11/10/2016. Meridian Health Plan. Care. Above All Else. MiMGMA s Third Party Payer Day

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1 MiMGMA s Third Party Payer Day Educational Conference 2016 Meridian Health Plan Our Mission: To continuously improve the quality of care in a low resource environment We are: Family-owned and operated, treating our employees, members and providers like our own Dedicated to making a difference through quality, innovative technology, member and provider satisfaction Vision: To be the premier service organization in government healthcare The be the #1 health organization based on quality, innovative technology and service to our Meridian Family Meridian is the only multi-state plan in the nation to receive an overall rating of 4 out of 5 for all three Medicaid HMO products Meridian Health Plan of Michigan and Meridian Health Plan of Illinois 2 Care. Above All Else 3 1

2 Why Meridian? We re one of the fastest growing groups of health plans in the country! We make preventive care a priority with our management programs and HEDIS Bonus Incentives. More than 850,000 members and 45,000 providers in MI, IL, OH, IN & KY 4 Meridian Programs MEDICAID: Provides healthcare services to Medicaid beneficiaries in all 68 counties in Michigan s lower peninsula based on the State of Michigan s Medicaid benefit guidelines. What services does Meridian manage? TANF, ABAD, CSHCS, MI Child MICHILD: Provides healthcare services to uninsured children of working families in Michigan. MERIDIAN CHOICE: A federal Health Insurance Marketplace Qualified Health Plan (QHP) which offers individual and family plans in the Catastrophic, Bronze, Silver and Gold categories through the Marketplace Service Area: Kalamazoo, Van Buren and Calhoun (Bronson Network) & Genesee and Lapeer (Meridian Network) HEALTHY MICHIGAN PLAN: Part of Medicaid expansion, provides care to eligible Michigan residents who have an income at or below 133% of the federal poverty level. 5 Meridian Programs MAPD-SNP: Medicare Advantage Prescription Drug Dual Special Needs Plan for people who have both Medicare and Medicaid. This plan provides members with Part A, Part B and Part D prescription drug benefits and includes additional benefits not covered by Original Medicare. What services does Meridian manage? SNP: Medicaid and Medicare services MAPD: Medicare Advantage Prescription Drug Plan in Michigan and Illinois. MAPDs are a type of Medicare health plan that provide Part A, Part B and Part D prescription drug benefits and include additional benefits that are not covered by Original Medicare. MI HEALTH LINK: Integrates managed care for individuals living in Region 4 who are eligible for both Medicare and Medicaid under one plan. What services does Meridian manage? MI Health Link: Medicaid, Medicare and Waiver services What services does Meridian manage? Medicare: Medicare services 6 2

3 Choose Meridian Choice (HIX) Meridian Choice Individual and family plans o Available through the Health Insurance Marketplace Low prices, better plan options and personalized service o Currently developing incentives for participation with Healthy Measures In 2018, Healthy Michigan Plan members will be allowed to enter the exchange. Meridian's goal is to retain membership and offer a similar plan on the exchange for ease of transition and use Meridian has a great need to network in all areas of Michigan in order to prepare for this growth 7 Community Events Host Healthy Events with Meridian! Back to school physicals Health fairs Mammogram events Baby showers Giveaways! Educational materials/brochures Meridian swag Meridian advocate onsite Raffles 8 Community Projects Meridian Winter Blast Donated $7,500 and more than 13,000 lbs. of food and children s books were raised in the event Meridian donated an additional $40,000 to assist children in Flint affected by the water crisis 9 3

4 Community Projects Flint Water Crisis Unlimited lead testing for all Meridian members o Completed by: blood draw, finger or heel poke Every Wednesday, the MDHHS holds telephonic meetings discussing updates with the action plans of the Crisis by Chief Medical Executive, Eden Wells Fueling Food For Flint o Food giveaways (12 million lbs. of food was donated through September!) o Foods high in calcium, iron and vitamin C to help reduce lead levels in the body Health Education Days o Food demonstrations o Complimentary water filter cartridges o Nutritionist o Bottled water o Physician educational seminars HEDIS Bonus Program For in-network Primary Care Providers (PCP) HEDIS services provided between 1/1/16 and 12/31/16 o Must be delivered in strict accordance with HEDIS guidelines o Generous incentives based on HEDIS measures ranging from $5 to $200 o Paid over $8 million in HEDIS incentives in 2015 Incentives paid in four installments: April 2016 July 2016 October 2016 March 2017 Monthly reports hand-delivered each month by PNDRs o Reports also available online through our secure Provider Portal 11 Healthy Michigan Plan Health Risk Assessment (HRA) The member is responsible for two part completions and the provider is responsible for one part completion Identifies special healthcare needs through a broad range of health issues and behaviors o Nutrition, alcohol/substance/tobacco abuse, mental health, chronic medical conditions, vaccinations Members are qualified for two incentives depending upon their income level: $50 Gift Card 50% reduction in copays and premiums 12 4

5 Healthy Michigan Plan Encouraged to complete HRA during initial visit, within 60 days of enrollment Health Risk Survey Submissions Copay Requirements o Meridian collects member copays, so the provider is not responsible for collection 13 How To Get HEDIS Hits Submission of Claims Fastest, most efficient Electronic Health Record (EHR) uploads Supplemental Data o Provider Portal o Internal supplemental data o Medical Record Data Entry from provider faxes, notify HEDIS Abstraction applications 14 Meridian Health Plan Support Contracted with a Medical Record Abstraction team to verify HEDIS completion Dedicated Provider Network Development Representative (PNDR) Hand-delivered reports to individual provider office locations Other Meridian support Free HEDIS reminder postcards for members Reminder phone calls Customized monthly reports Self-reporting online* *Please note: medical record documentation must be faxed to

6 Emergency Room Prevention Refer patients to community resources Review literature and office materials with patients Have open availability for sick visits Join Meridian's Patient-Centered Medical Home (PCMH) program Educate patients on proper ED utilization Strengthen patient access to PCPs and improve data sharing 16 Transportation Smoking Cessation o New beginnings Weight Management o Weight Watchers (Medicaid, Healthy Michigan Plan, Choice) Community Health Outreach Worker (CHOW) o Face-to-face or telephonic collaborations with members and family to assist with treatment interventions to prevent acute care readmissions Care Coordination o Assigned individual Care Coordinator to help manage their health needs and to help identify services and resources members may qualify for Member Programs 17 Care Coordination Focused on the individualized needs of the member Target populations: o Medical o Maternity: Pregnant members o High-ER: High Emergency Room utilizers o CSHCS: Children s Special Health Care Services o Medicare: Medicare enrolled members ICT Meeting Provider participation Benefits higher risk members to ensure the best Plan of Care is put in place for the member Utilized for Medicare members 18 6

7 Member Benefit 24/7 Nurse Advice Line Program: Telephonic Nurse Advice Line (NAL) MI: Electronic Health Information Portal Chat with a nurse or submit questions through the member portal: May Claims Meridian s preferred submission method is electronically through clearinghouses or via the online Provider Portal: Providers are responsible for ensuring that they receive a confirmation file for the claims submitted through Electronic Data Interchange (EDI) Contact your PNDRs for Payer ID # /Clearinghouses Electronic Funds Transfer (EFT) Contact your local PNDR for more information 20 Authorizations Provider Portal Submission - Preferred Method Ability to attach clinical information at initial request of submission Speeds up authorization process Reduces fax volume Eliminates faxing issues Fax Submission Authorization form can be found on our website at Select for Providers Prior Auth Fax Form 21 7

8 Authorizations 22 Authorizations 23 Provider Annual Training Navigate to: Select Our Plans Select Michigan Select Medicare Click Meridian Advantage Plan Providers Click Training and Education 24 8

9 Provider Directory Navigate to: Select For Providers Select Provider Search Choose State and Plan 25 Provider Directory 26 MeridianRx Website Features: Portal Login: 1. Formulary access 2. View & submit authorizations 3. See options for generic alternatives 4. View dosage requirements View participating prescribers Submit a medication appeal View pharmacy pricing Meridian members can locate the nearest pharmacy using our MeridianRx Mobile App 27 9

10 Electronic Authorization Submission Ability to attach clinical information No need to sign in to the Portal Submission for Appeals & Exceptions in the same form MeridianRx 28 Meridian Provider Manual Contains updates and helpful information Member Rights and Responsibilities Provider Rights and Responsibilities Online access at Click on Provider Resources on the top navigation menu, select Provider Manual and download the most current version For a paper or CD copy, please contact your local PNDR 29 Verify eligibility for ANY Meridian member Obtain service counts Enter/view authorizations Print enrollment and HEDIS Bonus* information HEDIS self-reporting View historical information for Meridian members Claims status and submission/correction Print remittance advice And much more! *Please note: medical record documentation must be faxed to

11 Training and User Guide 31 The best way to verify Medicare member eligibility is to call Meridian toll free at: OR for Medicaid members: Utilize the Provider Portal login at: *Medicaid-eligible members only 32 Eligibility Enter member ID# or search by name and DOB Select date range Submit 33 11

12 Eligibility 34 View Member Information 35 View Provider Information 36 12

13 View Provider Information 37 View Vendor Information 38 QUESTIONS?? 11/10/