NEWS July Clinical Practice & Preventive Health Guidelines. Community Outreach Events

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1 NEWS July 2015 Provider Satisfaction Survey Clinical Practice & Preventive Health Guidelines Molina Healthcare of Illinois (Molina) adopts Clinical Practice and Preventive Health guidelines to ensure Providers have up-to-date information to deliver quality, cost-effective and evidence-based care to Members. These guidelines are based upon recommendations by nationally recognized organizations and are used to assist practitioners in determining what is covered by Molina. Clinical Practice Guidelines: providers/il/medicaid/resource/pages/clinical.aspx Preventive Health Guidelines: providers/il/medicaid/resource/pages/prevent.aspx Community Outreach Events Molina hosts and participates in health education and preventive care-focused events to improve the health outcomes of Molina Members, potential Members, and the communities Molina serves. Molina Community Outreach and Care Management staff partner with Providers and community-based organizations to ensure consumers can make informed decisions concerning their health care and health care for their family members. To partner with Molina in hosting one of these events, please contact your Provider Services Representative. Upcoming events include: Healthy Living Expo (Seniors and Families) Bloomington July 2 Molina Health & Resource Fair (Seniors and Families) East St. Louis July 8 Molina Community Health and Wellness Fair (Seniors and Families) Springfield July 9 4th Annual Mammogram-A-Thon (Women) Peoria July 17 Older Adult Health Council Summer Health Fair (Seniors) Granite City July 22 Community Child Care Connection Health Fair (Families) Springfield July 24 Senior Lifestyle Event (Seniors) East Peoria July 25 Belleville Chamber Back 2 School Event (Families) Belleville July 28 Earlier this year, Molina conducted a Provider Satisfaction Survey to remain well-informed about Provider needs. The survey concentrated on a variety of subjects, including: customer service, Provider relations, Provider network, continuity/coordination of care, utilization/case management, claims, pharmacy and drug benefits, and overall satisfaction and loyalty. Molina will use results to develop new Provider initiatives. HCC Pearls Molina s HCC Pearls program focuses on the coding and documentation rules (Hierarchical Condition Category HCC) applied by the Centers for Medicare and Medicaid Services (CMS). HCC Pearls are concise tips for effectively and easily identifying, coding, and documenting the health status of your patients. Included in this month s packet are: Chronic Respiratory Failure Dialysis Additional HCC Pearls can be found at: il/duals/comm/pages/hcc-pearls.aspx No Balance Billing As a reminder, Providers are prohibited, per Illinois Department of Healthcare and Family Services (HFS) guidelines, from balance billing Molina Members for covered services. If you have questions as it relates to Molina, please contact your Provider Services Representative. July National Health Observances Cord Blood Awareness Month Juvenile Arthritis Awareness Month PS1506.2

2 HEDIS Hints Health Plan Effectiveness Data and Information Set (HEDIS ): Set of standardized measures developed by NCQA Molina will educate Providers monthly on new HEDIS measures, and July s focus is on Adult Access to Preventive/Ambulatory Health Services (AAP). The AAP table below provides the Primary Care Physician (PCP) with the appropriate billing codes to use when seeing patients 20 years and older who had an Ambulatory or Preventive Care visit during the measurement year. These codes ensure that Providers capture the correct data for the AAP HEDIS measure. Value Set Description CPT ICD-9-CM Diagnosis UB Revenue Office or other outpatient services , , Home services , x, , , 0982, 0983 Ambulatory Visits Other Ambulatory Visits Preventive medicine General medical examination Domiciliary, rest home or custodial care services , , , 99411, 99412, 99420, , V70.0, V70.3, V70.5, V70.6, V70.8, V70.9 How to Improve HEDIS Scores HEDIS results are the measurement standard for many of Molina s clinical quality improvement activities and health improvement programs. Improving these scores means improving clinical outcomes for Molina Members. Use appropriate billing codes as referenced above. Educate patients on the importance of having at least one Ambulatory or Preventive Care visit during each calendar year. Contact patients on the missing services list who have not had a Preventive or Ambulatory health visit. Look into offering expanded office hours to increase access to care. Make reminder calls to patients who have appointments to decrease no-show rates. Pregnancy Notification Form Molina has revised its Pregnancy Notification Form (PNF), which provides Molina with valuable information in identifying pregnant Members. Attached are the PNF and corresponding memo. For additional information, please contact your Provider Services Representative or call (855)

3 June 15, 2015 Provider Memorandum Updated Pregnancy Notification Form Molina Healthcare of Illinois (Molina) has revised its Pregnancy Notification Form (PNF). The PNF provides Molina with valuable information to assist in identifying pregnant Members and ensuring they receive the timely prenatal and postpartum care needed. Providers should complete the form for all pregnant Molina Members and fax to Molina s Quality Improvement Department. A copy of the attached PNF is also available on Molina s Provider website at: PNF Submission Process Complete all Member information. Complete the Provider Information section with the name of the OB/GYN to whom the Member was referred for prenatal care. Fax the PNF to Molina s Quality Improvement Department at (866) If you have any questions, please contact Provider Services at (855) Representatives are available Monday through Friday, 8 a.m. to 5 p.m. You may also visit our website at to learn more about Molina Healthcare. Q1506.9

4 Pregnancy Notification Form Molina Healthcare of Illinois Urgent - Time Sensitive Today s Date: Upon confirmation of a positive pregnancy test, please complete the form and fax toll free to (866) If you have questions or need assistance, please call (855) Member Information Member s Name: Member ID: Member s DOB: Preferred Language: Phone #: ( ) Alternate Phone #: ( ) Address: City: State: Zip: Last Menstrual Period (LMP): Estimated Date of Confinement (EDC): IPA Name: Current Pregnancy q Hypertension q Pre-term labor q Diabetes q Multiple Gestation q Smoking q Excessive Nausea & Vomiting q No problems with current pregnancy q Other: High Risk Condition(s) Past Pregnancy Provider Information q N/A q Hypertension q Diabetes q Pre-term labor q Pre-term delivery q No problems with past pregnancy q Other: Practitioner s Name: Practitioner s Address: Practitioner s Phone Number: Date of First Prenatal Appointment Scheduled/Completed: Referred to OB/GYN Practitioner: Referred OB/GYN Practitioner Phone #: ( ) Molina Healthcare of Illinois 1520 Kensington Road - Suite 212 Oak Brook, IL IL0515 Q

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