Healthy Rewards. Volume 5, Issue 4 May 2017

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1 SM Volume 5, Issue 4 May 2017 Healthy Rewards BlueChoice HealthPlan Medicaid shares the same commitment to your patients health and well-being as you do. We have implemented a new, easily accessible incentive program called Healthy Rewards. This program has been designed to help your patients stay on track with their health care visits. It s simple. Every time your patient completes one of the qualifying healthy activities, they will get dollars added to their reloadable Healthy Rewards debit card. Prenatal visit earns $25. Postpartum visit earns $50. Well-baby visit by two weeks of age earns $25. Well-child visit (at least six checkups before 15 months) earns $25. Healthy Rewards can be used at the following approved retailers: Dollar General Family Dollar Walmart Members can use these funds to purchase approved items, including baby-care items and more. If you would like more information on the Healthy Rewards program or our high-risk obstetric case management program, please call our Customer Care Center at Help ensure your patients are receiving these rewards. Schedule an initial OB visit within the first trimester or 42 days of enrollment with BlueChoice HealthPlan Medicaid. Complete the patient s postpartum checkup days after delivery. If your patient had a C-section, her postoperative visit after 1-2 weeks does not count as a postpartum visit. Encourage your patients to track their visits and earn rewards. Remind your patients after the baby is born to schedule their well-baby appointment with their pediatrician. Here s how patients report their activities: 1. Log in to 2. Call Healthy Rewards at Monday Thursday from 9 a.m. 8 p.m. and Friday, from 9 a.m. 7 p.m. ET. 3. Mail or fax the activity card your patients bring to your office to sign. Fax to Allow your patients to use an office-based terminal to report their activity online at 1

2 Consumer Assessment of Healthcare Providers and Systems Survey Shows Opportunities for Improvement in Physician Care BlueChoice HealthPlan Medicaid sends out the Consumer Assessment of Healthcare Providers and Systems (CAHPS ) survey to our members every year. This survey gives our members an opportunity to share their perceptions about the quality of care and services they receive from our network physicians. CAHPS is used by all Medicaid HMO plans that undergo accreditation review by the National Committee for Quality Assurance (NCQA). The following charts compare results from 2016 to those from the previous year. The column on the far right shows the percentiles achieved by BlueChoice HealthPlan Medicaid when scores were compared to those of other Medicaid plans across the country. Our goal is to achieve at least the 75th percentile in every rating category. As you review these results, we encourage you to focus on ways to address those areas in your own practice that may have room for improvement. Addressing those areas will help ensure that our members and your patients have positive experiences that meet their medical needs and ensure their satisfaction with the quality of services provided BlueChoice HealthPlan Medicaid CAHPS Adult Member Satisfaction Survey Results Survey Question BlueChoice HealthPlan Medicaid 2016 CAHPS Survey Question Trend 2016 Medicaid Percentile Arhieved 4 Shared decision-making 3 Doctor discussed reasons to take medicine 93% 97% 95th Doctor discussed reasons not to take medicine 61% 68% 50th Doctor asked what you thought was best for you 71% 76% 33rd Continuity of care 2 Doctor seemed informed about care you received from other health providers 78% 80% 25th * CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). CAHPS 2015 MY14 CAHPS 2016 MY15 Trend 2016 Medicaid Percentile Arhieved 4 Rating of physician 1 Rating of personal doctor 80% 85% 90th Rating of specialist seen most often 85% 73% 5th Rating of all health care provided in past 12 months 72% 72% 33rd Getting care quickly 2 Got appointment for urgent care as soon as needed 76.02% 84% 50th Got appointment for nonurgent care as soon as needed 80% 82% 75th Doctor s communication with patients 2 How often personal doctor explained things understandably to you 93% 92% 50th How often personal doctor listened carefully to you 94% 93% 75th How often personal doctor showed respect for what you had to say 93% 94% 67th How often personal doctor spent enough time with you 90% 90% 67th 2 Note: The source of data contained in this report is Quality Compass 2016 and is used with the permission of the NCQA. Quality Compass 2016 includes certain CAHPS data. Any analysis, interpretation or conclusion based on this data is solely that of the authors. NCQA specifically disclaims responsibility for any such analysis, interpretation or conclusion. 1 Percent responding 8, 9 or 10 (On a scale of 0 10 with 0 being the worst score and 10 being the best score). 2 Percent responding usually or always. 3 Percent responding a lot, yes or some. 4 Percentile definition: A score equal to or greater than 75 percent of all those attained on a survey question is said to be in the 75th percentile.

3 We re in Your Community Rural Health Clyburn Center was filled with excitement at the Dr. Seuss Read Across America day in Aiken, South Carolina. More than 40 people were in attendance, and participants received information about BlueChoice HealthPlan Medicaid and Dr. Seuss books to take home. The rural health center s staff participated in this event and also dressed up like Dr. Seuss characters. BlueChoice HealthPlan Medicaid Community Relations Representative Viticus Thomas read Dr. Seuss books to the families, as well as shared information about extra value benefits, health tips, giveaways and healthy snacks. BlueChoice HealthPlan Medicaid did not Keep It Undercover at the 18th Annual Charleston Black Expo. In partnership with BlueCross BlueShield of South Carolina at the North Charleston Convention Center, guests were met by more than 100 vendors, a Health Village and the Greek Village. BlueChoice HealthPlan Medicaid also partnered with Virginia College Charleston to provide exhibit guests with blood pressure, cholesterol and glucose health screenings. BlueChoice HealthPlan Medicaid Community Outreach Specialist Chimere Platt gave exposition goers important information on benefits and services. March 2, 2017, marked the 20th anniversary celebration of Dr. Seuss Read Across America. It was also Dr. Seuss s 113 th birthday! Staff members of Pediatric Associates of Florence (Palmetto St.) and Georgetown Pediatric Center put aside the many hats they wear for work and transformed into the book characters. They reminded us you re never too old, too wacky or too wild to pick up a book and read with a child. Our Community Relations Representative Channell Webster joined them in the ultimate reading hat: the red- and white-striped stovepipe. The first 75 children at each location received a goody bag with a Dr. Seuss book, snack and activity book. Parent participants received health tips, as well as information about BlueChoice HealthPlan Medicaid. 3

4 Recontracting Follow-Up Providers who have received a 2017 recontracting update packet (in accordance with the five-year South Carolina Department of Health and Human Services network requirement) should complete the packet in its entirety. Please return to your designated point of contact, based on your specialty type: By mail: BlueChoice HealthPlan Medicaid I-20 at Alpine Road Mail code: AX-E13 Columbia, SC Scott Crisler Ancillary, institutional and (PT/ST/OT) providers Scott.Crisler@BlueChoiceSC.com P F Tiesha William Physician practices and rural health clinic providers Tiesha.Williams@BlueChoiceSC.com P F For your convenience, the information can be ed or faxed for a quicker turnaround. Your designated contract manager can be reached by any of the methods above, should you have questions or need additional assistance. Behavioral Health Carve-In BlueChoice HealthPlan Medicaid will begin managing psychiatric residential treatment for mental health and autism spectrum disorder services on July 1, If you have members who might be currently in these services and may benefit from additional support, please contact our Customer Care Center to refer them to case management. We will be posting information related to both of these behavioral health carve-ins on the website. ADD/ADHD Outreach Support Program Launched We launched the ADHD/ADD outreach support program in late March. Our outreach specialist is making contact with the parents/guardians of members who are currently prescribed medication to offer support and to remind them of the importance of keeping follow-up appointments and remaining on medication as prescribed. If you have a member you believe may benefit from this program, please contact our Customer Care Center to initiate a referral to this program. Update to Provider Operations Manual Please be aware that the BlueChoice HealthPlan Medicaid Provider Operations Manual has been updated and is available on our website at Provider Manual Medicaid Managed Care 2017 BSC-PM If you do not have access to the internet and would like a hard copy of the manual, please contact the Customer Care Center at

5 Secondary Insurance Denied by Primary? As a Medicaid managed care organization, BlueChoice HealthPlan Medicaid is always the payer of last resort. We do accept secondary paper claims and electronic claims. If you submit paper claims, you must include the primary payer s Explanation of Benefits (EOB). When the primary insurance denies the claim, please submit a copy of the denial to our health plan. For electronic secondary claims: Use loop 2300 and segment REF02 to indicate the original claim number. Use loop 2300 and segment CLM05-3 to indicate the claim frequency code. Use 7 for replacement of prior claim. We pay maternity claims as primary, and then pursue payment from the primary (pay and chase). Proper Filing for Well-Child Incentive When filing claims for the well-child incentive, please remember to file G9153 on the line directly following the early and periodic screening, diagnostic and treatment (EPSDT) office visit code. The diagnosis pointer should be the same for the EPSDT office visit code and the G9153. If the diagnosis pointers are different, this will cause the G9153 line to split off of the claim and deny. Proper Filing for Centering Services When filing claims for centering services (code 99078), the diagnosis pointer should point to an approved diagnosis for centering. If the diagnosis pointer for code is not one of these approved diagnosis codes, that line of the claim will deny. Following is a listing of the codes. Diagnosis Codes Z34.00 Z34.01 Z34.02 Z34.03 Z34.80 Z34.81 Z34.82 Z34.83 Z34.90 Z34.91 Z34.92 Z34.93 Z33.1 O09.00 O09.01 O09.02 O09.03 O09.10 O09.11 O09.12 O09.13 O09.40 O09.41 O09.42 O09.43 O O O O O O O O O09.30 O09.31 O09.32 O09.33 O O O O O O O O O O O O O O O O O O O O O O O O O O O O O09.70 O09.71 O09.72 O09.73 O09.90 O09.91 O09.92 O

6 Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5 ) Updates In an effort to keep our providers informed of changes occurring in the behavioral health community, we wanted to share some updates from the DSM-5. When transitioning from the DSM-IV-TR to the DSM-5, the provider community moved from use of a multiaxial system to the current use of a nonaxial system upon diagnosis. While the information included in the diagnosis remains much the same, the axes are not included in DSM-5. Although formatted differently, the same information is found within the DSM-5 diagnostic system. DSM-5 combines DSM-IV-TR axes I-III diagnoses into one list, as shown in Table 1. Table 1: DSM-5 Diagnosis DSM-IV Multiaxial System DSM-5 Nonaxial System Axis I: clinical disorder and other conditions that are focus of treatment Axis II: personality disorder and mental retardation Axis III: general medical conditions Combined attention to clinical disorders, including personality disorders, intellectual disability and other conditions that are the focus of treatment and medical conditions. 6 Axis IV: psychosocial and environmental stressors Axis V: global assessment of functioning (GAF) Reason for visit and psychosocial and contextual factors via expanded list of V codes and Z codes. Disability included in notation. World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) included as option.

7 Additional conditions and problems relevant to the presenting symptoms, diagnoses and treatment are also listed as ICD-10-CM Z codes. These can be found in the section of DSM-5 entitled Other Conditions That May Be a Focus of Clinical Attention. In addition, Axis V GAF was removed from DSM-5. Alternatively, WHODAS 2.0 is included in section III of DSM-5. We understand that our providers depend upon diagnoses for guiding treatment recommendations, identifying prevalence rates for mental health service planning, identifying patient groups for clinical and basic research and documenting important public health information. As the understanding of mental disorders and their treatments has evolved, medical, scientific and clinical professionals have focused on the characteristics of specific disorders and their implications for treatment and research. Clinical training and experience are needed to use the DSM-5 for determining a diagnosis. The diagnostic criteria identify symptoms, behaviors, cognitive functions, personality traits, physical signs and syndrome combinations; durations require clinical expertise in order to differentiate psychiatric disorders from normal life variations and transient responses to stress. Revisions to the DSM-5 may continue to take place. In 2016, updates were made to the codes used for the diagnoses listed in Table 2. Detailed information about these updates can be viewed in an online supplement published by the American Psychiatric Association located at Select View the DSM-5 Update (September 2016). Table 2 Disorder Code Effective Oct. 1, 2016 Avoidant/restrictive food intake disorder F50.89 Binge-eating disorder F50.81 Disruptive mood dysregulation disorder F34.81 Excoriation (skin-picking) disorder F42.4 Gender dysphoria in adolescents and adults F64.0 Hoarding disorder F42.3 Obsessive-compulsive disorder F42.2 Other specified depressive disorder F32.89 Other specified feeding or eating disorder F50.89 Other specified obsessive-compulsive and related disorder F42.8 Pica, in adults F50.89 Premenstrual dysphoric disorder F32.81 Social (pragmatic) communication disorder F80.82 Unspecified obsessive-compulsive and related disorder F42.9 Some resources that may best help you include: American Medical Association, Professional Edition CPT (current procedural terminology), 2016 American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013 ICD-10-CM and ICD-10-PCS Coding Handbook

8 AX-400-Co1 P.O. Box 6170 Columbia SC PRSRT STD US POSTAGE PAID PERMIT NO 1240 COLUMBIA SC BlueChoice HealthPlan and BlueCross BlueShield of South Carolina are independent licensees of the Blue Cross and Blue Shield Association. BlueChoice HealthPlan has contracted with Amerigroup Partnership Plan, LLC, an independent company, for services to support administration of Healthy Connections. Some links in this newsletter lead to third party sites. Those organizations are solely responsible for the content and privacy policies on these sites. To report fraud, call our confidential Fraud Hotline at You may also call the South Carolina Department of Health and Human Services Fraud Hotline at or In This Issue Page 1 Healthy Rewards Page 2 Consumer Assessment of Healthcare Providers and Systems Survey Shows Opportunities for Improvement in Physician Care Page 3 We re In Your Community Page Recontracting Follow-Up Behavioral Health Carve-In ADD/ADHD Outreach Support Program Launched Update to Provider Operations Manual Page 5 Secondary Insurance Denied by Primary Proper Filing for Well-Child Incentive Proper Filing for Centering Services Page 6-7 Diagnostic and Statistical Manual of Mental Disorder Fifth Edition (DSM-5) Updates

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