020 UnitedHealthcare Community Plan of Washington is implementing the Integrated Managed Care (IMC) clinical care model also known as whole-person care This means that Apple Health (Medicaid) will integrate behavioral health benefits into the Apple Health managed care program so members have access to both medical and behavioral health services through a single plan
UnitedHealthcare will provide support to network care providers as they incorporate the IMC clinical model into their practices There are several educational and training opportunities available at UHCprovidercomwa-comm-training If you have any questions about the Integrated Managed Care contact Andrea Ray Senior Clinical Practice Performance Consultant at 763-361-3659 or andrearayuhccom
Tips to Raise the Rate of Well-Care Visits in Primary Care ClinicsHere is some guidance to increase the rate of well-care visits to primary care practices
bull Offer well-care appointments outside standard business hours one or two nights a week mdash or on a weekend day by allowing a care provider to flex their hours to cover these This allows parents to come in during non-work hours and students to be present for school and afterschool activities
bull Consider what well-care visits are called by clinic staff The term ldquowell-childrdquo visit is offensive to adolescents
bull Parents report that clinic reminders get attention while a reminder from a health plan may not receive the attention merited
bull Many parents prefer a text message reminder from the clinic Clinics report that including a link or phone number in a text or email to contact scheduling is highly successful
bull Compare the Medicaid lists of patients attributed to the clinic against the electronic medical record list of clinic patients Medicaid MCOs post a list of each clinic online Patients who are not established at the clinic offer an opportunity to increase well-care visit rates and build new relationships
bull Having difficulty reaching an unestablished patient If the patient is age 6 or younger check the Immunization Information System (IIS) IIS maintains their contact information through frequent mailings Community health workers may offer another strategy to locate parentspatients
bull Informal research suggests that reminders sent out three weeks in advance with reminders three days and three hours in advance are effective in getting appointments rescheduled and reducing missed appointments
bull Schedule the next well-care visit when the patient checks in for any appointment
(continued on next page)
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33687 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92317
Important information for health care professionals and facilities
bull Allow parentspatient to schedule the next annual checkup at this yearrsquos checkup
bull When reminding parents or patients to schedule a well-care visit mention
ndash Apple Health appointments are based on the calendar year (Note Medicaid provides one free well-care appointment (Early and Periodic Screening Diagnostic and Treatment (EPSDT) each calendar year)
ndash Immunization benefits will be offered at the appointment in plain English (eg cancer immunization for those who are age 12 flu vaccine for all kids or particularly children with asthma Note that the flu vaccine may prevent sick days for kids and parents)
bull Perform a well-care visit while the patient is at the clinic for a problem visit mdash when time permits
bull EPSDT and treated health problems can be completed and billed on the same day
bull Give schedulers and receptionists the ability to tell parentspatients when a well-care visit is needed If a well-care visit is needed it can be scheduled at check-in while the parent is fresh and children are cooperative
bull Most parents prefer to be reminded about needed preventive care by the clinic rather than the managed care organization and are more likely to read or listen to the reminder as well
Benefit Enhancements for Washington Dual Special Needs Plan The UnitedHealthcare Dual Completereg plan is available for members who qualify for both Medicare and Medicaid The plan has enhanced several benefits for qualified plan participants in 2020
New or enhanced member benefits in 2020
bull Dental An annual exam and $3000 in credits for dental care including dentures root canals bridges and more This is an increase of $1000 in credits
bull Over-the-Counter (OTC) Debit Card UnitedHealthcare will provide $275 quarterly$1100 annually in OTC product credits Members will have the option of using a debit card at their local Walgreens online at healthproductscardcom or by phone This is an increase of $420 in credits per year
bull Hearing An annual exam and $2000 in credits every two years for hearing devices This is an increase of $400 in credits every two years
bull Virtual Medical Visits Available to members 24 hours a day seven days a week through live video chat with a doctor via computer tablet or smartphone New benefit
Members also have the following additional benefits
bull Routine acupuncture and chiropractic carebull Fitness benefit bull Foot carebull NurseLinebull Personal emergency response systembull Transportationbull Vision
If you would like to learn more about the UnitedHealthcare Dual Complete Plan visit UHCprovidercomWAcommunityplan or contact your Provider Advocate
Where can members get more informationProspective DSNP members can call 855-332-0756 TTY 711 8 am to 8 pm seven days a week
Current members can call 844-368-6883 TTY 711 8 am to 8 pm seven days a week
Members can also visit the UnitedHealthcare Community Plan of Washington Dual Complete Plan for more information
(continued from previous page)
1111 3rd Ave Suite 1100 Seattle WA 98101
Practice Matters is a quarterly publication for physicians and other health care professionals and facilities in the UnitedHealthcare network
Washington
practicematters
copy2020 United HealthCare Services IncPCA-1-19-01276-CampS-Multi-04242020
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33684 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92314
Important information for health care professionals and facilities
Reimbursements also depend on the fee schedule and the procedure performed Refer to your bulletins for correct coding Use the appropriate modifier codes on your claim form The modifier must be used based on the date of service
For claims billing and payment questions go to UHCprovidercomenclaims-payments-billinghtml
Health Home ProgramOur Health Home program is managed in partnership with the Washington state HCA Health Home provides community-based intensive care coordination and comprehensive care management to improve health outcomes and reduce service costs for some of Washingtonrsquos highest-need individuals
The Health Home program provides services beyond those typically offered by care providers including but not limited to
bull Comprehensive care management bull Care coordination and health promotion bull Individual and family support bull Referral to community services
Health Home also strives to increase an individualrsquos participation in their own care This program helps reduce Medicaid inpatient hospital admissions avoidable emergency room visits inpatient psychiatric admissions and the need for nursing home admissions It also works with area hospitals to provide transitional care services to members who are enrolled in the program
Hospitals and care providers may refer members to us for potential Health Home enrollment however Health Home-eligibility is determined by the HCA For more information about Health Home call 888-702-2053
UM Appeals These appeals contest the decisions made by UnitedHealthcare Community Planrsquos UM program They are appeals of UnitedHealthcare Community Planrsquos admission extension of stay level of care or other health care services determination These appeals typically state that it isnrsquot medically necessary or is considered experimental or investigational It may also contest any admission extension of stay or other health care service due to late notification or lack of complete or accurate information Any member their designee or care provider who is dissatisfied with a UnitedHealthcare Community Plan UM decision may file a UM appeal Adverse benefit determination decisions may include UnitedHealthcare Community Planrsquos decision to deny a service authorization request or to authorize a service in an amount duration or scope less than requested
Call 866-815-5334 to discuss the guidelines and utilization management
Billing and Claims SubmissionUnitedHealthcare Community Plan follows the same claims process as UnitedHealthcare Your clean claims must include your National Provider Identification (NPI) number and federal tax ID number Also include the Unique Care Provider Identification number (UPIN) for laboratory claims
We only consider reimbursing claims if you meet billing and coverage requirements Submitting a referral does not guarantee that wersquoll pay you Payment depends on the memberrsquos coverage on the date(s) of service medical necessity plan rules about limitations and exclusions and UnitedHealthcare Community Plan policies We donrsquot reimburse excessive inappropriate or non-covered charges To comply with applicable standards policies and laws we may adjust previous payments for services and audit claims We may also seek reimbursement for overpayments or offset future payments as allowed by law
(continued from previous page)
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33685 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92315
Important information for health care professionals and facilities
Long-Term Services and Supports Aging and Long-Term Support Administration (ALTSA) mdashHome and Community Services (HCS) mdash provides long-term care services for members who are older or have disabilities in their own homes which includes community residential settings or an in-home caregiver HCS also provides services to assist family caregivers or people who are transitioning from nursing homes
These services are not provided by UnitedHealthcare Community Plan To get more information about long-term care services visit dshswagovaltsalong-term-care-services-information You can also visit Community Living Connections or call 855-587-0252
Increasing Education and Awareness of Opioids Itrsquos critical that you are up-to-date on research and evidence-based clinical practice guidelines of opioid use We offer opioid use disorders (OUD)-related training and resources available on our care provider website to help ensure you have the information you need
For example state-specific Behavioral Health Toolkits are developed to provide access to clinical practice guidelines free substance use disordersOUD assessments and screening resources and other important state-specific resources Additionally Pain Management Toolkits are available and provide resources to help you identify members who present with chronic physical pain and who may need behavioral health services to address the psychological aspects of pain Continuing education is available and includes webinars such as ldquoThe Role of the Health Care Team in Solving the Opioid Epidemicrdquo and ldquoThe Fight Against the Prescription Opioid Abuse Epidemicrdquo
While resources are available we also work to help ensure you have the educational resources you need For example our Drug Utilization Review Provider Newsletter includes opioid trends prescribing and key resources
Access these resources by visiting UHCprovidercom gt Drug Lists and Pharmacy gt Resource Library
Prescribing Opioids Go to our Prescription Drug List (PDL) to learn more about which opioids require prior authorization and if there are prescription limits
Hepatitits A Update The Washington State Department of Health (DOH) announced an outbreak of hepatitis A (HAV) within Washington state on July 30 2019 Multiple states across the country have reported outbreaks of HAV primarily among people experiencing homelessness and people using drugs
People experiencing homelessness andor users of injection and non-injection drugs are at increased risk of infection during an outbreak due to lack of access to sanitation and should be offered a vaccine if susceptible People who have frequent ongoing contact with the above populations are also recommended for the hepatitis A vaccination People with chronic liver conditions such as hepatitis B or C should get the hepatitis A vaccine because of an increased risk for severe disease
Additional recommendations by the Advisory Committee on Immunization Practices (ACIP) for hepatitis A can be found at cdcgovvaccineshcpacip-recsvacc-specifichepahtml For questions about the hepatitis A vaccine or vaccine recommendations email DOH at oicpdohwagov
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33686 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92316
Important information for health care professionals and facilities
Education and Training Opportunities for Integrated Managed Care In 2020 UnitedHealthcare Community Plan of Washington is implementing the Integrated Managed Care (IMC) clinical care model also known as whole-person care This means that Apple Health (Medicaid) will integrate behavioral health benefits into the Apple Health managed care program so members have access to both medical and behavioral health services through a single plan
UnitedHealthcare will provide support to network care providers as they incorporate the IMC clinical model into their practices There are several educational and training opportunities available at UHCprovidercomwa-comm-training If you have any questions about the Integrated Managed Care contact Andrea Ray Senior Clinical Practice Performance Consultant at 763-361-3659 or andrearayuhccom
Tips to Raise the Rate of Well-Care Visits in Primary Care ClinicsHere is some guidance to increase the rate of well-care visits to primary care practices
bull Offer well-care appointments outside standard business hours one or two nights a week mdash or on a weekend day by allowing a care provider to flex their hours to cover these This allows parents to come in during non-work hours and students to be present for school and afterschool activities
bull Consider what well-care visits are called by clinic staff The term ldquowell-childrdquo visit is offensive to adolescents
bull Parents report that clinic reminders get attention while a reminder from a health plan may not receive the attention merited
bull Many parents prefer a text message reminder from the clinic Clinics report that including a link or phone number in a text or email to contact scheduling is highly successful
bull Compare the Medicaid lists of patients attributed to the clinic against the electronic medical record list of clinic patients Medicaid MCOs post a list of each clinic online Patients who are not established at the clinic offer an opportunity to increase well-care visit rates and build new relationships
bull Having difficulty reaching an unestablished patient If the patient is age 6 or younger check the Immunization Information System (IIS) IIS maintains their contact information through frequent mailings Community health workers may offer another strategy to locate parentspatients
bull Informal research suggests that reminders sent out three weeks in advance with reminders three days and three hours in advance are effective in getting appointments rescheduled and reducing missed appointments
bull Schedule the next well-care visit when the patient checks in for any appointment
(continued on next page)
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33687 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92317
Important information for health care professionals and facilities
bull Allow parentspatient to schedule the next annual checkup at this yearrsquos checkup
bull When reminding parents or patients to schedule a well-care visit mention
ndash Apple Health appointments are based on the calendar year (Note Medicaid provides one free well-care appointment (Early and Periodic Screening Diagnostic and Treatment (EPSDT) each calendar year)
ndash Immunization benefits will be offered at the appointment in plain English (eg cancer immunization for those who are age 12 flu vaccine for all kids or particularly children with asthma Note that the flu vaccine may prevent sick days for kids and parents)
bull Perform a well-care visit while the patient is at the clinic for a problem visit mdash when time permits
bull EPSDT and treated health problems can be completed and billed on the same day
bull Give schedulers and receptionists the ability to tell parentspatients when a well-care visit is needed If a well-care visit is needed it can be scheduled at check-in while the parent is fresh and children are cooperative
bull Most parents prefer to be reminded about needed preventive care by the clinic rather than the managed care organization and are more likely to read or listen to the reminder as well
Benefit Enhancements for Washington Dual Special Needs Plan The UnitedHealthcare Dual Completereg plan is available for members who qualify for both Medicare and Medicaid The plan has enhanced several benefits for qualified plan participants in 2020
New or enhanced member benefits in 2020
bull Dental An annual exam and $3000 in credits for dental care including dentures root canals bridges and more This is an increase of $1000 in credits
bull Over-the-Counter (OTC) Debit Card UnitedHealthcare will provide $275 quarterly$1100 annually in OTC product credits Members will have the option of using a debit card at their local Walgreens online at healthproductscardcom or by phone This is an increase of $420 in credits per year
bull Hearing An annual exam and $2000 in credits every two years for hearing devices This is an increase of $400 in credits every two years
bull Virtual Medical Visits Available to members 24 hours a day seven days a week through live video chat with a doctor via computer tablet or smartphone New benefit
Members also have the following additional benefits
bull Routine acupuncture and chiropractic carebull Fitness benefit bull Foot carebull NurseLinebull Personal emergency response systembull Transportationbull Vision
If you would like to learn more about the UnitedHealthcare Dual Complete Plan visit UHCprovidercomWAcommunityplan or contact your Provider Advocate
Where can members get more informationProspective DSNP members can call 855-332-0756 TTY 711 8 am to 8 pm seven days a week
Current members can call 844-368-6883 TTY 711 8 am to 8 pm seven days a week
Members can also visit the UnitedHealthcare Community Plan of Washington Dual Complete Plan for more information
(continued from previous page)
1111 3rd Ave Suite 1100 Seattle WA 98101
Practice Matters is a quarterly publication for physicians and other health care professionals and facilities in the UnitedHealthcare network
Washington
practicematters
copy2020 United HealthCare Services IncPCA-1-19-01276-CampS-Multi-04242020
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33685 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92315
Important information for health care professionals and facilities
Long-Term Services and Supports Aging and Long-Term Support Administration (ALTSA) mdashHome and Community Services (HCS) mdash provides long-term care services for members who are older or have disabilities in their own homes which includes community residential settings or an in-home caregiver HCS also provides services to assist family caregivers or people who are transitioning from nursing homes
These services are not provided by UnitedHealthcare Community Plan To get more information about long-term care services visit dshswagovaltsalong-term-care-services-information You can also visit Community Living Connections or call 855-587-0252
Increasing Education and Awareness of Opioids Itrsquos critical that you are up-to-date on research and evidence-based clinical practice guidelines of opioid use We offer opioid use disorders (OUD)-related training and resources available on our care provider website to help ensure you have the information you need
For example state-specific Behavioral Health Toolkits are developed to provide access to clinical practice guidelines free substance use disordersOUD assessments and screening resources and other important state-specific resources Additionally Pain Management Toolkits are available and provide resources to help you identify members who present with chronic physical pain and who may need behavioral health services to address the psychological aspects of pain Continuing education is available and includes webinars such as ldquoThe Role of the Health Care Team in Solving the Opioid Epidemicrdquo and ldquoThe Fight Against the Prescription Opioid Abuse Epidemicrdquo
While resources are available we also work to help ensure you have the educational resources you need For example our Drug Utilization Review Provider Newsletter includes opioid trends prescribing and key resources
Access these resources by visiting UHCprovidercom gt Drug Lists and Pharmacy gt Resource Library
Prescribing Opioids Go to our Prescription Drug List (PDL) to learn more about which opioids require prior authorization and if there are prescription limits
Hepatitits A Update The Washington State Department of Health (DOH) announced an outbreak of hepatitis A (HAV) within Washington state on July 30 2019 Multiple states across the country have reported outbreaks of HAV primarily among people experiencing homelessness and people using drugs
People experiencing homelessness andor users of injection and non-injection drugs are at increased risk of infection during an outbreak due to lack of access to sanitation and should be offered a vaccine if susceptible People who have frequent ongoing contact with the above populations are also recommended for the hepatitis A vaccination People with chronic liver conditions such as hepatitis B or C should get the hepatitis A vaccine because of an increased risk for severe disease
Additional recommendations by the Advisory Committee on Immunization Practices (ACIP) for hepatitis A can be found at cdcgovvaccineshcpacip-recsvacc-specifichepahtml For questions about the hepatitis A vaccine or vaccine recommendations email DOH at oicpdohwagov
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33686 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92316
Important information for health care professionals and facilities
Education and Training Opportunities for Integrated Managed Care In 2020 UnitedHealthcare Community Plan of Washington is implementing the Integrated Managed Care (IMC) clinical care model also known as whole-person care This means that Apple Health (Medicaid) will integrate behavioral health benefits into the Apple Health managed care program so members have access to both medical and behavioral health services through a single plan
UnitedHealthcare will provide support to network care providers as they incorporate the IMC clinical model into their practices There are several educational and training opportunities available at UHCprovidercomwa-comm-training If you have any questions about the Integrated Managed Care contact Andrea Ray Senior Clinical Practice Performance Consultant at 763-361-3659 or andrearayuhccom
Tips to Raise the Rate of Well-Care Visits in Primary Care ClinicsHere is some guidance to increase the rate of well-care visits to primary care practices
bull Offer well-care appointments outside standard business hours one or two nights a week mdash or on a weekend day by allowing a care provider to flex their hours to cover these This allows parents to come in during non-work hours and students to be present for school and afterschool activities
bull Consider what well-care visits are called by clinic staff The term ldquowell-childrdquo visit is offensive to adolescents
bull Parents report that clinic reminders get attention while a reminder from a health plan may not receive the attention merited
bull Many parents prefer a text message reminder from the clinic Clinics report that including a link or phone number in a text or email to contact scheduling is highly successful
bull Compare the Medicaid lists of patients attributed to the clinic against the electronic medical record list of clinic patients Medicaid MCOs post a list of each clinic online Patients who are not established at the clinic offer an opportunity to increase well-care visit rates and build new relationships
bull Having difficulty reaching an unestablished patient If the patient is age 6 or younger check the Immunization Information System (IIS) IIS maintains their contact information through frequent mailings Community health workers may offer another strategy to locate parentspatients
bull Informal research suggests that reminders sent out three weeks in advance with reminders three days and three hours in advance are effective in getting appointments rescheduled and reducing missed appointments
bull Schedule the next well-care visit when the patient checks in for any appointment
(continued on next page)
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33687 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92317
Important information for health care professionals and facilities
bull Allow parentspatient to schedule the next annual checkup at this yearrsquos checkup
bull When reminding parents or patients to schedule a well-care visit mention
ndash Apple Health appointments are based on the calendar year (Note Medicaid provides one free well-care appointment (Early and Periodic Screening Diagnostic and Treatment (EPSDT) each calendar year)
ndash Immunization benefits will be offered at the appointment in plain English (eg cancer immunization for those who are age 12 flu vaccine for all kids or particularly children with asthma Note that the flu vaccine may prevent sick days for kids and parents)
bull Perform a well-care visit while the patient is at the clinic for a problem visit mdash when time permits
bull EPSDT and treated health problems can be completed and billed on the same day
bull Give schedulers and receptionists the ability to tell parentspatients when a well-care visit is needed If a well-care visit is needed it can be scheduled at check-in while the parent is fresh and children are cooperative
bull Most parents prefer to be reminded about needed preventive care by the clinic rather than the managed care organization and are more likely to read or listen to the reminder as well
Benefit Enhancements for Washington Dual Special Needs Plan The UnitedHealthcare Dual Completereg plan is available for members who qualify for both Medicare and Medicaid The plan has enhanced several benefits for qualified plan participants in 2020
New or enhanced member benefits in 2020
bull Dental An annual exam and $3000 in credits for dental care including dentures root canals bridges and more This is an increase of $1000 in credits
bull Over-the-Counter (OTC) Debit Card UnitedHealthcare will provide $275 quarterly$1100 annually in OTC product credits Members will have the option of using a debit card at their local Walgreens online at healthproductscardcom or by phone This is an increase of $420 in credits per year
bull Hearing An annual exam and $2000 in credits every two years for hearing devices This is an increase of $400 in credits every two years
bull Virtual Medical Visits Available to members 24 hours a day seven days a week through live video chat with a doctor via computer tablet or smartphone New benefit
Members also have the following additional benefits
bull Routine acupuncture and chiropractic carebull Fitness benefit bull Foot carebull NurseLinebull Personal emergency response systembull Transportationbull Vision
If you would like to learn more about the UnitedHealthcare Dual Complete Plan visit UHCprovidercomWAcommunityplan or contact your Provider Advocate
Where can members get more informationProspective DSNP members can call 855-332-0756 TTY 711 8 am to 8 pm seven days a week
Current members can call 844-368-6883 TTY 711 8 am to 8 pm seven days a week
Members can also visit the UnitedHealthcare Community Plan of Washington Dual Complete Plan for more information
(continued from previous page)
1111 3rd Ave Suite 1100 Seattle WA 98101
Practice Matters is a quarterly publication for physicians and other health care professionals and facilities in the UnitedHealthcare network
Washington
practicematters
copy2020 United HealthCare Services IncPCA-1-19-01276-CampS-Multi-04242020
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33686 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92316
Important information for health care professionals and facilities
Education and Training Opportunities for Integrated Managed Care In 2020 UnitedHealthcare Community Plan of Washington is implementing the Integrated Managed Care (IMC) clinical care model also known as whole-person care This means that Apple Health (Medicaid) will integrate behavioral health benefits into the Apple Health managed care program so members have access to both medical and behavioral health services through a single plan
UnitedHealthcare will provide support to network care providers as they incorporate the IMC clinical model into their practices There are several educational and training opportunities available at UHCprovidercomwa-comm-training If you have any questions about the Integrated Managed Care contact Andrea Ray Senior Clinical Practice Performance Consultant at 763-361-3659 or andrearayuhccom
Tips to Raise the Rate of Well-Care Visits in Primary Care ClinicsHere is some guidance to increase the rate of well-care visits to primary care practices
bull Offer well-care appointments outside standard business hours one or two nights a week mdash or on a weekend day by allowing a care provider to flex their hours to cover these This allows parents to come in during non-work hours and students to be present for school and afterschool activities
bull Consider what well-care visits are called by clinic staff The term ldquowell-childrdquo visit is offensive to adolescents
bull Parents report that clinic reminders get attention while a reminder from a health plan may not receive the attention merited
bull Many parents prefer a text message reminder from the clinic Clinics report that including a link or phone number in a text or email to contact scheduling is highly successful
bull Compare the Medicaid lists of patients attributed to the clinic against the electronic medical record list of clinic patients Medicaid MCOs post a list of each clinic online Patients who are not established at the clinic offer an opportunity to increase well-care visit rates and build new relationships
bull Having difficulty reaching an unestablished patient If the patient is age 6 or younger check the Immunization Information System (IIS) IIS maintains their contact information through frequent mailings Community health workers may offer another strategy to locate parentspatients
bull Informal research suggests that reminders sent out three weeks in advance with reminders three days and three hours in advance are effective in getting appointments rescheduled and reducing missed appointments
bull Schedule the next well-care visit when the patient checks in for any appointment
(continued on next page)
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33687 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92317
Important information for health care professionals and facilities
bull Allow parentspatient to schedule the next annual checkup at this yearrsquos checkup
bull When reminding parents or patients to schedule a well-care visit mention
ndash Apple Health appointments are based on the calendar year (Note Medicaid provides one free well-care appointment (Early and Periodic Screening Diagnostic and Treatment (EPSDT) each calendar year)
ndash Immunization benefits will be offered at the appointment in plain English (eg cancer immunization for those who are age 12 flu vaccine for all kids or particularly children with asthma Note that the flu vaccine may prevent sick days for kids and parents)
bull Perform a well-care visit while the patient is at the clinic for a problem visit mdash when time permits
bull EPSDT and treated health problems can be completed and billed on the same day
bull Give schedulers and receptionists the ability to tell parentspatients when a well-care visit is needed If a well-care visit is needed it can be scheduled at check-in while the parent is fresh and children are cooperative
bull Most parents prefer to be reminded about needed preventive care by the clinic rather than the managed care organization and are more likely to read or listen to the reminder as well
Benefit Enhancements for Washington Dual Special Needs Plan The UnitedHealthcare Dual Completereg plan is available for members who qualify for both Medicare and Medicaid The plan has enhanced several benefits for qualified plan participants in 2020
New or enhanced member benefits in 2020
bull Dental An annual exam and $3000 in credits for dental care including dentures root canals bridges and more This is an increase of $1000 in credits
bull Over-the-Counter (OTC) Debit Card UnitedHealthcare will provide $275 quarterly$1100 annually in OTC product credits Members will have the option of using a debit card at their local Walgreens online at healthproductscardcom or by phone This is an increase of $420 in credits per year
bull Hearing An annual exam and $2000 in credits every two years for hearing devices This is an increase of $400 in credits every two years
bull Virtual Medical Visits Available to members 24 hours a day seven days a week through live video chat with a doctor via computer tablet or smartphone New benefit
Members also have the following additional benefits
bull Routine acupuncture and chiropractic carebull Fitness benefit bull Foot carebull NurseLinebull Personal emergency response systembull Transportationbull Vision
If you would like to learn more about the UnitedHealthcare Dual Complete Plan visit UHCprovidercomWAcommunityplan or contact your Provider Advocate
Where can members get more informationProspective DSNP members can call 855-332-0756 TTY 711 8 am to 8 pm seven days a week
Current members can call 844-368-6883 TTY 711 8 am to 8 pm seven days a week
Members can also visit the UnitedHealthcare Community Plan of Washington Dual Complete Plan for more information
(continued from previous page)
1111 3rd Ave Suite 1100 Seattle WA 98101
Practice Matters is a quarterly publication for physicians and other health care professionals and facilities in the UnitedHealthcare network
Washington
practicematters
copy2020 United HealthCare Services IncPCA-1-19-01276-CampS-Multi-04242020
Practice Matters TX - Summer 2013 Customer Service Center 888-362-33687 Practice Matters WA - Winter 2019 ndash 2020 Provider Services Center 877-542-92317
Important information for health care professionals and facilities
bull Allow parentspatient to schedule the next annual checkup at this yearrsquos checkup
bull When reminding parents or patients to schedule a well-care visit mention
ndash Apple Health appointments are based on the calendar year (Note Medicaid provides one free well-care appointment (Early and Periodic Screening Diagnostic and Treatment (EPSDT) each calendar year)
ndash Immunization benefits will be offered at the appointment in plain English (eg cancer immunization for those who are age 12 flu vaccine for all kids or particularly children with asthma Note that the flu vaccine may prevent sick days for kids and parents)
bull Perform a well-care visit while the patient is at the clinic for a problem visit mdash when time permits
bull EPSDT and treated health problems can be completed and billed on the same day
bull Give schedulers and receptionists the ability to tell parentspatients when a well-care visit is needed If a well-care visit is needed it can be scheduled at check-in while the parent is fresh and children are cooperative
bull Most parents prefer to be reminded about needed preventive care by the clinic rather than the managed care organization and are more likely to read or listen to the reminder as well
Benefit Enhancements for Washington Dual Special Needs Plan The UnitedHealthcare Dual Completereg plan is available for members who qualify for both Medicare and Medicaid The plan has enhanced several benefits for qualified plan participants in 2020
New or enhanced member benefits in 2020
bull Dental An annual exam and $3000 in credits for dental care including dentures root canals bridges and more This is an increase of $1000 in credits
bull Over-the-Counter (OTC) Debit Card UnitedHealthcare will provide $275 quarterly$1100 annually in OTC product credits Members will have the option of using a debit card at their local Walgreens online at healthproductscardcom or by phone This is an increase of $420 in credits per year
bull Hearing An annual exam and $2000 in credits every two years for hearing devices This is an increase of $400 in credits every two years
bull Virtual Medical Visits Available to members 24 hours a day seven days a week through live video chat with a doctor via computer tablet or smartphone New benefit
Members also have the following additional benefits
bull Routine acupuncture and chiropractic carebull Fitness benefit bull Foot carebull NurseLinebull Personal emergency response systembull Transportationbull Vision
If you would like to learn more about the UnitedHealthcare Dual Complete Plan visit UHCprovidercomWAcommunityplan or contact your Provider Advocate
Where can members get more informationProspective DSNP members can call 855-332-0756 TTY 711 8 am to 8 pm seven days a week
Current members can call 844-368-6883 TTY 711 8 am to 8 pm seven days a week
Members can also visit the UnitedHealthcare Community Plan of Washington Dual Complete Plan for more information
(continued from previous page)
1111 3rd Ave Suite 1100 Seattle WA 98101
Practice Matters is a quarterly publication for physicians and other health care professionals and facilities in the UnitedHealthcare network
Washington
practicematters
copy2020 United HealthCare Services IncPCA-1-19-01276-CampS-Multi-04242020
1111 3rd Ave Suite 1100 Seattle WA 98101
Practice Matters is a quarterly publication for physicians and other health care professionals and facilities in the UnitedHealthcare network
Washington
practicematters
copy2020 United HealthCare Services IncPCA-1-19-01276-CampS-Multi-04242020