Staff Newsletter #19 IEHP Now Covers Care for Autism Spectrum Disorder Page 3 New Prior Authorization Forms Page 4 What's New with the Flu Page 5 Summer Fall 2014 2012 New Online Features Enhance the Initial Health Assessment Roster To better assist you in getting new IEHP patients in for their Initial Health Assessments (IHA), IEHP updated the IHA roster page on our Provider website. The new IHA roster page, which was called the 120 Days Assessment, now includes: A new field for the Date of Birth of each patient An Assessment Due date to be calculated based on the Effective Date of the Member To access the.dated updated page, visit our secure Provider website at www.iehp.org,.ect select Eligibility & Rosters and then click on Initial Health.sessmen Assessment. When you review your Initial Health Assessment (IHA) roster each month for new IEHP patients, you can help improve the care they receive and stay in compliance with the Department of Health Care Services (DHCS). That s because DHCS requires that all newly enrolled Medi-Cal Members must receive an IHA within Continued on page 2...
Have You Implemented the New Staying Healthy Assessment? What Changed? As of April 2014, physicians are responsible for administering the Staying Healthy Assessment (SHA) to all Medi-Cal Managed Care patients during their Initial Health Assessment (IHA) and well care visit. The SHA consists of seven age-specific pediatric questionnaires and two adult questionnaires, which seek to help identify, track and ultimately treat high-risk behaviors in patients. What You Need to Do If you haven t already, IEHP is requesting physicians to complete mandatory training on how to administer the Stay Healthy Assessment to your patients as soon as possible. To access the training resources, visit IEHP s website at www.iehp.org/goto/staying-healthy. On this page you can also access the SHA questionnaires in nine languages. Don't forget to fax in the Proof of Training Form to 909-890-2968 once the training has been completed. Continued from page 1... New Online Features Enhance the Initial Health Assessment Roster 60 days of enrollment for Members 18 months and under, or within 120 days of enrollment for Members over 18 months of age. As your partner in providing care, IEHP appreciates your commitment to ensuring your IEHP patients get the care they need. Quick Tip: Set a Reminder If your office uses Microsoft Outlook or a similar program for email, set a recurring reminder to review the IHA roster page at the beginning of each month. Then you can schedule appointments.as needed. 2
IEHP Now Covers Care for Autism Spectrum Disorder As of September 15, 2014 IEHP provides new benefits for your Medi-Cal patients (up to age 21) with Autism Spectrum Disorder (ASD). What is Autism Spectrum Disorder? ASD is a group of disorders in brain development. It affects one s language and social skills. In other words, it disturbs how one relates to the world and people around him or her. The spectrum refers to the degree of difficulty and impact people may have because of ASD. Who can get this new benefit? Medi-Cal Members with ASD up to age 21 who also meet these criteria: Display an excess amount of certain behaviors or lack of social responses. These behaviors must interfere with activities at home or in the community. Are stable not in need of 24-hour medical or nursing monitoring, or procedures (in a hospital or other care facility for those with intellectual disabilities). Have a complete exam that shows Behavioral Health Therapy (BHT) services are medically necessary. These services also must be recognized as being medically sound. Get a prescription for services from a licensed Doctor, surgeon or licensed psychologist..what the new benefits cover: Review of health and development history Diagnosis and treatment Behavioral Health Treatment (BHT) if medically necessary 3
Change Affecting Prior Authorization Form for Medi-Cal & Healthy Kids What s Changed? Your physician writes many prescriptions, and some of them may require a pharmacy exception request to be completed. In January 2015, new regulations from the California Department of Managed Health Care will take effect for Medi-Cal members, requiring physicians to use a new Prescription Drug Authorization Request Form Form 61-211. This change does not affect Medicare members who are enrolled in IEHP DualChoice Cal MediConnect Plan and Medicare DualChoice (HMO SNP) Plan. Please note, IEHP will require the new California Prescription Drug Authorization Request Form beginning November 3, 2014, for members of Medi-Cal and Healthy Kids. What You Need to Know Physicians in your office MUST use this new Prescription Drug Authorization Request Form for prior authorization requests. IEHP will only accept this form to process PER requests. Other forms submitted will not be accepted or processed. DMHC also requires health plans and insurers to review the completed Prescription Drug Prior Authorization Requests and make a determination of coverage within one day of receipt. IEHP will deny PER requests if the new form.s is not filled out completely or does not include all the ẹe information necessary to make a sound determination..mination How to Help Your Physician Visit the IEHP Formulary page on our Provider website or more information and resources like the Formulary Tool. Encourage your physician to E-prescribe, use electronic requests, or utilize formulary medications. When a non-formulary drug is needed, physicians can submit a California Prescription Drug Authorization Request Form directly to IEHP. Don t wait until the last minute. Start preparing now for the changes ahead and help your physician stay in compliance. IEHP Secure Provider Site: Are We Compatible? You support your physician, and your office, in so many ways. And one of the best tools at your disposal is IEHP s secure Provider website at www.iehp.org. To ensure that you can always access us online, your operating systems and browsers must be compatible. IEHP is currently in the development phase to expand compatibility of our secure site to accommodate more systems and browsers. For now, please use the following quick-reference guide: Operating Systems: Compatible Windows XP Windows 7 Windows 8/8.1 Internet Browsers Not Compatible Mac: Apple OS X (any version) Compatible Not Compatible Mozilla Firefox 12 and up Internet Explorer 9 and below Internet Explorer 10 & 11 (enable Compatibility View) Google Chrome Firefox (any version below 12) Safari (any version) If you re unsure how to check your operating system or browser: Visit http://ww3.iehp.org/en/providers and click on the link for our Guide for Operating System and Browser Compatibility. 4
Want to Get Claims Paid Accurately and On Time? Use the new CMS-1500. As of April 2014, IEHP no longer accepts CMS-1500 claim form version 08/05. Please use the revised version (02/12), updated to prepare for the implementation of the ICD-10 provisions on October 1, 2015. 3 The revised CMS-1500 claim version (02/12) has had several modifications that, if not addressed, may result in claim denials or improper payment. If you haven t already, please notify your billing department and your clearing house (if you file electronic claims) about these important changes.. For a sample of the updated form and the CMS 1500 Reference Instruction Manual, visit the IEHP website at www.iehp.org and click on For Providers then click on Forms." What s New with the Flu? Here are the 2014-2015 flu vaccination recommendations as published by the Advisory Committee on Immunization Practices (ACIP): Everyone 6 months old or older. Children between 6 months and 8 years of age may need two doses of flu vaccine (administered a minimum of 4 weeks apart) to be fully protected. Doctors should offer the vaccine to all patients at any visit (not just well visits), as long as he or she does not have the contraindicated illness. Vaccination is also especially important for people at high risk for serious flu complications, and their close contacts, such as: Pregnant women Children younger than 5 (especially children younger than 2 years old) Adults 65 years of age or older People with certain chronic medical conditions, such as diabetes and asthma Reimbursement: VFC (Vaccines for Children) eligible children, ages 6 months to 18 years IEHP will reimburse physicians the cost of the vaccine for IEHP Medi-Cal (over 18 years old), Healthy Kids, IEHP Medicare DualChoice (HMO SNP) and IEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid Plan) Members. Don t forget to submit completed CMS 1500 claim forms with the correct CPT code to: IEHP Claims Dept P.O. Box 4349 Rancho Cucamonga, CA 91729-4349 For more information and resources, please visit www.iehp.org and click on For Providers then Flu Updates. 5
IEHP Scrub of the Month Crystal Herrera has one of those smiles that make everyone smile, especially the patients at Dr. Ronald Becker s office in Murietta where she s worked as a Medical Assistant for about a year. Nominate a co-worker Crystal Herrera While she usually focuses on the front office, Crystal is smart and versatile enough to assist with the back office, medical records, eligibility and check-out as well. In fact, it was her willingness to go above and beyond that most impressed Ruby Larson, a co-worker and friend, who nominated Crystal. Crystal loves children, Ruby told us. And, when she s not at work, she enjoys going on outings, shopping and cooking. Ruby also revealed a good reason why Crystal may be smiling so much at work these days: she s expecting her first child! Congratulations are definitely due to Crystal Herrera, the IEHP Scrub of the Month. Do you work with a winner? A hard worker who.htens brightens your office with kindness, inspiring your team to do its best? Tell us why: Write your reason why you think this person should be Scrub of the Month. Keep it under 500 words. If you give us the best reason, we ll give you and your co-worker a $50 Target gift card. Send your name, office location and work phone number. Fax, mail or e-mail your entry: Fax: (909) 890-5652. On cover sheet, write ScrubTalk - Scrub of the Month Nomination. Mail: IEHP ScrubTalk - Scrub of the Month Nomination, P.O. Box 1800, Rancho Cucamonga, CA 91729-1800 E-mail: providerservices@iehp.org ASK Susie Q. Dear Susie, When I check for Medicare/ Medi-Cal Member eligibility, how should I interpret the Member s eligibility when their ID number ends with with a 00 versus a 01? A. Enter the first 12 digits of the Member s ID, leaving off the 00 or 01. The verification that shows online will be the Member s primary eligibility with IEHP. For example, if you type a Member s ID who has Medicare with IEHP as well as Medi-Cal, you will see the Member s Plan showing as Medicare as well as the effective date with Medi-Cal. Remember, you can easily check eligibility for up to 10 IEHP Members at once at www.iehp.org. When you do, be sure to review what lab and urgent care the Member should access. We also have the Member s medical history, so you can see the most recent prescriptions, hospital visits and lab results. Ask Susie about IEHP procedures or programs: Call (909) 890-2054. Fax to Ask Susie at (909) 890-5652. Email: providerservices@iehp.org 6
Cultural Corner Support Your Doctor and Empower Your Patients Many patients say they leave the Doctor s office without fully understanding what they need to do. A great way to support your Doctor, and avoid this challenge, is to provide clear instructions to your patients before they leave the office. This could involve discussing topics from medicines and vaccines, to helping with referrals and getting lab tests done or even just scheduling follow-up visits. Based on the patient s needs, try to anticipate the challenges he or she may face once they leave the office, and then address those concerns. Remember, when your patients know exactly what they need to do to comply with their treatment plan, they: tend to feel more satisfied with the visit and less likely to want to change Doctors; are less likely to miss appointments or make repeated calls to the office for clarification; and are less likely to make mistakes that could lead to emergencies or physical harm. Most importantly, when patients are informed, your Doctor can feel more confident that they are following the treatment plan and getting the care they need. Fun, Free, Educational Events For You and Your Kids Summer is over and the kids.ck are back to school, but that doesn t mean the fun has to end. Here are some great fall activities.or for you and your kids to enjoy on the weekends. Most public libraries in the Inland.Empire offer free story times for children. Many offer free reading programs, workshops, movies, children's theater, puppet shows and more. In San Bernardino County, check out www.sbclib.org for libraries near you. In Riverside County, visit goo.gl/bdqpj Many museums in the Inland Empire are free for children under 12. Other museums have special days and times during the day when admission is free for adults as well. For museums in your area, visit goo.gl/r99kfm Did you know that hardware stores like Home Depot and Lowe s offer free workshops for kids? For Home Depot events, check out homedepot.com and search "workshops" For Lowe s workshops, visit lowesbuildandgrow.com The Inland Empire offers great opportunities for star gazing. For a list of 7 great places in your area, visit kcet.org and search "star gazing inland empire" 7
P.O Box 1800 Rancho Cucamonga, CA 91729-1800 Staff Newsletter 2014 Inland Empire Health Plan. All Rights Reserved. PS-14-00419 IEHP Expands Behavioral Health Benefits Behavioral Health Providers IEHP has expanded treatment benefits to Medi-Cal patients with mild to moderate behavioral health conditions, as of January 1, 2014. Here s how the expansion may affect you: You will continue to receive referrals from the County to treat Medi-Cal patients who meet Specialty Mental Health Criteria." If you are not working with the County Mental Health department you will receive Medi-Cal referrals from IEHP for Members who do not meet Specialty Mental Health Criteria. IEHP will directly authorize and pay you for treating Medi-Cal patients who do not qualify for services from the County Mental Health department for IEHP. Please schedule new IEHP Medi-Cal referrals the same as you would Medicare DualChoice referrals. Substance Abuse treatment for Medi-Cal patients will continue to be provided through the County Drug Medi-Cal program. Here's how screening works: The IEHP Behavioral Health (BH) Care Management Team will screen patients and refer only those who do not need Specialty Mental Health services. However, you may occasionally evaluate a patient with a more severe mental health condition who meets Specialty Mental Health criteria. If so, please document the patient s Specialty Mental Health condition on your initial Coordination of Care Web form and call the IEHP Care Management Team to transition the patient to the appropriate County mental health program. Your authorization will cover the treatment you provide until the patient is fully transitioned. Assessment.IEHP is pleased to offer a full range of behavioral.h health services to our Medi-Cal and Medicare.M Members. Please call the BH Care Management Team at 909-890-2362 for more information or questions. Moving Your Office? Please give the IEHP Provider Relations Team (and your IPA) a 60-day notice. Member notification is required by State agencies. Your IEHP patients will be notified, so they can keep receiving their medical care. Questions? Ideas? Reach Your Provider Relations Team at (909) 890-2054 Fax: (909) 890-5652