It's Summertime...Fun Time!

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1 Staff Newsletter #7 Summer 2007 It's Summertime...Fun Time! Here Are 5 Ways To Keep Cool & Healthy Summer means hotter weather and more time spent outdoors - vacations, getaways, backyard barbecues and leisurely days at the beach. Stay healthy and keep cool during the summer months while enjoying this special time of year! Drink plenty of water - it will keep your body hydrated during warm weather. Wear a hat and put on sunscreen - to protect you from harmful sunrays, skin damage, or getting a painful sunburn. Wear light loose fitting clothing - so your body will stay cooler. Eat fresh seasonal fruits and vegetables - to nourish your body. Wear sunglasses - protect your eyes from the sun's UV rays. Above all, give yourself the time to truly relax and breathe. Turn off the cell phone, TV or ipod and go for a walk at the park or beach. Experience nature and let stress just blow away in the breeze. Have a healthy and happy summer... you deserve it! Refreshing Lemon & Strawberry Smoothie! (serves 2) 1 teaspoon of fresh lemon juice 1 cup fresh strawberries 1 cup fresh orange juice pinch of sugar (or substitute) 8 ice cubes Place all ingredients in a blender, then blend for 25 seconds or until smooth. Serve in a chilled glass. Hello! It's summertime, and we here at IEHP hope that you and your family are having a good one! Taking care of patients on a daily basis can take a lot out of you. So have fun this summer and know that we appreciate the quality care that you give our Members! In this issue of ScrubTalk, we've included some important IEHP information for you about Chlamydia screenings and the $25 P4P incentive program. Also, read about updates on checking eligibility status on Healthy Families and Healthy Kids Members, the new CMS 1500 forms, vision authorizations, and more. Did you get your copy of "HOW - To Raise Your Patient Survey Scores" guidebook? If not, give us a call and we'll make sure you get yours. Read about it on page 7. Good stuff! On April 1, 2007, IEHP assumed Urgent Care (UC) responsibility for all IEHP Members. Therefore, your IEHP patients should be referred to an IEHP contracted UC. Get a copy of IEHP UC's by calling your IPA, or call your IEHP Provider Relations representative. As always IEHP patients can still call the IEHP 24-Hour Nurse Advice Line to find the nearest Urgent Care Center. Your IEHP Provider Relations Team is here for you. If you have any questions, concerns or comments, please call us (909) We'd be happy to visit your office; just call and we'll schedule an appointment. Have a great summer! Sincerely, Eric Haden, IEHP Chief Network Officer What s Inside... Ask Susie...3 Our Referral Process Gets Better...5 How To Raise Your Patient Satisfaction Scores...7

2 Reminder Report! You can't use POS to check eligibility for Healthy Families and Healthy Kids. AEVS is only for Medi-Cal Members. For current eligibility status go to www. iehp.org. IEHP is now accepting the new CMS 1500 Forms. NPI (National Provider Identifier) numbers should be registered on IEHP secure provider website at Human Papillomavirus (HPV) Gardasil Serum is only reimbursed for Healthy Families and Healthy Kids Serum. Gardasil Serum is available from VFC for Medi-Cal Members. Members eligible to receive Gardasil are between the ages of 9-26 years old. IEHP will pay for the serum for Medi-Cal Members years old who don't qualify for the serum through VFC. IEHP is not offering an incentive for reporting the administration of Gardasil on a PM160. Provider Inservices - Please call your Provider Relations Team if you would like information on the following: P4P Program, IEHP website, Health Education Programs, Health Management Programs, and IEHP Policies and Procedures. If you and your staff would like a representative to make a visit to your office, just call (909) to set up a meeting. Vision Authorizations can be verified online even if you originally got them through the IVR, VERs also. Just visit the Provider Secure Site at Provider Manuals are available for provider review. Check out the redline version for changes effective August 1, Prevnar series 1-4 is now a requirement on Yellow Cards effective January 1, It's New. It's Simple! Our Newest Healthcare Plan - IEHP Medicare DualChoice It's a plan for people all ages that have both Medicare and Medi-Cal. It offers Medi-Medi's streamlined healthcare services by combining their Medicare, Medi-Cal and pharmacy benefits into one single plan - IEHP Medicare DualChoice! IEHP Medicare DualChoice Is Simpler For You! If your IPA has chosen to participate in IEHP Medicare DualChoice, referrals will be handled exactly like they are for all your IEHP Members through your IPA. You won't have to bill CMS (Center for Medicare and Medicaid Services) for Medicare services, or DHS (Department of Health Services) for Medi-Cal services. You get payment for your healthcare services from your IPA in a timely manner. For questions contact your IPA or your IEHP PSR. Want to refer your Medi-Medi patients to IEHP Medicare DualChoice? Tell your Medi-Medi patients to call IEHP (4347) or TTY :00 a.m. - 8:00 p.m., 7 days a week, including holidays. CMS Contract: H5640 Here is what IEHP Medicare DualChoice Member ID Card Isser No Telephone/Teléfono: (909) looks like After Hours/Después Del Horario Normal: (888)

3 Q. A. Our IPA recently informed us that the list of IEHP Urgent Care Centers has changed. Do we now contact IEHP for the current Urgent Care list? As of April 1, 2007, IEHP assumed responsibility for the Urgent Cares (UC) in our network. IEHP patients should be referred to an IEHP contracted UC. A copy of IEHP contracted UC is available through your IPA, or you may call IEHP Provider Relations Team at (909) If you don't see an Urgent Care Center you know about on our list, please let us know. We always want to add more to our list. Remember IEHP believes that our Members receive the best care in their PCP's office. UC should only be used in cases when an appointment can't be given and the Member requires urgent medical care. Q. A. I'm a new front office staff member in a Family Practice office. I got a call from an IEHP Provider Relations Coordinator about the status of a referral submission for an IEHP Member. What can I do to ensure that I follow IEHP's guidelines regarding referrals to specialists? Congratulations on your new position! IEHP appreciates your concern about IEHP Members receiving specialty care in a timely manner. The process is simple. When a Member assigned to your provider needs a referral to a specialist, your office should submit a referral to the IPA to whom the Member is assigned. If the referral is routine, your office should expect a response from the IPA within 5 to 7 working days - a "stat" response back within 72 hrs. There are services that don't require a referral for the Member, namely OB/GYN services. Members have "open access" under the law. Please inform Members their right to seek services without a referral from an IEHP OB/GYN provider within their IPA. These services include, but are not limited to, family planning/birth control, well woman check-ups, breast lump and pelvic exams. You're required to keep a Referral Tracking Log. Your office's Referral Coordinator should follow up with the IPA for status on all referral submissions within the timeframes mentioned above. Don't wait to get a call from the Member requesting status on their referral - be proactive and contact the IPA within the timeframes to obtain status. Your office is responsible for contacting Members to inform them whether their referral has been approved or denied. When a Member calls into your office to request status on a referral, please transfer their call to your Referral Coordinator instead of just referring them back to IEHP. Remember, when it comes to referrals: Be proactive. Keep track of the referrals submitted. Follow up with the IPAs on the status of referrals. Notify the IEHP Member promptly of the status of their referral. Everyday, we get calls from you with questions about IEHP procedures or programs. In this column, we'll address some of your most common ones. If there's a specific question you would like addressed, or have comments concerning any answers, please call us at (909) Or just fax your question to "Ask Susie" at (909) Or mail it to IEHP, "Ask Susie", Provider Relations, P.O. Box 19026, San Bernardino, CA We want to hear from you! Susie White, Provider Relations Manager. providerservices@iehpexch.org 3

4 SCRUB OF THE MONTH Hey Is There Someone In Your Office That Inspires You? Is there that special co-worker who always seems to know what to say or do, someone who's always ready with a helping hand? Someone who takes the time to be kind and respectful? Maybe there is someone who just makes people laugh? Please Let Us Know! If we choose your story, we'll feature him/her in Scrub Talk with their photo and honor them with special recognition. Plus, they'll get a $25 Target Card, and...you'll get one, too just for the nomination! Here's How... Tell us briefly, in 500 words or less, why you're nominating this special person for Scrub of the Month. Make sure to include your name, office location, and your work telephone number. Just fax your nomination to us at (909) On the fax cover sheet write: Scrub Talk - Scrub of the Month Nomination Or mail it to IEHP, Scrub Talk - Scrub of the Month Nomination P.O. Box 19026, San Bernardino, CA If your nomination is chosen, we'll call you to make plans for photos and further details. Nominate someone in your office today! If your nomination is chosen, we'll call you to make plans for photos and further details. Nominate someone in your office today! Congratulations to Micaiela Maghoney, Medical Receptionist Scrub of the Month! "She is very compassionate, patient, caring and respectful to our patients, as well as our office staff. She makes a good impression for our office since she is the first person that our patients see when they come into our office. Our patients love her, and on many occasions they brought her gifts to show their appreciation. Micaiela goes above and beyond to help our patients and make sure that they get what they need in a timely manner. They miss her when she is out of the office. She is a very hard worker, but always keeps a smile on her face." - Micaiela was nominated by her co-worker Travia Graves from Obstetrics & Gynecology Office of Dr. Samir Hage, Redlands, California. Micaiela was presented a Certificate of Appreciation for being IEHP Scrub of the Month. Both ladies were awarded with a $25 Target Gift Card from IEHP. 4

5 We re Your Provider Relations Team... We're here to help you! Call us at (909) or (909) : Terry Redden Martha Contreras Alicia Oviedo Alma Favela (Provider Relations Coordinators) Teresa Meza Ailene Zamora Jaclyn Patterson Specialist Elizabeth Sandoval For your : Daniel Vargas for Alphacare Medical Group, Desert Family Practice Associates, Mission Medical Group and Vantage Medical Group Wendy Barrios for LaSalle Medical Associates, Inland Faculty Medical Group, Loma Linda University Health Care, Physicians Health Network, and Physicians Healthways, and New Horizon Medical Group. Ailene Zamora for McKinley Medical Group, Riverside Family Health Medical Group, Kaiser, Inland Health Organization, and Val Vista Medical Group. Esther Iverson - Provider Relations Supervisor Are you with IEHP Direct? Call us at Elizabeth Sandoval - Jaclyn Patterson - Spcialist Terry Redden - Steve Avila - Coordinator Esther Iverson Provider Relations Supervisor Daniel Vargas Steve Avila Wendy Barrios Coordinator A Reminder: You can check P4P payment and status issues, and submit VERs and check status online at Our Referral Process Gets Even Better...Starting August 1st! We've been looking into our referral program - Doctor-2-Doctor (D2D) - which lets you refer a patient to a specialist with no approval. Last year we held round table meetings with you. We listened. And here's the concern we heard: Your patient's first visit with a specialist is just a consultation. Yet your patient doesn't know that. Your patient expects a cure that day. But the specialist needs more test results. Your patient returns to you. Unhappy. Weeks go by. Still no solution. We're making our referral process more effective. 1. You examine the patient. You look for the right care - the first time. If you feel a specialist is needed, you order needed services. Once all results are in, fill out a referral form. Attach clinical information. And submit it to your IPA. 2. Your IPA will review the referral. Then inform you - and your patient. An approved referral then goes to a specialist in time for your patient's visit. 3. Now, the specialist knows about your patient, about the problem. Your patient can start treatment as needed. Your patients are happier with you. The new process cuts delays. It may even reduce referral complaints. You and your IPA save time. You're a team. You look for the best treatment option. This new referral process gives you the right care the first time. Additional information will follow. Consult your IPA for specific referral guidelines. Or for more details, call Provider Relations at (909)

6 Chlamydia Testing Urine vs. Pelvic Exam P4P Bonus $25 Studies show that Chlamydia infections are now more common. However, a woman's fear or discomfort with pelvic exams can present a barrier to getting screened for sexually transmitted infections like Chlamydia. Good news, screening for Chlamydia using a urine sample is now both feasible and acceptable, and studies indicate that women prefer urine sampling to a pelvic exam. IEHP covers both types of Chlamydia testing and pays a P4P bonus of $25 once per year for female Members between the age of 16 and 26. We recommend that you request this urine test at any visit for a qualified member and do not wait for a pelvic exam or pap smear visit. We encourage you to submit qualified Chlamydia testing for your P4P bonus. Refer to your IEHP P4P packet or call your Provider Relations Team at (909) , for the proper codes and claims submission process. Tips for collecting the most accurate urine samples from females: The patient should not urinate for at least one hour prior to collecting the specimen. Collect the first ml of voided urines (non midstream) to a maximum of 60 ml. Ensure the lid is secure. The lab will reject leaking specimens. Urine samples must be transferred to a Urine Preservative Transport tub (UPT) within 8 hours of collection if the specimen is stored at room temperature, or within 24 hours of collection if specimen has been continuously refrigerated. The urine volume transferred to the tube must be sufficient to fill the tube to a level indicated by black lines on the UPT tube label. Over filled or under filled UPT tubes will be rejected. Sample preserved in the UPT can be tested up to 30 days after collected. Submit specimen as Chlamydia only, Gonorrhea only, or duplex test for Chlamydia and Gonorrhea. Urine samples submitted in any transport vessel other than the UPT will be cancelled as " Improper Specimen" and the test will not be performed. As a reminder, the following requirements apply to swab specimen collection: BD ProbeTecET Chlamydia Trachomatis/Neisseria Gonorrhoeae (CT/GC) Amplified DNA Assay Collection Kit for Endocervical Speciments (Wet Swabs) HAS REPLACED the BD ProbeTec ET CT/GC amplified DNA Assay Endocervical Specimen Collection and DRY TRANSPORT Kit. BD ProbeTec ET Chlamydia Trachomatis/Neisseria Gonorrhoeae (CT/GC) Amplified DNA Assay Collection Kit for Male Urethral Specimens (Wet Swabs) HAS REPLACED the BD ProbeTec ET CT/GC Amplified DNA Assay Male Urethral Specimen Collection Kit and DRY TRANSPORT Kit. For any specific questions, please call your IEHP Provider Relations Team at (909) or ProviderServices@iehpexch.org. 6

7 Cultural Corner What is Cultural Competency? "A learning process that involves the ability to respond to challenges and opportunities posed by the presence of socio-cultural diversity." You can have a positive impact on your patients' care and treatment by effectively using a combination of knowledge, attitude and skills about another culture or ethnic group. To enhance patient/provider communication and to avoid being unintentional goofs, be mindful of: Styles of Speech - Impatience can be seen as a sign of disrespect. Listen to the volume and speed of your patient's speech as well as the content. Eye Contact - Most people expect you look to them in the eyes. Failure to do so may seem disrespectful. If your patient seems uncomfortable with direct gazes, try sitting next to them instead of across from them. Body Language - Don't interpret your patient's feelings or levels of pain just from facial expressions - ask them how they feel. Avoid questions that can be answered with "yes" or "no". Research indicates that when patients, regardless of cultural background are asked, "Do you understand," many will answer, "yes" even when they really do not. Win A Prize! Tell us three ways that you were "Culturally Competent" with your patients! Fax your explanations to "Scrub Talk Culture Corner" at (909) If your office has more than one site, please indicate your particular site. All answers must be submitted to "Culture Corner" by Friday, September 14, "HOW To Raise Your Patient Survey Scores" Guide Book? Did you participate in the IEHP Communication Enhancement Programs? If so, you should have received your "HOW - To Raise Your Patient Survey Scores" Guidebook. Physicians nationwide have used these ideas to raise their scores. Read It For: How to set appointments fast and efficiently. How playing "mystery patient" will reveal how well you're doing. How to describe test and procedures so patients understand. Customer service scripts that get you better satisfaction scores. Patients' overall satisfaction with your practice is a cumulative sense of how they are treated from their first telephone encounter through their appointment departure. If you would like to receive a copy of "HOW - To Raise Your Patient Survey Scores" Guidebook, please call your IEHP Provider Relations Team at

8 Information You Should Know! IEHP P4P Website You can reach us online for updated information, anytime. Try it and you'll see how simple it is! To print copies of the current forms and information listed below, just go to Recommended Immunization Schedule This schedule indicates the recommended ages for routine administration of current licensed childhood vaccines, as of December 1, 2006, for children through age 18 years old Recommended Immunization Schedule This schedule indicates the recommended ages for routine administration of current licensed childhood vaccines, as of December 1, 2006, for children through age 18 years old Recommended Immunization Schedule This schedule indicates the recommended ages for routine administration of current licensed childhood vaccines, as of December 1, 2006, for children through age 18 years old Updated Vaccine Reimbursement Schedule This schedule is payable for serum reimbursement provided to IEHP Members not eligible for serum/ vaccines through the VFC program. Vaccine: MMR CPT Code: Reimbursement Rate Change: from $38.27 to $47.16 (Non VFC Members only) Reimbursement Process: Submit a CMS1500 Claim Form with appropriate CPT code, quantity dispensed and billed amount to: IEHP Claims Department P.O. Box San Bernardino, CA Reminder: PCPs who have identified and are treating Members with Diabetes and/or Asthma can have their Members added to the Diabetes and Asthma Program by contacting the Health Management Department at: or Coming Soon! Yellow Card Submission Online - You will no longer have to mail or fax shot records. Information will be coming soon. Are You Moving Your Office? Suggestions, Recommendations, Questions? Call us! You can reach the Provider Relations Team at (909) , or fax us at (909) You must give IEHP and your IPA a 60-day advance notice if you are planning to move your office. Member notification is required by DHS/DMHC (Department of Health Care Services /California Department of Managed Health Care). This way your IEHP patients will get the information they need to prevent disruption of care with your office. So, if you are planning a move, please contact your IEHP Provider Relations Team at (909) A Public Entity INLAND EMPIRE HEALTH PLAN PO Box San Bernardino, CA PRSRT STD U.S. POSTAGE PAID INLAND EMPIRE HEALTH PLAN Staff Newsletter 2007 IEHP All Rights Reserved. PS