Michigan Newsletter Summer 2010

Transcription

1 What s New Michigan Newsletter Summer 2010 Provider Demographic Changes Effective September 1, 2010 Molina Healthcare will allow Providers to submit their demographic changes either via , regular mail or by fax. Molina Healthcare asks that you allow up to 60 days to process your request(s). If you have knowledge of changes in advance, specifically a TAX ID change, we ask that you submit those changes as soon as they are available so your information can be updated accurately and to avoid any delay in claims reimbursement. We are excited about this change and the efficiency it will provide to the processing of your change requests. The form will be available at in the Provider section under forms or you can contact your Territory Manager. The requested changes are to be submitted, legibly, on the enclosed Provider Change Form, along with the supporting documentation to the following: Mail: Systems Configuration Dept Molina Healthcare of Michigan 100 West Big Beaver Rd; Ste 600 Troy, MI Fax: (248) Molina HealthcareProviderChangeForm@molinahealthcare.com For questions, please contact the Provider Call Center at (888) , Option 1. In This Issue Provider Demographic Changes pg 1 Medicare Increase pg 2 Back To School Fair pg 2 Stop Health Care Fraud & Abuse pg 3 Patients Skipping Their Asthma Medications pg 4 Molina Medicare and Med Assurant Working Together pg 5 Risks & Benefits of Aspirin Use pg 5 Nurse Advice Line pg 6 Claims Submission Requirements Please mail all initial Medicaid claims to: Molina Healthcare, Inc. PO Box Long Beach, CA Please mail all initial Medicare claims to: Molina Healthcare Options Claims PO Box Long Beach, CA Please do not submit initial claims to the Troy address as this will delay the processing of your claims, and your claim may be returned. Please contact the Claims Department with any questions or concerns at

2 What s New Summer 2010 Michigan Medicare Increase On June 25, 2010, President Obama signed into law the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of This law establishes a 2.2 percent update to the Medicare Physician Fee Schedule (MPFS) payment rates retroactive to June 1 continuing through November 30, Molina Medicare followed suit and loaded the new rates during July All claims processed after July 16, 2010 were paid at the new rate. Claims paid at the old rates will be reprocessed as soon as possible. Under current law, Medicare payments to physicians and other providers paid under the MPFS are based upon the lesser of the submitted charge on the claim or the MPFS amount. Claims containing June and July dates of service that were submitted with charges greater than or equal to the new 2.2 percent update rates will be automatically reprocessed. Please note: To avoid duplication, physicians/providers should not resubmit claims that have already been submitted to Molina Medicare. Molina Healthcare works proactively with state and federal agencies when changes occur. We appreciate you seeing our members and please contact Molina Healthcare if you need further assistance at Dr. Cleo Participates in the 9th Annual After School Back To School Fair The Belle Isle Casino hosted this event on Saturday August 21 st! Molina Healthcare is always willing to participate in community events. Let us know if you have any upcoming events that you would like our participation in! Pat Embry and Dr. Cleo 2

3 What s New Summer 2010 Michigan How Can You Help Stop Health Care Fraud & Abuse? Health care fraud is rising higher and higher every year. Molina Healthcare and Federal Agencies are working together to help prevent fraud and abuse. Health care fraud takes money from health care programs, which leaves less money for true medical care. What should providers do to assist Molina Healthcare with its compliance efforts? Exhibit ethical and professional behavior when providing services to Molina Healthcare members. Ensure billing practices are truthful. Only bill for services that were provided and medically necessary. Notify MOLINA HEALTHCARE immediately of any concerns about member or provider fraud and abuse. By working together we can make a difference. If you suspect fraud report it today, through one of the following ways: Molina Healthcare of Michigan Attn: Compliance Director 100 W. Big Beaver, Ste. 600 Troy, MI Phone (877) Molina Healthcarecompliance@MolinaHealthcare.com Or contact the: Michigan Department of Community Health (MDCH), Attn: Program Investigation Unit, Capitol Commons Center Building, 400 South Pine, 6th Floor, Lansing, MI Phone (866) All reports will be thoroughly investigated and verified instances will be reported to the proper authorities. 3

4 Are Your Patients Skipping Their Asthma Medications in the Summer? During the summer months, Molina Healthcare of Michigan members who feel well may stop taking their asthma controller medications. These members are more likely to suffer in the Fall. When the Fall comes, hospital admissions increase and data shows these hospitalized members have not been filling their controller medications. In fact, 75% of the hospitalized pediatric members had no prescriptions filled the month prior to admission. MOLINA HEALTHCARE is encouraging providers to contact their patients with asthma and make sure they fill their prescriptions or see if they need refills during the summer months. Also, 50% of MOLINA HEALTHCARE members did not fill their prescriptions after hospitalization. When there is a hospital discharge or any other emergency situation, an emergency over ride can be entered 24 hours/7 days a week. Providers or pharmacies can call: Some members are leaving the hospital without medication due to use of non formulary medications. Formulary information can be found on the website at the following links: drug/pages/formulary.aspx manual/pages/medicaid.aspx What s New Summer 2010 Michigan HEALTHCARE is using QVAR as the preferred inhaled corticosteroid. When providers write for this product there is No PA required. When an inhaled corticosteroid is needed, please consider using QVAR, Other products require prior authorization. No PA Required- ProAir HFA-MOLINA HEALTHCARE is using ProAir HFA (albuterol) as the preferred short acting beta agonist. When providers write for this product no PA is required. When your members require a short acting beta agonists, please consider ProAir HFA. All other albuterol products require a PA. NO PA Required for members 9 years and under for: Singulair chewables and Pulmicort respules Here are some suggestions: Please stress the importance of staying on a controller medicine even when feeling well Create an Asthma Action Plan and emphasize the importance of following the plan Have each patient demonstrate they know the difference between rescue and controller medications Evaluate the inhaler technique of each of your patients Peak Flow Meters are FREE. Each MOLINA HEALTHCARE member with asthma should have one. Contact MOLINA HEALTHCARE extension or Using MOLINA HEALTHCARE Formulary Medications Prevents Prior Authorization: No PA Required- QVAR 40 and 80 mcg-molina 4

5 What s New Summer 2010 Michigan Molina Medicare and Med Assurant Working Together Molina Medicare has selected MedAssurant, Inc., to deliver a disease management program to Molina Medicare members with diabetes, asthma, chronic obstructive pulmonary disease (COPD), heart failure and coronary artery disease (CAD). MedAssurant s team of health care professionals is committed to developing a supportive, collaborative partnership with primary care practitioners and the team of physicians who make up the Molina Medicare practitioner network. The Chronic Care Solutions program, CCS Advantage, is designed to increase the frequency of primary care visits and assist the member to prepare for their visits. The CCS Advantage program has skilled Registered Nurses located in a call center and also within your local area. The call center nurses contact Molina Medicare members enrolled in the program to discuss relevant health topics and provide coaching and support to assist members in acquiring knowledge and the self-care skills necessary to achieve their treatment goals. The nurses located in your local area meet face-to-face with Molina Medicare members to answer their questions and to provide assessment and education based on their needs and prescribed treatment plan. The team of MedAssurant nurses work with primary care practitioners, specialists, social workers and local social agencies to provide care coordination on behalf of Molina Medicare members enrolled in the program. As an overview, the CCS Advantage program is designed to benefit practitioners and Molina Medicare members by: Identifying treatment goals and providing the education and support deemed appropriate to resolve barriers to achieving these goals Providing education, support and program referrals to members seeking assistance with lifestyle issues such as smoking cessation, isolation or nutrition counseling Encouraging members who have a chronic illness to obtain ongoing primary care in addition to necessary specialty care Supporting members with adhering to their treatment plan Analyzing administrative and member-reported data to identify possible gaps in members adherence with standards of care; the information is provided to the practitioners and members on a monthly basis Engaging and empowering members through education to take an active role in their own health Please contact a MedAssurant representative if you have questions or comments about the program. You may contact a representative Monday through Friday between 8:00 am and 7:00 pm by calling Do You Discuss Risks & Benefits of Aspirin Use With Your Patients? The Consumer Assessment of Healthplan Survey (CAHPS) & National Committee for Quality Assurance (NCQA) Are Measuring the Rates Both NCQA and the member survey CAPHS will begin measuring how often providers are discussing aspirin use with their patients. While aspirin use is not the clear choice for everyone, healthcare providers will begin to be measured on how often they discuss the benefits and risk within their practice. Why the change? The United States Preventive Services Task Force found that regular aspirin use can reduce the risk of first heart attacks for men and first strokes for women. Aspirin should only be used when the benefits outweigh the risks. The recommendation for daily use applies to: Men between the ages of and women between the ages of For primary prevention in Type 1 or Type 2 diabetics at increased cardiovascular risks including those over 40 years of age For secondary prevention in diabetics with a history of cardiovascular disease What are members being asked? Health plans will be measured on how often clinicians discuss aspirin use with their patients as follows: Do you take aspirin daily or every other day? Do you have a health problem or take medication that makes taking aspirin unsafe for you? Has a doctor or other health provider ever discussed with you the risks and benefits of aspirin to prevent heart attack or stroke? What OTC aspirin is covered? OTC aspirin 81 mg - enteric coated, chewable and regular 5

6 100 West Big Beaver Road, Suite 600 Troy, MI MI0810 Questions about your health? Call Our Nurse Advice Line! English Spanish OPEN 24 HOURS! Your family s health is our priority! For the hearing impaired please call TTY/ English TTY/ Spanish Editor: Brenda Lever Co-editior: Leann Conway 6