Articles of Importance to Read: UnitedHealthcare Goes Live With 13th Edition of Milliman Care Guidelines. Summer 2009

Size: px
Start display at page:

Download "Articles of Importance to Read: UnitedHealthcare Goes Live With 13th Edition of Milliman Care Guidelines. Summer 2009"

Transcription

1 Important information for physicians and other health care professionals and facilities serving UnitedHealthcare Medicaid members Summer 2009 UnitedHealthcare Goes Live With 13th Edition of Milliman Care Guidelines UnitedHealthcare Medical Management continues to use the Milliman Care Guidelines in the utilization management of both inpatient and outpatient services for all plans except our Pennsylvania plans, and on May 1st went live with the use of the 13th Edition of the Care Guidelines. The Care Guidelines are nationally recognized evidence-based guidelines; and are more than just a tool used by the payer community to guide the authorization of care and services. The key aspects of the Care Guidelines: Clinical indications for decision-making for admission, procedures, testing and services; A guide for optimal recovery (the Milliman Care Guidelines Optimal Recovery Course) which is reflective of best practices in prescriptive care; Discharge planning guidelines; Patient education/teaching information; Clinical documentation requirements; Extended Stay criteria; Common Complications and Conditions guidelines; Hospital Care Planning; Articles of Importance to Read: Page 1 UnitedHealthcare Goes Live With 13th Edition of Milliman Care Guidelines Page 2 H1N1 (Swine Flu) Update The Importance of Collaboration between Primary Physicians and Behavioral Health Clinicians Member ID Card Updates Page 3 Provider Satisfaction Survey Provider Directories Care Management and Disease Management Page 4 The Medical Technology Assessment Committee (MTAC) Quality Measures; Opportunity to use guidelines to guide collaboration and consultation between payers and providers regarding patient care and management. If you have questions or want to know more about the Milliman Care Guidelines, please contact your local UnitedHealthcare plan.

2 H1N1 (Swine Flu) Update UnitedHealthcare providers are directed to the Centers of Disease Control (CDC) Web site at for the latest H1N1 (swine flu) updates. Providers can also download a Frequently Asked Questions (FAQ) document for their patients by accessing their state-specific physician Web site at The Importance of Collaboration between Primary Physicians and Behavioral Health Clinicians A substantial number of patients who have serious illnesses also have behavioral health conditions. For example, 20% of patients who have had a heart attack are likely to develop depression within 12 months of the event. Between 20% and 27% of patients with diabetes also have depression. It is important to determine if a behavioral health clinician is treating a patient with these and other illnesses. If so, it is helpful to coordinate care with the behavioral health clinician. Coordination of care takes on greater importance for enrollees with severe and persistent mental health and/or substance abuse problems. This is especially true when medications are prescribed, when there are coexisting medical/psychiatric symptoms and when patients have been hospitalized for a medical or psychiatric condition. Communication between clinicians can also maximize the efficiency of diagnosis and treatment, while minimizing the risk of adverse medication interactions for patients being prescribed psychotropic medication. It can also help reduce the risk of relapse for patients with substance abuse disorders or psychiatric conditions. Please discuss with your patients the benefits of sharing essential clinical information. We encourage you to obtain a signed release from each UnitedHealthcare patient that allows you to share appropriate treatment information with the patient s behavioral health clinician. Psychiatric Consults for Medical Patients If you would like to arrange a psychiatric consultation for a patient in a medical bed, are unclear whether a consultation is warranted, or need assistance with any needed authorization, please call United Behavioral Health at (800) In addition, if a PCP or a non-psychiatrist prescribes an antipsychotic medication for a member, it is highly recommended that the prescribing physician contact United Behavioral Health to discuss the appropriateness for the utilization of this medication. Member ID Card Updates UnitedHealthcare ID cards have been redesigned to incorporate the feedback we received from physicians and practice managers. We believe this is an important step in simplifying the administration of health care for you and our members. Beginning Fall 2009, the new ID card will be reissued to all UnitedHealthcare Medicaid members. You may continue to see the older ID cards for a period of time until the mass mailing is completed. Please continue to accept both versions of the ID cards from your patients. In addition, if you participate in both UnitedHealthcare s Medicaid and commercial page 2 Provider Service Center:

3 networks, you may have already seen the ID card enhancements for your commercial patients. Some of the important changes which abide by the Workgroup for Electronic Data Interchange (WEDI) health care ID card standards include: Consistency layout based on WEDI standards for data fields, placement and size; personalization and variable information with labels printed on front of card and instructions on back of card Readability limited information on the card, machine readable formatting, and use of large font size Copying/Scanning ability to clearly copy or scan for patient health records with white background Compliance compliant with the National Council for Prescription Drug Programs (NCPDP) Please note: the following information has not changed: Claims process Member benefits Contact information If you have any questions, please contact Provider Services. Provider Satisfaction Survey Tell Us What You Think UnitedHealthcare is committed to making sure that our services support the ability of your practice to provide the safest and highest possible quality of health care to your patients who are our members. We value and seek administrative simplicity that takes the hassles out of clinical practice and reduces inefficiency and waste. For this reason, we periodically offer our network physicians the opportunity to comment on our services. You will be receiving a survey to evaluate the services UnitedHealthcare provides to our members and you in the near future. Your opinions are important to us and will help us assess the level of satisfaction with our health plan, as well as identify opportunities for improvements so that we may better meet the needs of your practice. We appreciate your time and cooperation. Provider Directories Just a reminder, updated Provider Directories are located at A Provider Directory can be requested by contacting Customer Service at Care Management and Disease Management The Personal Care Model is a holistic approach to care for members with complex needs, especially for those with chronic conditions. The goal is to keep our members in the community with the resources necessary to maintain the highest functional status possible. What can the UnitedHealthcare Case Manager provide for your patients? Telephonic contact with members and home visits as needed Disease management programs Health education and educational materials page 3 Provider Service Center:

4 A health assessment with stratification of diagnosis and severity of condition and psychosocial needs Referrals to community resources as needed Assistance with medical transportation Arrangements for DME and ancillary services as needed or ordered by the physician Outreach to members to promote assistance with keeping doctors appointments Facilitation with members to identify and address barriers to seeking health care and to following their medical treatment plan of care Areas of Expertise Disease Management programs Diabetes CHF Asthma HIV COPD Sickle cell Special Needs Case Management (adults and children) Complex Needs Case Management Pediatrics/NICU Case Management Emergency Room Utilization Case Management Healthy First Steps Program for pregnant women (members do not have to be high risk to receive this service) How to refer For more information or to make a referral, call our referral line at ext The Medical Technology Assessment Committee (MTAC) The Committee meets at least 10 times per year. Reports from the MTAC are reviewed by the EMPC (Executive Medical Policy Committee) and recommendations are forwarded to the health plans. MTAC is responsible for the development and management of: Evidence-based position statements on selected medical technologies Assessments of the evidence supporting new and emerging technologies Evaluation of new usage of existing technologies Maintenance of externally licensed guidelines The consideration and incorporation of nationally accepted consensus statements, clinical guidelines and expert opinions into the establishment of national standards for UnitedHealth Group Ensuring that clinical decisions about the safety and efficacy of medical care are consistent across all products and businesses page 4 Provider Service Center:

5 13621 NW 12th Street Sunrise, FL Practice Matters is a periodic publication for physicians and other health care professionals and facilities in the UnitedHealthcare network. M /09 AHCA/FHK-B-N /09-08/12

QUALITY IMPROVEMENT. Molina Healthcare has defined the following goals for the QI Program:

QUALITY IMPROVEMENT. Molina Healthcare has defined the following goals for the QI Program: QUALITY IMPROVEMENT Molina Healthcare maintains an active Quality Improvement (QI) Program. The QI program provides structure and key processes to carry out our ongoing commitment to improvement of care

More information

Welcome to the Agency for Health Care Administration (AHCA) Training Presentation for Managed Medical Assistance Specialty Plans

Welcome to the Agency for Health Care Administration (AHCA) Training Presentation for Managed Medical Assistance Specialty Plans Welcome to the Agency for Health Care Administration (AHCA) Training Presentation for Managed Medical Assistance Specialty Plans The presentation will begin momentarily. Please dial in to hear audio: 1-888-670-3525

More information

ProviderReport. Managing complex care. Supporting member health.

ProviderReport. Managing complex care. Supporting member health. ProviderReport Supporting member health Managing complex care Do you have patients whose conditions need complex, coordinated care they may not be able to facilitate on their own? A care manager may be

More information

October Program/Policy Updates

October Program/Policy Updates October 2017 An An Update Update for for Highmark Highmark Health Health Options Options Providers Providers and and Clinicians Clinicians Program/Policy Updates Clinical Practice and Preventive Health

More information

Medical Management. G.2 At a Glance. G.3 Procedures Requiring Prior Authorization. G.5 How to Contact or Notify Medical Management

Medical Management. G.2 At a Glance. G.3 Procedures Requiring Prior Authorization. G.5 How to Contact or Notify Medical Management G.2 At a Glance G.3 Procedures Requiring Prior Authorization G.5 How to Contact or Notify Medical Management G.6 When to Notify Medical Management G.11 Case Management Services G.14 Special Needs Services

More information

Medical Management. G.2 At a Glance. G.2 Procedures Requiring Prior Authorization. G.3 How to Contact or Notify Medical Management

Medical Management. G.2 At a Glance. G.2 Procedures Requiring Prior Authorization. G.3 How to Contact or Notify Medical Management G.2 At a Glance G.2 Procedures Requiring Prior Authorization G.3 How to Contact or Notify G.4 When to Notify G.7 Case Management Services G.10 Special Needs Services G.12 Health Management Programs G.14

More information

Integration Workgroup: Bi-Directional Integration Behavioral Health Settings

Integration Workgroup: Bi-Directional Integration Behavioral Health Settings The Accountable Community for Health of King County Integration Workgroup: Bi-Directional Integration Behavioral Health Settings May 7, 2018 1 Integrated Whole Person Care in Community Behavioral Health

More information

Specialty Behavioral Health and Integrated Services

Specialty Behavioral Health and Integrated Services Introduction Behavioral health services that are provided within primary care clinics are important to meeting our members needs. Health Share of Oregon supports the integration of behavioral health and

More information

Healthcare Effectiveness Data and Information Set (HEDIS)

Healthcare Effectiveness Data and Information Set (HEDIS) Healthcare Effectiveness Data and Information Set (HEDIS) IlliniCare Health is a proud holder of NCQA accreditation as a managed behavioral health organization (MBHO) and prioritizes best in class performance

More information

Residential Treatment Facility TRR Tool 2016

Residential Treatment Facility TRR Tool 2016 Provider Name: Address: Provider Type: Name of Reviewer: Date of Review: Residential Treatment Facility TRR Tool 2016 Member ID Auth Dates 1 Initial Assessment Areas of Review Reference Record 1 Record

More information

Provider Information Guide Complex Care and Condition Care Overview

Provider Information Guide Complex Care and Condition Care Overview Complex and Overview Introduction Complex and are essential components of Passport Health Plan s (Passport) Coordination services, which are used to support the practitioner-patient relationship and plan

More information

Provider Treatment Record Audit Tool

Provider Treatment Record Audit Tool Provider Treatment Record Audit Tool Provider Name: Discipline: Practice Name: Solo Group Provider ID Number: Provider Location: Address: Suite: (City) Phone Number: (State) Enrollee ID: Age: Diagnosis

More information

2017 Quality Improvement Work Plan Summary

2017 Quality Improvement Work Plan Summary Project Member Service and Satisfaction Commercial Products: Commercial Project Description: To improve member service and satisfaction and increase member understanding of how the member s plan works.

More information

Section IX Special Needs & Case Management

Section IX Special Needs & Case Management Section IX Special Needs & Case Management Special Needs and Case Management 181 Integrated Health Care Management (IHCM) The Integrated Health Care Management (IHCM) program is a population-based health

More information

FREQUENTLY ASKED QUESTIONS Iowa PASRR Onsite Provider Training 10/18/ /21/2016

FREQUENTLY ASKED QUESTIONS Iowa PASRR Onsite Provider Training 10/18/ /21/2016 Below you will find the frequently asked questions for the multi location Onsite Provider Training conducted. Answers to these questions were based on knowledge and policy as of 10/18/2016. Due to policy

More information

WPS Integrated Care Management Improving health, one member at a time

WPS Integrated Care Management Improving health, one member at a time WPS Integrated Care Management Improving health, one member at a time Integrated Care Management supports and promotes member health Looking for more from your group health insurance for your employees?

More information

PRIMARY CARE PHYSICIAN MANUAL FOR BEHAVIORAL HEALTH SERVICES

PRIMARY CARE PHYSICIAN MANUAL FOR BEHAVIORAL HEALTH SERVICES PRIMARY CARE PHYSICIAN MANUAL FOR BEHAVIORAL HEALTH SERVICES Version 2013 2014 CLIENT PRIMARY CARE PHYSICIAN MANUAL SURVEY, V. 2013-2014 Dear Client Primary Care Physician: Psychcare annually distributes

More information

Model of Care Heritage Provider Network & Arizona Priority Care Model of Care 2018

Model of Care Heritage Provider Network & Arizona Priority Care Model of Care 2018 Model of Care Model of Care 2018 Learning Objectives Program participants will be able to: List two differences between the Complex Care Management (CCM), and Special Needs Program (SNP) programs. Identify

More information

Medicaid Update Special Edition Budget Highlights New York State Budget: Health Reform Highlights

Medicaid Update Special Edition Budget Highlights New York State Budget: Health Reform Highlights Page 1 of 6 New York State April 2009 Volume 25, Number 4 Medicaid Update Special Edition 2009-10 Budget Highlights David A. Paterson, Governor State of New York Richard F. Daines, M.D. Commissioner New

More information

Chapter 2 Provider Responsibilities Unit 6: Behavioral Health Care Specialists

Chapter 2 Provider Responsibilities Unit 6: Behavioral Health Care Specialists Chapter 2 Provider Responsibilities Unit 6: Health Care Specialists In This Unit Unit 6: Health Care Specialists General Information 2 Highmark s Health Programs 4 Accessibility Standards For Health Providers

More information

Special Needs Plan Model of Care Chinese Community Health Plan

Special Needs Plan Model of Care Chinese Community Health Plan Special Needs Plan Model of Care 2017 2017 Chinese Community Health Plan Elements of CCHP SNP Model of Care Special Needs Plan (SNP) Goals CCHP Dual Eligible SNP Enrollment & Eligibility Vulnerable Beneficiaries

More information

Community Counseling Centers, Inc. & North Country Health Care

Community Counseling Centers, Inc. & North Country Health Care Community Counseling Centers, Inc. & North Country Health Care Holbrook & Show Low Navajo County Communities 9/28/11 The CCC multi-faceted approach to an integrated health program with North Country Health

More information

Provider Manual. Utilization Management Care Management

Provider Manual. Utilization Management Care Management Provider Manual Utilization Management Care Management Utilization Management This section of the Manual was created to help guide you and your staff in working with Kaiser Permanente s Resource Stewardship

More information

Behavioral Health Provider Training: Program Overview & Helpful Information

Behavioral Health Provider Training: Program Overview & Helpful Information Behavioral Health Provider Training: Program Overview & Helpful Information Overview The Passport Behavioral Health Program provides members with access to a full continuum of recovery and resiliency focused

More information

VSHP/ Behavioral Health

VSHP/ Behavioral Health VSHP/ Behavioral Health Deb Dukes & Dr Kelly Askins The contact numbers in the presentation apply to WEST Member Services ONLY. New numbers for EAST Member Services will be published and distributed by

More information

Behavioral Health Provider Training: Program Overview & Helpful Information

Behavioral Health Provider Training: Program Overview & Helpful Information Behavioral Health Provider Training: Program Overview & Helpful Information Overview The Passport Behavioral Health Program provides members with access to a full continuum of recovery and resiliency focused

More information

BHS Policies and Procedures

BHS Policies and Procedures BHS Policies and Procedures City and County of San Francisco Department of Public Health San Francisco Health Network BEHAVIORAL HEALTH SERVICES 1380 Howard Street, 5th Floor San Francisco, CA 94103 415.255-3400

More information

REPORTING METRICS FOR INTEGRATION OF PHYSICAL-BEHAVIORAL HEALTH CARE

REPORTING METRICS FOR INTEGRATION OF PHYSICAL-BEHAVIORAL HEALTH CARE 9/26/213 REPORTING METRICS FOR INTEGRATION OF PHYSICAL-BEHAVIORAL HEALTH CARE MARISA DERMAN, MD, MSC (OMH) M. ASHLEY HEALD, MA (UW) OBJECTIVES FOR THIS WEBINAR Review goals/ standards Review mandatory

More information

2017 Congestive Heart Failure. Program Evaluation. Our mission is to improve the health and quality of life of our members

2017 Congestive Heart Failure. Program Evaluation. Our mission is to improve the health and quality of life of our members 2017 Congestive Heart Failure Program Evaluation Our mission is to improve the health and quality of life of our members 2017 Congestive Heart Failure Program Evaluation Program Title: Congestive Heart

More information

Breaking Down Silos of Care: Integration of Social Support Services with Health Care Delivery

Breaking Down Silos of Care: Integration of Social Support Services with Health Care Delivery Breaking Down Silos of Care: Integration of Social Support Services with Health Care Delivery Betty Shephard Lead VP, Care Management HealthCare Partners National Health Policy Forum October 19, 2012 HCP

More information

STAR+PLUS through UnitedHealthcare Community Plan

STAR+PLUS through UnitedHealthcare Community Plan STAR+PLUS through UnitedHealthcare Community Plan Optum 06012014 Who We Are United Behavioral Health (UBH) was created February 2, 1997, through a merger of U.S. Behavioral Health, Inc. (USBH) and United

More information

CMHC Healthcare Homes. The Natural Next Step

CMHC Healthcare Homes. The Natural Next Step CMHC Healthcare Homes The Natural Next Step Partners in Planning A collaborative effort involving Dept. of Social Services (Mo HealthNet) Dept. of Mental Health Primary Care Association (FQHCs) Coalition

More information

Mental Health Rehabilitation Authorization Resource Kit

Mental Health Rehabilitation Authorization Resource Kit Mental Health Rehabilitation Authorization Resource Kit CONTENTS Introduction... 2 Provider Notice 2018-27: Revised and Streamlined MHR Authorization Process... 3 Process Overview & Submission Checklist...

More information

IMPLEMENTATION OF INTEGRATED CARE FROM A LEADERSHIP PERSPECTIVE. Tennessee Primary Care Association Annual Conference October 25 26, 2012.

IMPLEMENTATION OF INTEGRATED CARE FROM A LEADERSHIP PERSPECTIVE. Tennessee Primary Care Association Annual Conference October 25 26, 2012. IMPLEMENTATION OF INTEGRATED CARE FROM A LEADERSHIP PERSPECTIVE Tennessee Primary Care Association Annual Conference October 25 26, 2012 Outline I. Brief Overview of Cherokee (Who are we?) II. The Integrated

More information

EmblemHealth Advocate for Quality

EmblemHealth Advocate for Quality EmblemHealth Advocate for Quality 2013 Average Health Care Spending per Capita, 1980 2009 Adjusted for differences in cost of living 1 Dollars Source: OECD Health Data 2011 (June 2011). THE COMMONWEALTH

More information

Behavioral Health Care

Behavioral Health Care Provider Communications MHN Behavioral Health Care PCP tools for coordinating care Tina Machi, Health Net We offer tools and resources for improving member health. Managed Health Network (MHN), Health

More information

Medicaid Funded Services Plan

Medicaid Funded Services Plan Clinical Communication Bulletin 007 To: From: All Enrollees, Stakeholders, and Providers Cham Trowell, UM Director Date: May 10, 2016 Subject: Medicaid Funded Services Plan benefit changes, State Funded

More information

New provider orientation. IAPEC December 2015

New provider orientation. IAPEC December 2015 New provider orientation IAPEC-0109-15 December 2015 Welcome 2 Agenda Introduction to Amerigroup Provider resources Preservice processes Member benefits and services Claims and billing Provider responsibilities

More information

Behavioral Health Services

Behavioral Health Services 18 Behavioral Health Services Reviewed/Revised: 10/10/2017, 02/01/2017, 02/15/2016, 08/31/2015, 09/18/2014 INTRODUCTION The State of Arizona has contracted the administration of AHCCCS mental health and

More information

Checklist for Ocean County Community Health Improvement Plan Implementation of Strategies- Activities for Ocean County Health Centers: CHEMED & OHI

Checklist for Ocean County Community Health Improvement Plan Implementation of Strategies- Activities for Ocean County Health Centers: CHEMED & OHI Checklist for Community Health Improvement Plan Implementation of Strategies- Activities for Lead Organizations Activities Target Date Progress to Date Childhood Obesity (4 Health Centers 1-Educate on

More information

FOR BCBSTX Providers Only

FOR BCBSTX Providers Only Integrated Behavioral Health Program Updates Frequently Asked Questions For BCBSTX Providers Only Blue Cross and Blue Shield of Texas (BCBSTX) will implement changes to the Behavioral Health Program*.

More information

L8: Care Management for Complex Patients: Strategies, Tools and Outcomes

L8: Care Management for Complex Patients: Strategies, Tools and Outcomes The Triple Aim 16 th Annual Summit: Institutes for Healthcare Improvement - Improving Patient Care in the Office Practice and the Community March 16, 2015 Dallas, Texas L8: Care Management for Complex

More information

Health Home Flow Hypothetical Patient Scenario

Health Home Flow Hypothetical Patient Scenario Health Home Flow Hypothetical Patient Scenario Client Background: Soozie SoonerCare Soozie is a single female, age 42, 5'6" tall 215 pounds. She smokes 2 packs of cigarettes a day. At age 24, Soozie was

More information

Benefits. Benefits Covered by UnitedHealthcare Community Plan

Benefits. Benefits Covered by UnitedHealthcare Community Plan Benefits Covered by UnitedHealthcare Community Plan As a member of UnitedHealthcare Community Plan, you are covered for the following MO HealthNet Managed Care services. (Remember to always show your current

More information

Ryan White Part A. Quality Management

Ryan White Part A. Quality Management Quality Management Mental Health Services Broward County/Fort Lauderdale Eligible Metropolitan Area (EMA) The creation of this public document is fully funded by a federal Ryan White CARE Act Part A grant

More information

April Data Jam: Tracking Progress and Facilitating Improvement with your Data Dashboard

April Data Jam: Tracking Progress and Facilitating Improvement with your Data Dashboard April Data Jam: Tracking Progress and Facilitating Improvement with your Data Dashboard Elizabeth Arend, MPH Quality Improvement Advisor National Council for Behavioral Health CMS Change Package: Primary

More information

INTEGRATION AND COORDINATION OF BEHAVIORAL HEALTH SERVICES IN PRIMARY CARE

INTEGRATION AND COORDINATION OF BEHAVIORAL HEALTH SERVICES IN PRIMARY CARE THE CENTER FOR POLICY, ADVOCACY, AND EDUCATION OF THE MENTAL HEALTH ASSOCIATION OF NEW YORK CITY INTEGRATION AND COORDINATION OF BEHAVIORAL HEALTH SERVICES IN PRIMARY CARE A Presentation at The Community

More information

The Psychiatric Shortage:

The Psychiatric Shortage: ational Council Medical Director Institute The Psychiatric Shortage: National Council Medical Causes and Solutions Director Institute Update National Council Medical Director Institute Medical directors

More information

AETNA BETTER HEALTH OF ILLINOIS Provider Newsletter June 2017, Vol. 7

AETNA BETTER HEALTH OF ILLINOIS Provider Newsletter June 2017, Vol. 7 AETNA BETTER HEALTH OF ILLINOIS Provider Newsletter June 2017, Vol. 7 www.aetnabetterhealth.com/illinois With questions or concerns, please contact Provider Services at 866-212-2851 Option 2 We heard you!

More information

Ryan White Part A Quality Management

Ryan White Part A Quality Management Quality Management Mental Health Services Broward County/Fort Lauderdale Eligible Metropolitan Area (EMA) The creation of this public document is fully funded by a federal Ryan White CARE Act Part A grant

More information

Prepaid Inpatient Health Plans (PIHP), Community Mental Health Services Programs (CMHSP)

Prepaid Inpatient Health Plans (PIHP), Community Mental Health Services Programs (CMHSP) Bulletin Michigan Department of Health and Human Services Bulletin Number: MSA 15-42 Distribution: Prepaid Inpatient Health Plans (PIHP), Community Mental Health Services Programs (CMHSP) Issued: October

More information

Provider Orientation to Magellan s Outpatient Behavioral Health Model

Provider Orientation to Magellan s Outpatient Behavioral Health Model Provider Orientation to Magellan s Outpatient Behavioral Health Model July 2017 Big-picture objectives Magellan Healthcare s outpatient care management model: Reduces provider administrative tasks Expedites

More information

Anthem Blue Cross Cal MediConnect Plan (Medicare- Medicaid Plan) Santa Clara County Behavioral Health provider training

Anthem Blue Cross Cal MediConnect Plan (Medicare- Medicaid Plan) Santa Clara County Behavioral Health provider training Anthem Blue Cross Cal MediConnect Plan (Medicare- Medicaid Plan) Santa Clara County Behavioral Health provider training Anthem Blue Cross Cal MediConnect Plan Effective January 1, 2015, Anthem Blue Cross

More information

HHW-HIPP0314 (9/13) MDwise Annual IHCP Seminar. Exclusively serving Indiana families since 1994.

HHW-HIPP0314 (9/13) MDwise Annual IHCP Seminar. Exclusively serving Indiana families since 1994. HHW-HIPP0314 (9/13) MDwise 101 2013 Annual IHCP Seminar Exclusively serving Indiana families since 1994. Agenda Indiana Health Coverage Overview MDwise Overview MDwise Hoosier Healthwise MDwise Healthy

More information

2017 Catastrophic Care. Program Evaluation. Our mission is to improve the health and quality of life of our members

2017 Catastrophic Care. Program Evaluation. Our mission is to improve the health and quality of life of our members 2017 Catastrophic Care Program Evaluation Our mission is to improve the health and quality of life of our members 2017 Catastrophic Care Program Evaluation Table of Contents Program Purpose Page 1 Goals

More information

USING PSYCKES TO SUPPORT CARE COORDINATION IN NEW YORK STATE

USING PSYCKES TO SUPPORT CARE COORDINATION IN NEW YORK STATE USING PSYCKES TO SUPPORT CARE COORDINATION IN NEW YORK STATE NYS Office of Mental Health Edith Kealey, PhD Deputy Director, PSYCKES OVERVIEW Introduction to PSYCKES: The Psychiatric Services and Clinical

More information

Molina Healthcare Michigan Health Care Services Department Phone: (855) Fax: (800)

Molina Healthcare Michigan Health Care Services Department Phone: (855) Fax: (800) Utilization Management Program Molina Healthcare of Michigan s Utilization Management (UM) program utilizes a care management approach based upon empirically validated best practices, where experience

More information

Communicator. the JUST A THOUGHT. Ensuring HEDIS-Compliant Preventive Health Services. Provider Portal Features. Peer-to-Peer Review BY DR.

Communicator. the JUST A THOUGHT. Ensuring HEDIS-Compliant Preventive Health Services. Provider Portal Features. Peer-to-Peer Review BY DR. WINTER 2016 MHS NEWSLETTER FOR PHYSICIANS Ensuring HEDIS-Compliant Preventive Health Services Here are a few best practice strategies for raising HEDIS and EPSDT onsite review scores, as demonstrated by

More information

Using Facets of Midas+ Hospital Case Management to Support Transitions of Care. Barbara Craig, Midas+ SaaS Advisor

Using Facets of Midas+ Hospital Case Management to Support Transitions of Care. Barbara Craig, Midas+ SaaS Advisor Using Facets of Midas+ Hospital Case Management to Support Transitions of Care Barbara Craig, Midas+ SaaS Advisor What does Transitional Care Include? Transitional Care is the smooth conversion of a patient

More information

Tufts Health Unify. A One Care plan (Medicare-Medicaid) for people ages March 16, /27/2017 1

Tufts Health Unify. A One Care plan (Medicare-Medicaid) for people ages March 16, /27/2017 1 Tufts Health Unify A One Care plan (Medicare-Medicaid) for people ages 21-64 March 16, 2017 3/27/2017 1 About Tufts Health Plan Founded in 1979, Tufts Health plan is a nonprofit organization nationally

More information

Solution Title: Population Health: A Paradigm Shift in how we care for Behavioral Health Patients

Solution Title: Population Health: A Paradigm Shift in how we care for Behavioral Health Patients Solution Title: Population Health: A Paradigm Shift in how we care for Behavioral Health Patients Overview of Project A drive to Population Health and changes in reimbursement have prompted the need to

More information

Utilization Management

Utilization Management Utilization Management Section J-1 Services Requiring Prior Authorizations All authorized services are subject to the member s benefit plan and eligibility at the time the service is provided. A list of

More information

Objectives. Models of Integrated Behavioral Health Care 9/23/2015

Objectives. Models of Integrated Behavioral Health Care 9/23/2015 Models of Integrated Behavioral Health Care Carlton D. Craig, Ph.D. Vernon R. Wiehe Endowed Professor in Family Violence University of Kentucky College of Social Work Carlton.craig@uky.edu (859)-257-6657

More information

THE BEST OF TIMES: PHARMACY IN AN ERA OF

THE BEST OF TIMES: PHARMACY IN AN ERA OF OBJECTIVES THE BEST OF TIMES: PHARMACY IN AN ERA OF ACCOUNTABLE CARE Toni Fera, BS, PharmD October 17, 2014 1. Describe the role of pharmacists in accountable care organizations (ACO). 2. List four key

More information

Introducing AmeriHealth Caritas Iowa

Introducing AmeriHealth Caritas Iowa Introducing AmeriHealth Caritas Iowa A presentation for Iowa providers. CPC; Q215 Iowa V1 Who We Are Who We Serve Agenda Our Mission AmeriHealth Caritas Iowa Why Partner With Us? Questions 2 2 Who We Are

More information

2015 Congestive Heart Failure. Program Evaluation. Our mission is to improve the health and quality of life of our members

2015 Congestive Heart Failure. Program Evaluation. Our mission is to improve the health and quality of life of our members 2015 Congestive Heart Failure Program Evaluation Our mission is to improve the health and quality of life of our members 2015 Congestive Heart Failure Program Evaluation Program Title: Congestive Heart

More information

Passport Advantage (HMO SNP) Model of Care Training (Providers)

Passport Advantage (HMO SNP) Model of Care Training (Providers) Passport Advantage (HMO SNP) Model of Care Training (Providers) 2018 Passport Advantage (HMO SNP) is an HMO Special Needs plan with a Medicare contract and an agreement with the Kentucky Department for

More information

SECTION 3. Behavioral Health Core Program Standards. Z. Health Home

SECTION 3. Behavioral Health Core Program Standards. Z. Health Home SECTION 3 Behavioral Health Core Program Standards Z. Health Home Description Health home is a healthcare delivery approach that focuses on the whole person and provides integrated healthcare coordination

More information

Overview. Improving Chronic Care: Integrating Mental Health and Physical Health Care in State Programs. Mental Health Spending

Overview. Improving Chronic Care: Integrating Mental Health and Physical Health Care in State Programs. Mental Health Spending Improving Chronic Care: Integrating Mental Health and Physical Health Care in State Programs Barbara Coulter Edwards bedwards@healthmanagement.com NCSL Winter CHAPS Meeting December 4, 2006 Overview Current

More information

Comprehensive Community Services (CCS) File Review Checklist Comprehensive

Comprehensive Community Services (CCS) File Review Checklist Comprehensive This is a sample form developed by the "CCS Statewide QA/QI Work Group", and is available to CCS sites as a sample for consideration of use, modification, and customization. There is no implicit or explicit

More information

4.401 Substance Use Partial Hospitalization Program (Adults and Adolescents)

4.401 Substance Use Partial Hospitalization Program (Adults and Adolescents) 4.40 STRUCTURED DAY TREATMENT SERVICES 4.401 Substance Use Partial Hospitalization Program (Adults and Adolescents) Description of Services: Substance use partial hospitalization is a nonresidential treatment

More information

Office of Mental Health Continuous Quality Improvement Initiative for Health Promotion and Care Coordination: 2013 Project Activities and

Office of Mental Health Continuous Quality Improvement Initiative for Health Promotion and Care Coordination: 2013 Project Activities and Office of Mental Health Continuous Quality Improvement Initiative for Health Promotion and Care Coordination: 2013 Project Activities and Expectations March 2013 Overview Welcome 2013 CQI Project Options

More information

2013 Summary of Benefits Humana Medicare Employer RPPO

2013 Summary of Benefits Humana Medicare Employer RPPO 2013 Summary of Benefits Employer RPPO RPPO 079/631 Loudoun County Public Schools Y0040_GHA0B4IHH13 PPO 079/631 Thank you for your interest in the Employer Regional PPO Plan. This plan is offered by Humana

More information

2016 Maryland Patient Safety Center s Call for Solutions

2016 Maryland Patient Safety Center s Call for Solutions 2016 Maryland Patient Safety Center s Call for Solutions Organization: Solution Title: Anne Arundel Medical Center Referral for Recovery Program Program/Project Description, Including Goals: What was the

More information

Project AIDS Care Waiver: Level of Need (LON) Assessment Case Management Tool

Project AIDS Care Waiver: Level of Need (LON) Assessment Case Management Tool Instructions: Identify the initial Level of Need (LON) by entering a number on the criteria that best describes the client's situation. Use the space labeled (B) for the first re-assessment, and the spaces

More information

Section 2703: State Option to Provide Health Homes for Enrollees with Chronic Conditions

Section 2703: State Option to Provide Health Homes for Enrollees with Chronic Conditions Section 2703: State Option to Provide Health Homes for Enrollees with Chronic Conditions Center for Medicaid, CHIP, and Survey & Certification Centers for Medicare & Medicaid Services Background. A goal

More information

Creating the Collaborative Care Team

Creating the Collaborative Care Team Creating the Collaborative Care Team Social Innovation Fund July 10, 2013 Social Innovation Fund Corporation for National & Community Service Federal Funder The John A. Hartford Foundation Philanthropic

More information

Healthy Aging Recommendations 2015 White House Conference on Aging

Healthy Aging Recommendations 2015 White House Conference on Aging Healthy Aging Recommendations 2015 White House Conference on Aging Chronic diseases are the leading causes of death and disability in the U.S. and account for 75% of the nation s health care spending.

More information

Care Coordination (CC) assists members and their families with complex needs

Care Coordination (CC) assists members and their families with complex needs Care Coordination (CC) assists members and their families with complex needs Care is member-centered, family-focused, and culturally competent. CC assists in locating services to meet the health and social

More information

ACOs & Chronic Care Management: Opportunities For Behavioral Health Organizations In Population Health Management

ACOs & Chronic Care Management: Opportunities For Behavioral Health Organizations In Population Health Management ACOs & Chronic Care Management: Opportunities For Behavioral Health Organizations In Population Health Management The 2017 OPEN MINDS Strategy & Innovation Institute Tuesday, June 6, 2017 11:45am 1:00pm

More information

ALL MENTAL HEALTH AND SUBSTANCE USE DISORDER PROGRAMS MUST INCLUDE PSYCHOSOCIAL AND PSYCHIATRIC EVALUATIONS

ALL MENTAL HEALTH AND SUBSTANCE USE DISORDER PROGRAMS MUST INCLUDE PSYCHOSOCIAL AND PSYCHIATRIC EVALUATIONS COUNTY of NASSAU DEPARTMENT OF HUMAN SERVICES Office of Mental Health, Chemical Dependency and Developmental Disabilities Services 60 Charles Lindbergh Boulevard, Suite 200, Uniondale, New York 11553-3687

More information

Medicaid Efficiency and Cost-Containment Strategies

Medicaid Efficiency and Cost-Containment Strategies Medicaid Efficiency and Cost-Containment Strategies Medicaid provides comprehensive health services to approximately 2 million Ohioans, including low-income children and their parents, as well as frail

More information

Ohio Non-participating. Quick Reference Guide. UHCCommunityPlan.com. Community Plan. UHC2455a_

Ohio Non-participating. Quick Reference Guide. UHCCommunityPlan.com. Community Plan. UHC2455a_ Ohio Non-participating Quick Reference Guide UHCCommunityPlan.com UHC2455a_20130610 Important Phone Numbers Administrative Office 412-858-4000 Provider Services Department 800-600-9007 Fax: 877-877-7697

More information

October 5 th & 6th, The Managed Care Technical Assistance Center of New York

October 5 th & 6th, The Managed Care Technical Assistance Center of New York October 5 th & 6th, 2015 The Managed Care Technical Assistance Center of New York What is MCTAC? MCTAC is a training, consultation, and educational resource center that offers resources to all mental health

More information

2015 Summary of Benefits

2015 Summary of Benefits 2015 Summary of Benefits Health Net Cal MediConnect Plan (Medicare-Medicaid Plan) Los Angeles County, CA H3237_2015_0291 CMS Accepted 09082014 Health Net Cal MediConnect Summary of Benefits! This is a

More information

South Dakota Health Homes Care Coordination Innovation

South Dakota Health Homes Care Coordination Innovation South Dakota Health Homes Care Coordination Innovation Senator Deb Soholt NCSL Health Innovation Task Force December 6, 2016 South Dakota Health Homes Health Homes (HH)- provide enhanced health care services

More information

Provider Evaluation of Performance. Plan. Tennessee

Provider Evaluation of Performance. Plan. Tennessee Provider Evaluation of Performance Plan Tennessee 2018 Executive Summary UnitedHealthcare Community Plan is committed to ensuring the services members receive from network providers meet the requirements

More information

Macomb County Community Mental Health Level of Care Training Manual

Macomb County Community Mental Health Level of Care Training Manual 1 Macomb County Community Mental Health Level of Care Training Manual Introduction Services to Medicaid recipients are based on medical necessity for the service and not specific diagnoses. Services may

More information

PROPOSED AMENDMENTS TO HOUSE BILL 4018

PROPOSED AMENDMENTS TO HOUSE BILL 4018 HB 01-1 (LC ) //1 (LHF/ps) Requested by Representative BUEHLER PROPOSED AMENDMENTS TO HOUSE BILL 01 1 1 1 1 On page 1 of the printed bill, line, after ORS insert.0 and. In line, delete Section and insert

More information

Table of contents Quarter 1

Table of contents Quarter 1 2016 Quarter 1 Welcome to Amerigroup Iowa, Inc. Welcome to the Amerigroup Iowa, Inc. network provider family! We are pleased you have joined our Iowa network, which consists of some of the finest health

More information

Connected Care Connected Car Program Connected Care

Connected Care Connected Car Program Connected Care Connected Care Program Connected Care Initiative to improve the connection and coordination of care for those with Serious Mental Illness among health plans, PCPs, and behavioral health providers in outpatient,

More information

EVOLENT HEALTH, LLC. Heart Failure Program Description 2017

EVOLENT HEALTH, LLC. Heart Failure Program Description 2017 EVOLENT HEALTH, LLC Heart Failure Program Description 2017 1 Evolent Health Heart Failure Program Description 2017 Table of Contents Section Page Number I. Introduction. 3 II. Program Scope. 3 III. Program

More information

Service Review Criteria

Service Review Criteria Client Name: SAR#: Administrative Review Process notes: When documenting call outs to provider, please document the call in a patient note in Alpha the day the call is made. tes should be coded as Care

More information

HEALTH HOME INTEGRATED PRIMARY AND BEHAVIORAL HEALTH CARE SERVICES

HEALTH HOME INTEGRATED PRIMARY AND BEHAVIORAL HEALTH CARE SERVICES COMPARISON OF EXISTING SERVICES AND DELIVERY MODELS WITH DEFINITIONS PRIMARY CARE CASE MANAGEMENT (PCCM) Oklahoma s PCCM program is called SoonerCare Choice (SCC), in which each enrollee is linked to a

More information

Three World Concept of Behavioral Health and Primary Care Integration Part 3 The Clinician Perspective

Three World Concept of Behavioral Health and Primary Care Integration Part 3 The Clinician Perspective Three World Concept of Behavioral Health and Primary Care Integration Part 3 The Clinician Perspective Colorado Behavioral Health Association October 3, 2010 Three World Model C. J. Peek suggests that

More information

New provider orientation

New provider orientation New provider orientation Welcome 2 Agenda Introduction to Amerigroup Provider resources Contact numbers and questions Provider responsibilities Member benefits and services Claims and billing Preservice

More information

Behavioral health provider overview

Behavioral health provider overview Behavioral health provider overview KSPEC-1890-18 February 2018 Agenda Provider manual and provider website Behavioral Health (BH) program goals Access and availability standards Care coordination and

More information

UTILIZATION MANAGEMENT Section 4. Overview The Plan s Utilization Management (UM)

UTILIZATION MANAGEMENT Section 4. Overview The Plan s Utilization Management (UM) Overview The Plan s Utilization Management (UM) Program is designed to meet contractual requirements and comply with federal regulations while providing members access to high quality, cost effective medically

More information

Using population health management tools to improve quality

Using population health management tools to improve quality Using population health management tools to improve quality Jessica Diamond, MPA, CPHQ Chief Population Health Officer CHCANYS Statewide Conference and Clinical Forum Sunday, October 18, 2015 Introduction

More information

COMPASS Workflow & Core Elements

COMPASS Workflow & Core Elements COMPASS Workflow & Core Elements Care of Mental, Physical, and Substance use Syndromes! The project described was supported by Grant Number 1C1CMS331048-01-00 from the Department of Health and Human Services,

More information