QARR/HEDIS Records Retrieval Underway Annually, Fidelis Care submits Quality Assurance Reporting Requirements/Healthcare Effectiveness Data Information Set (QARR/HEDIS) rates to the New York State Department of Health (SDOH) and to the Centers for Medicare and Medicaid Services (CMS). SDOH and CMS use the rates to evaluate the quality of care that our members receive from Fidelis Care and our providers. Retrieving medical records is an integral part of QARR. The retrieval process began in February and will continue until required submission to SDOH in June. On-site reviews are being conducted at larger facilities. Fidelis Care is grateful to our providers for the care and service you provide, and we appreciate your help and support with this effort. Medicaid Redesign Team Update: Non-Emergency Transportation Benefits Changes for Schoharie and Onondaga Counties As required by the New York State Medicaid Redesign Team, non-emergency transportation (NEMT) benefits for Medicaid members are to be phased out of managed care benefit packages, by region, in 2012. Per this requirement, as of March 1, 2012, NEMT for Fidelis Care Medicaid members in Onondaga and Schoharie counties transitioned from Fidelis Care, to fee-for-service Medicaid with Medical Answering Services (MAS). Based on the March 1 date, prior authorization requests and claims for nonemergency services for these members should be directed to MAS, at the county-specific number below. Please note that all non-emergency services for Medicaid members in Onondaga and Schoharie counties that were approved by Fidelis Care prior to March 1, 2012 for trips that occur after March 1, 2012, will be honored by MAS. MAS Contact Numbers Onondaga County 855-852-3287 Schoharie County 855-852-3290 Members are encouraged to talk their providers about their transportation needs. FIDELIS CARE PROVIDER RELATIONS AND QUALITY HEALTH CARE MANAGEMENT LEADERSHIP SANJIV SHAH, M.D. Chief Medical Officer, 718-393-6117 ROBERT WICKS, M.D. Vice President & Medical Director, 718-393-6176 CHRISTOPHER WANG, M.D. Vice President, Medical Director, 718-393-6161 JONATHAN KAPLAN, M.D. Medical Director, 718-393-6164 DAVID THOMAS Senior Vice President and Chief Administrative Officer, 718-393-6113 MARYJEAN VALIGORSKY Vice President, Provider Services, 518-445-3970 ANNE-MARIE COLELLA Director, Provider Relations, 315-434-2150 JULIE MCKAY Director, Provider Relations, 518-445-3950 MICHELLE NEVERSON Director, Provider Relations, 718-393-6671 EDINA VUKIC Director, Provider Relations, 718-393-6573 Heartbeat is published quarterly by Fidelis Care New York, the New York State Catholic Health Plan, partnering with more than 49,000 health care providers statewide. Produced by the Corporate Communications Department DARLA SKIERMONT Assistant Vice P esident, Corporate Communications and Advertising MARIA MAROTTA Manager, Advertising and Graphics PRESCRIBED Ways To Improve QARR/HEDIS Scores Provide and/or refer members for recommended and needed services. Review your quarterly report card and the member lists provided for outreach services. (Log on to Provider Access Online for your latest report card and other important QARR/HEDIS information.) Educate your patients about preventive care and routine screenings. Submit claims for delivered services (or by encounter submission), regardless of contract status. Contact members who miss or cancel scheduled appointments. Report any immunizations administered to NYSIIS and/or CIR (Citywide Immunization Registry). Invest in understanding the specifications for each QARR/HEDIS measure. Bill Fidelis Care for all services rendered using the correct CPT-4 and ICD-9 codes. Ensure timely submission of accurate claim/encounter data to reduce records review. Document all services/test results provided in medical records so that they reflect services billed. Contact the Provider Call Center at 1-888-FIDELIS (1-888-343-3547) if you have any questions related to QARR/HEDIS. Fidelis Care is here to help. 6 FIDELIS CARE PROVIDER NEWSLETTER