New Jersey Fall/Winter practicematters. For More Information. Call our Provider Services Center at Visit UHCCommunityPlan.
|
|
- Piers Washington
- 6 years ago
- Views:
Transcription
1 New Jersey Fall/Winter 2017 practicematters For More Information Call our Provider Services Center at Visit UHCCommunityPlan.com
2 In This Issue... Expansion of Dual-Eligible Special Needs Program 2017 CAHPS Member Satisfaction Scores Use of Imaging Studies with Low Back Pain HEDIS Measure for Medication Reconciliation Post-Discharge Primary Care Provider and Primary Care Dental Coordination Changes to Member Appeal Process A Reminder about Comprehensive Diabetes Care p.1 Helping Members Control Their Blood Pressure HEDIS Measures for Respiratory Conditions Guidance for Managing Antidepressant Medications Treating Members with Substance Abuse Managing Medication for People with Asthma Annual Monitoring for Patients on Persistent Medications UHCprovider.com Our New Care Provider Website Overcoming Barriers with 270/271 Eligibility and Benefits Transactions We hope you enjoy this edition of Practice Matters. In this issue, you can read about the expansion of the Dual Special Needs program, CAHPS survey results, treatment of members with substance abuse, and much more. Practice Matters: Fall/Winter 2017 Provider Services Center:
3 Expansion of Dual-Eligible Special Needs Program Beginning Jan. 1, 2018, UnitedHealthcare Dual Complete ONE, also known as Dual Special Needs Plan (D-SNP) or HMO SNP, will expand to serve members who live in Cumberland, Salem and Sussex counties. The plan had served members in Atlantic, Bergen, Burlington, Camden, Essex, Gloucester, Hudson, Hunterdon, Mercer, Middlesex, Monmouth, Morris, Ocean, Passaic, Somerset and Union counties. This fully integrated D-SNP plan better integrates coordination of care for members enrolled in Medicaid and Medicare in New Jersey. Here are a few of the plan features: Integrates all available Medicaid and Medicare managed care benefits across acute, primary, behavioral health and long-term care Submit the claim once using the Medicare ID and we ll coordinate collections from different payer sources, such as Medicare and Medicaid Preventive services at no cost to our members Reimbursement is based on your existing network agreement. Members receive a single ID card with both Medicare and Medicaid ID numbers For more information about UnitedHealthcare Dual Complete ONE, visit UHCCommunityPlan.com > For Healthcare Professionals > New Jersey > Dual Complete ONE. You ll find frequently asked questions, Quick Reference Guide and other resources related to UnitedHealthcare Dual Complete ONE CAHPS Member Satisfaction Scores UnitedHealthcare conducts an annual Consumer Assessment of Health Providers and Systems (CAHPS) Health Plan Survey to measure satisfaction with health care and the health plan quality of service. UnitedHealthcare Community Plan of New Jersey monitors member satisfaction with care and services to help make sure member interactions are working effectively and identify ways that we can improve on member satisfaction scores. The 2017 CAHPS survey results showed high overall satisfaction with customer service 88.8 percent for adults and 86.3 percent for children. Survey respondents were asked to rate their personal doctor for their children on a scale from 1-10, with 10 being a perfect score. The survey found that 86.3 percent of respondents rated their personal doctor for children an 8, 9 or 10. Adults rated their personal doctor 78.8% on a score of 8, 9 or 10. The survey also found: Overall health care scores are at 82.7 percent for adults and 73.4 percent for children. Ease of receiving care, tests or treatment increased from 78.2 percent in 2016 to 84.1 percent in Ability to receive an appointment for a checkup or routine care at a doctor s office or clinic as soon as needed also improved from 73.9 percent in 2016 to 82.1percent in 2017 for adults. A continued area of focus for 2018 is coordination of care. We re taking steps to educate specialists to share information about member test results and observation feedback with Primary Care Providers (PCPs) and encouraging PCPs to provide a comprehensive assessment to specialists when making a referral. 1
4 Use of Imaging Studies with Low Back Pain Back pain can be excruciating, and low back pain is the fifth most common reason for a physician or outpatient visit. Unless red flags are present (e.g. neurologic deficits, fever, trauma, malignancy), current recommendations are to not order imaging tests in the first four to six weeks. Studies have shown there s no clinically significant difference in patient outcomes between those who had immediate imaging versus those who had usual care, such as applying heat and taking an over-the-counter pain reliever. In addition, studies have shown that patients with occupation-related back pain who had early magnetic resonance imaging (MRI) had an eightfold increase risk of surgery. The National Committee for Quality Assurance (NCQA) has included Use of Imaging Studies for Low Back Pain as a reportable measure for the HEDIS 2018 audit. The measure will count the percentage of members with a primary diagnosis of low back pain who did not have an imaging study (x-ray, MRI, CT scan) within 28 days of diagnosis. The measure is reported as an inverted rate; a higher score indicates appropriate treatment of low back pain. For more information on imaging for back pain, go to aafp.org/patient-care/clinicalrecommendations/all/cw-back-pain.html. HEDIS Measure for Medication Reconciliation Post-Discharge As a reminder, this measure requires care providers and/ or pharmacists to review the medications prescribed to our members at an inpatient facility and compare them against the medication they were taking prior to admission. After reviewing the medication list, please include any new or discontinued medication and/or changes in dosage or frequency. The review must take place within 30 days after discharge. Medication reconciliation can help: Improve adherence to the treatment plan given Address medication errors or duplications Educate your patients on their new medications and side effects Lower the risk for adverse interactions Primary Care Provider and Primary Care Dental Coordination Continuous quality improvement is part of the UnitedHealthcare Community Plan culture. We re working to help ensure that our care providers have the information they need to help members get dental care and coordinate treatment related to dental needs. Our provider network is an essential part of our team. If a member needs dental care, the member s Primary Care Provider (PCP) should refer them to a dental provider. The referral process should include two-way communication between the referring provider and the provider receiving the referral. The Primary Care Dentist (PCD) should communicate a diagnosis and proposed treatment to the PCP and work together to achieve optimal dental health for our members. (continued on next page) 2
5 (continued from previous page) Changes to Member Appeal Process As a participating UnitedHealthcare Community Plan care provider, you may occasionally submit appeals on behalf of our members. On July 1, 2017, we altered the New Jersey Managed Care Organization member appeal process for denials of health care services to mirror changes to the federal rules. The PCP to PCD Referral Process A referral to a dentist by age 1 or soon after the eruption of the first primary tooth is mandatory and, at a minimum, a dental visit twice a year with follow up during well child visits to ensure that all needed dental preventive and treatment services are provided through age 20. PCPs can refer to any in-network pediatric or general dental provider for routine and emergency dental care for all members, regardless of age. No referral form is needed. Members are free to see any in-network dental provider. For a list of dental specialists, contact Provider Services at General dentists, as well as pediatric dentists who treat patients through age 6, may be found in the provider listing at myuhc.com: 1. Click Find a Dentist 2. Choose New Jersey from the Location drop down menu 3. Choose NJ Community Plan Medicaid/Fam Care/Medicare from the Select a Network drop down menu 4. Populate the search criteria to locate a provider The PCD should communicate a diagnosis and proposed treatment to the PCP. The PCP and PCD should work together to achieve optimal dental health for our members. Here are highlights of changes to the member appeal process: We shortened the timeframe to request an Internal (Stage 1 or Level 1) Appeal from 90 days to 60 days We eliminated the Stage 2 or Level 2 Appeal We shortened the timeframe to request an Independent Utilization Review Organization (IURO) Appeal (previously known as a Stage 3 or Level 3 Appeal) from four months to 60 days We extended the timeframe to request a Medicaid Fair Hearing from 20 days to 120 days If members need to request an appeal for a denial of a health care service, they will receive the appropriate letter from us at each stage or level of their appeal. The letters will guide them through the process, and members can call us if they have any questions. We re Here to Help If you have questions or need more information, please call Member Services at , TTY 711, 8 a.m. to 6 p.m. Easter Time, Monday through Friday. The phone number also is listed on the back of a member s ID card. For more information, go to UHCCommunityPlan.com> For Healthcare Professionals > New Jersey > Bulletins > Changes to Member Appeal Process - Effective July 1,
6 A Reminder about Comprehensive Diabetes Care Diabetes is the seventh leading cause of death in the United States. According to the Centers for Disease Control and Prevention 2014 National Diabetes Fact Sheet, 29.1 million adults in the United States have diabetes and 79 million of American adults have prediabetes, the precursor to diabetes. The rate of new cases of diagnosed diabetes in the United States has begun to fall, but the numbers are still high. Recent studies show that early detection of diabetes symptoms and treatment can decrease the chance of developing debilitating complications, including heart disease, blindness, kidney failure and lower-extremity amputations. Diabetes control and care consists of many complex components. A healthy lifestyle that includes weight management, physical activity, healthy eating should be the cornerstone of therapy for a patient with diabetes. Education for the patient should include an explanation of the disease and emphasizing how the body uses glucose and forms insulin. Patients should be informed how diabetes can cause serious health complications. When drug therapy is initiated, lifestyle initiatives should continue to help lower glucose levels and increase insulin sensitivity. HbA1c should continue to be monitored, and HbA1c testing should be done at least twice a year to determine what the average blood glucose level was for the last two to three months. Positive compliance with National Committee for Quality Assurance (NCQA) and HEDIS is < 8 and < 7 for select population. The NCQA has included Comprehensive Diabetes Care as a report measure for the Healthcare Effectiveness Data and Information Set (HEDIS ). The measure will count the percentage of members who are ages with diabetes (type 1 or Type 2) who had the following: Hemoglobin A1c control (<7 percent) Eye Exam ( retinal ) performed. Medical attention for nephropathy BP control (<140/90mm Hg) For more information, visit diabetes.org/. Helping Members Control Their Blood Pressure According to the CDC, about 75 million American adults have high blood pressure about one in three adults. It s important to educate your patients of the risk factors and physical lifestyle factors that can make them more likely to develop high blood pressure. A recommendation to control high blood pressure includes both lifestyle changes and medication therapy. NCQA has included controlling high blood pressure as a reportable measure for the HEDIS 2017 Audit. The measure focuses on the percentage of members ages who had a diagnosis of hypertension and whose blood pressure was adequately controlled during the measurement year based on the following criteria. The measure is reported as single rate and is the sum of all three groups: Members ages whose BP was <140/90 Members ages with a diagnoses of diabetes whose BP was <140/90 Members ages without a diagnoses of diabetes whose BP was < 150/90 For more information, go to cdc.gov/heartdisease/index.htm and cdc.gov/stroke/index.htm. Hemoglobin A1c testing Hemoglobin A1c poor control (>9 percent) Hemoglobin A1c control (<8 percent) 4
7 HEDIS Measures for Respiratory Conditions The CDC Antibiotic Resistance Solutions Initiative seeks to cut inappropriate prescribing of antibiotics in doctors offices by 50 percent. But many patients believe antibiotics are relatively benign and can be used to fight symptoms of an upper respiratory infection. When a member requests an antibiotic for treatment of an upper respiratory infection (URI), there s a great opportunity for education. Most care providers understand the problem of overprescribing antibiotics and do their best not to contribute to it. Yet, it s easy to underestimate how a patient or caregiver can influence the outcome of a sick visit. Being prepared with alternative strategies to manage symptoms can greatly impact the use of antibiotics by patients with adults and children with URI. Patient education on the danger of antibiotic resistance should be discussed in every sick visit. There are two measures that are counted in the yearly Healthcare Effectiveness Data and Information Set (HEDIS) audit that relate to this treatment concern: HEDIS measure URI, Appropriate Treatment for Children with Upper Respiratory Infection, includes the percentage of children, ages 3 months to 18 years old, who were given a diagnosis of URI and were not prescribed an antibiotic. This measure is reported as an inverted rate; a higher rate indicates appropriate treatment of children with URI (i.e., the proportion for whom antibiotics were not prescribed). HEDIS measure AAB, Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis, measures the percentage of adults ages with a diagnosis of acute bronchitis who were not prescribed an antibiotic. This measure is also reported as an inverted rate. A higher rate indicates appropriate treatment of adults with acute bronchitis (i.e., the proportion for whom antibiotics were not prescribed). Guidance for Managing Antidepressant Medications In the United States, approximately 20 million adults suffer from some form of a depressive disorder. Without appropriate treatment, the symptoms can last for years and lead to death by suicide or other causes. Fortunately, many people with depressive disorders can improve with the right medications. HEDIS uses a measure that assesses the percentage of adults age 18 and older with a diagnosis of major depression who were newly treated with antidepressant medication and remained on an antidepressant medication treatment. Two rates are reported for this measure: Effective Acute Phase Treatment: The percentage of members who remained on an antidepressant medication for at least 84 days (12 weeks). Effective Continuation Phase Treatment: The percentage of members who remained on an antidepressant medication for at least 180 days (6 months). (continued on next page) 5
8 (continued from previous page) adequate care. The Healthcare Effectiveness Data and Information Set (HEDIS) has developed a measure that assesses the percentage of adolescent and adult members with a new episode of AOD dependence who initiate treatment through an inpatient admission, outpatient visit, intensive outpatient encounter or partial hospitalization within 14 days of the diagnosis. The measure also assesses an engagement phase, in which those members have two or more additional services within 30 days of the initial encounter. To help you improve outcomes for this measure, please consider the following: Here s some guidance to help achieve higher quality of care for our members diagnosed with major depression: 1. Discuss all aspects of the member s medication regime and encourage questions. 2. Stress the need to continue medication even if the member is feeling better. 3. Schedule a follow-up visit to evaluate the member s status and adjust medication regime if necessary. 4. If the medication is proving effective, consider providing a 90-day supply. 5. Refer the member to a behavioral health professional when appropriate. Treating Members with Substance Abuse Research shows that substance abuse causes more deaths, illnesses and disabilities in the United States each year than any other preventable health condition. According to the National Institute of Drug Abuse, the cost of care for substance abuse has risen to over $166 billion annually. An immediate referral to a behavioral health provider (BHP) for any member with a diagnosis of AOD dependence. The treatment should be started within 14 days. If you or the member doesn t want to begin treatment with a BHP, make a follow-up appointment within 14 days of diagnosis to initiate treatment. Schedule two additional visits within 30 days of initiating treatment. Managing Medication for Members with Asthma Finding the right asthma medication for your patients will improve their condition and allow them to live a more active and normal life. To help accomplish this, we track the percentage of patients, ages 5 to 85, who were identified as having persistent asthma and were prescribed appropriate medications that they stayed on 50 percent to 75 percent of the year. You can help by monitoring these patients annually for use and compliance of their bronchodilator and corticosteroid medication. Identifying people with alcohol and other drug (AOD) disorders is an important first step to treatment, but appropriate identification does not always lead to 6
9 Annual Monitoring for Patients on Persistent Medications Glycemic control, management of hypertension and reducing dietary salt intake are essential during the care of patients with diabetic nephropathy. Careful management and control is needed to prevent the progression of kidney disease and other complications. By performing therapeutic monitoring tests, you can meet quality improvement requirements while helping these patients receive hypertensive care. Health care standards say care providers should monitor levels in the percentage of members age 18 and older who received at least 180 days of ambulatory medication therapy for a select therapeutic agent during the measurement year, as well as at least one therapeutic monitoring test for the therapeutic agent in the measurement year. Any of the following therapeutic monitoring tests meets these criteria: Members on angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB) should have a complete metabolic lab panel or a serum potassium test and a serum creatinine test. Members on digoxin should have a complete metabolic lab panel or a serum digoxin test (HEDIS specifications no longer allow a blood urea nitrogen test). Members on diuretics should have a complete metabolic lab panel or a serum potassium test and a serum creatinine test. These tests do not have to take place on the same service date, only within the measurement year. UHCprovider.com Our New Care Provider Website UHCprovider.com is your new home for the latest news, policy information and access to Link selfservice tools. You told us you wanted provider content in one place, and we heard you. The new site is the first step in bringing provider content together for your convenience, and will begin by replacing UHCWest. com, UnitedHealthcareOnline.com and the healthcare professional content on UHCCommunityPlan.com over the coming months. UHCprovider.com is available now and includes several new features: 24/7 access to the Link self-service tool dashboard A predictive search function with filtering and sorting capabilities to help you find what you need faster and easier An easy-to-read design whether you re on a desktop computer, tablet or smart phone UHCprovider.com was designed with your feedback in mind, but our job is just beginning. Tell us how we re doing by clicking the Feedback button on the right side of any page. Your suggestions will help us continue to improve so we can better meet your needs. You ll be able to access your state-specific content on UHCCommunityPlan.com until late spring Watch for additional information in the Spring 2018 edition of Practice Matters. 7
10 Overcoming Barriers with 270/271 Eligibility and Benefits Transactions UnitedHealthcare wants to help you overcome barriers to obtain member eligibility and benefits from your 270/271 Health Care Eligibility and Benefit Inquiry and Response transactions. For more information on 270/271 EDI transactions, go to UHCprovider.com > Menu > Resource Library > Electronic Data Interchange (EDI) > Electronic Transactions > EDI 270/271: Eligibility and Benefit Inquiry and Response. If you have any questions, please contact EDI Support: Our current search logic allows you to enter different criteria related to the member or patient for the eligibility and benefits inquiry transaction (270). If the information given in the request doesn t match the data in our system, you will receive an AAA code telling you what information did not match in the eligibility and benefits transaction response (271). We ve outlined suggestions to resolve errors for the most common reasons we re unable to find a match. We recommend researching the information and resubmitting a 270 transaction to help ensure your records are accurate. Verify information is accurate from the member ID card, patient records or contacting the member when receiving the following 271 responses: If you receive: AAA*Y**73*C~AAA*Y**71*C~ (Invalid or missing name and DOB) Then verify name and date of birth in your records and include member ID If you receive: AAA*Y**75: (Subscriber/insured not found) Then member has no active coverage or may not be a UnitedHealthcare member If you receive: AAA*Y**71 (Subscriber/insured birth date does not match patient database) Then check formatting of date of birth should be YYMMDD UnitedHealthcare Community Plan EDI issue reporting form or ac_edi_ops@uhc.com or
11 New Jersey practicematters Practice Matters is a quarterly publication for physicians and other health care professionals and facilities in the UnitedHealthcare network. Doc#: PCA _ UnitedHealth Group, Inc. All Rights Reserved. P.O. Box 2040 Edison, NJ 08837
UnitedHealthcare Dual Complete ONE (HMO SNP) New Jersey
UnitedHealthcare Dual Complete ONE (HMO SNP) New Jersey Agenda Overview Service Area Contracting Member ID Cards Sample Member ID Card Checking Member Enrollment Claim Submission Additional Benefits Additional
More informationCare1st Health Plan Taking Quality to the Next Level REPORTING YEAR HEDIS Summary - MPL (Measurement Year 2012)
Care1st Health Plan s Quality Improvement Department has been diligently working towards improving the Healthcare Effectiveness Data and Information Sets (HEDIS) results across all lines of business. HEDIS
More information2017 Diabetes. Program Evaluation. Our mission is to improve the health and quality of life of our members
2017 Diabetes Program Evaluation Our mission is to improve the health and quality of life of our members Diabetes Program Evaluation Program Title: Diabetes Program Evaluation Period: January 1, 2017 December
More informationArkansas Blue Cross and Blue Shield (ABCBS) Patient Centered Medical Home (PCMH) Specifications Manual
Arkansas Blue Cross and Blue Shield (ABCBS) Patient Centered Medical Home (PCMH) Specifications Manual 2017 This document is a guide to the 2017 Arkansas Blue Cross and Blue Shield Patient-Centered Medical
More information2015 Diabetes. Program Evaluation. Our mission is to improve the health and quality of life of our members
2015 Diabetes Program Evaluation Our mission is to improve the health and quality of life of our members Diabetes Care Program Evaluation Program Title: Diabetes Care Program Evaluation Period: January
More informationKey Behavioral Health Measures (18 Years and Older)
At WellCare, we value everything you do to deliver quality care for our members your patients to make sure they have a positive health care experience. That s why we ve created this easy-to-use, informative
More information2017 HEDIS Measures. PREVENTIVE SCREENING 2017 Measure Quality Indicator
PREVENTIVE SCREENING Childhood Immunization Children who turn 2 during the Adolescent Immunization Adolescents who turn 13 during the Lead Screening Children who turn 2 during the Breast Cancer Screening
More informationMEASURING CARE QUALITY
MEASURING CARE QUALITY Region December 2013 For Clinical Effectiveness of Care Measures of Performance From: Healthcare Effectiveness Data and Information Set (HEDIS ) HEDIS is a set of standardized performance
More informationPCMH 2018 Enrollment and Update August 25, 2017
PCMH 2018 Enrollment and Update August 25, 2017 Enrollment Requirements Anne Santifer HealthCare Innovations Department of Human Services 2018 Enrollment Requirements A physician practice that is enrolled
More informationHEDIS/CAHPS 101 August 13, 2012 Minnesota Measurement and Reporting Workgroup
HEDIS/CAHPS 101 Minnesota Measurement and Reporting Workgroup MNsure s Accessibility & Equal Opportunity (AEO) office can provide this information in accessible formats for individuals with disabilities.
More informationHedis Behavioral Health Measures
Hedis Behavioral Health Measures Generating better health outcomes and improving HEDIS scores is a positive outcome for everyone. Magellan Complete Care is offering support by providing the details of
More informationQuality measures desktop reference for Medicaid providers
Quality measures desktop reference for Medicaid providers providers.amerigroup.com Please note: The information provided is based on 2016 technical specifications and is subject to change based on guidance
More informationMulti-Specialty Quality Measure Information Sheet 2017
Prevention and Screening Adolescent Preventive Care Measures (APC) The percentage of adolescents 12-17 years of age who had at least one outpatient visit with a PCP or OB/ GYN practitioner during the measurement
More informationQuality measures desktop reference for Medicaid providers
Quality measures desktop reference for Medicaid providers providers.amerigroup.com Please note: The information provided is based on 2016 technical specifications and is subject to change based on guidance
More informationAsthma in New Jersey
Asthma in New Jersey County Asthma Profiles Overview The New Jersey Department of Health has designed profiles of each New Jersey County presenting asthma prevalence and asthma-related emergency department
More informationNew Jersey Department of Human Services Division of Mental Health and Addiction Services Substance Abuse Treatment State Performance Report
New Jersey Department of Human Services Substance Abuse Treatment January 1, 2016 - December 31, 2016 Prepared by: Office of Planning, Research, Evaluation and Prevention June 2017 : 1/1/2016-12/31/2016
More informationNew Jersey Department of Health Division of Mental Health and Addiction Services Substance Abuse Treatment State Performance Report
New Jersey Department of Health Substance Abuse Treatment July 1, 2016 - June 30, 2017 Prepared by: Office of Planning, Research, Evaluation and Prevention October 2017 : 07/01/2016-06/30/2017 Primary
More informationIntroduction to HEDIS 2016 Presented by the Quality Improvement Department at Gold Coast Health Plan
Introduction to HEDIS 2016 Presented by the Quality Improvement Department at Gold Coast Health Plan Ventura County s Medi-Cal Managed Care Plan Serving Ventura County since July 1, 2011 1 Contents I.
More informationMEASURING CARE QUALITY
MEASURING CARE QUALITY Region November 2016 For Clinical Effectiveness of Care Measures of Performance From: Healthcare Effectiveness Data and Information Set (HEDIS ) HEDIS is a set of standardized performance
More informationNCQA Health Insurance Plan Ratings Methodology October 2014
NCQA Health Insurance Plan Ratings Methodology October 2014 REVISION CHART Date Published December 2013 April 2014 October 2014 Description Draft version Final version Updated measure list with 50% rule
More informationStatewide Influenza Activity Levels. 0=No report/activity 1=Sporadic 2=Local 3= Regional 4=Widespread
Communicable Disease Service Influenza Activity Summary Week Ending October 3, 7 (MMWR Week 4) Influenza activity level: NO ACTIVITY No Activity- At least of 3 parameters at or below state baseline AND
More informationCommercial HMO/POS Effectiveness of Care Measure
Commercial HMO/POS Effectiveness of Care Measure HEDIS 2017 NCQA Quality Compass National Average Adult BMI Assessment 91.85% 76.17% Weight Assessment and Counseling for Nutrition and Physical Activity
More informationQuality measures desktop reference for Medicaid providers
Please note: The information provided is based on 2016 technical specifications and is subject to change based on guidance given by the National Committee for Quality Assurance (NCQA), the Centers for
More informationQuality measures desktop reference for Medicaid providers
Quality measures desktop reference for Medicaid providers Please note: The information provided is based on 2016 technical specifications and is subject to change based on guidance given by the National
More information2018 Commercial HMO/POS HEDIS 1 Results
08 Commercial HMO/POS HEDIS Results Weight Assessment & Counseling for Nutrition & Physical Activity for Children/Adolescents HEDIS 06 CY 05 HEDIS 07 CY 06 HEDIS 08 CY 07 Compass BMI Percentile 70.47%
More informationHEDIS Quick Reference Guide Updated to reflect NCQA HEDIS 2016 Technical Specifications
HEDIS Quick Reference Guide Updated to reflect NCQA HEDIS 2016 Technical Specifications Fidelis SecureCare strives to provide quality healthcare to our membership as measured through HEDIS quality metrics.
More informationKEY BEHAVIORAL MEASURES
2019 HEDIS AT-A-GLANCE: KEY BEHAVIORAL MEASURES (18 Years and Older) At WellCare, we value everything you do to deliver quality care for our members your patients to make sure they have a positive healthcare
More informationHealthcare Effectiveness Data and Information Set Quality Assurance Reporting Requirements
HEDIS/QARR Healthcare Effectiveness Data and Information Set Quality Assurance Reporting Requirements 2015 Quick Reference Guide ADULTS Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis
More informationNew Jersey Drug and Alcohol Abuse Treatment Substance Abuse Overview 2016 Statewide
New Jersey Drug and Alcohol Abuse Treatment Substance Abuse Overview 2016 Statewide Department of Human Services Division of Mental Health and Addiction Services Office of Planning, Research, Evaluation
More informationYou Can Impact HEDIS Scores. Peer-to-Peer Review
winter 2015 www.buckeyehealthplan.com Peer-to-Peer Review Buckeye Health Plan will send you and your patient written notification any time we make a decision to deny, reduce, suspend or stop coverage of
More informationEstimated HIV/AIDS Newly Diagnosed Cases In New Jersey
Introduction n As of 12/31/2009 there were more than 73,800 HIV/ AIDS cases in New Jersey including 1,353 pediatric HIV/AIDS cases. Over 4,000 children were also exposed to HIV. Over half of the cumulative
More informationChanges for Physician Measurement 2018
Changes for Physician Measurement 2018 Measure Name Guidelines for Physician Measurement Effectiveness of Care Changes Revised the Systematic Sampling Methodology to require organizations to report using
More informationGetting Started Guide Make the most of your health plan.
Getting Started Guide Make the most of your health plan. Look inside for: Getting Help Benefits Extras Getting Care 2018 United Healthcare Services, Inc. All rights reserved. CST11731 2/18 CSMI16MC3886893_000
More informationEMS Monthly Report for February, NJ Department of Health Office of Emergency Medical Services (OEMS)
EMS Monthly Report for February, 2019 NJ Department of Health Office of Emergency Medical Services (OEMS) All EMS Agency Response Times by County, in Minutes February, 2019 County 90 th Percentile Total
More informationConsensus Core Set: ACO and PCMH / Primary Care Measures Version 1.0
Consensus Core Set: ACO and PCMH / Primary Care s 0018 Controlling High Blood Pressure patients 18 to 85 years of age who had a diagnosis of hypertension (HTN) and whose blood pressure (BP) was adequately
More informationA new code for this year! G9153
SM www.bluechoicescmedicaid.com Volume 5, Issue 1 February 2017 2017 Incentive Payments: A new code for this year! G9153 The South Carolina Department of Health and Human Services (SCDHHS) has identified
More information2012 Chronic Respiratory. Program Evaluation. Our mission is to improve the health and quality of life of our members
2012 Chronic Respiratory Program Evaluation Our mission is to improve the health and quality of life of our members 2012 Chronic Respiratory Program Evaluation Program Title: Chronic Respiratory Program
More information2017 Chronic Respiratory. Program Evaluation. Our mission is to improve the health and quality of life of our members
2017 Chronic Respiratory Program Evaluation Our mission is to improve the health and quality of life of our members 2017 Chronic Respiratory Program Evaluation Program Title: Chronic Respiratory Program
More informationHealthy Tracks Program Guide (Pre-Launch Testing)
Healthy Tracks Program Guide (Pre-Launch Testing) Welcome to Healthy Tracks! Healthy Tracks is a fun, year-long program where you will have access to a state-of-the-art health and wellness portal found
More informationNew Jersey Drug and Alcohol Abuse Treatment Substance Abuse Overview 2016 Hudson County
New Jersey Drug and Alcohol Abuse Treatment Substance Abuse Overview 2016 Hudson County Department of Human Services Division of Mental Health and Addiction Services Office of Planning, Research, Evaluation
More informationHEDIS 2017 MQIC MEASURES SUMMARY LISTING FOR ANNUAL PERFORMANCE REPORTING
HEDIS 2017 MQIC MEASURES SUMMARY LISTING FOR ANNUAL PERFORMANCE REPORTING ATTENTION-DEFICIT/HYPERACTIVITY DISORDER 1. Follow-up Care for Children Prescribed ADHD Medication (ADD) Percent children newly
More informationNew Jersey Department of Health and Senior Services. Recommendations for Adult Closed Acute Care Inpatient Psychiatric Beds
JON S. CORZINE Governor DEPARTMENT OF HEALTH AND SENIOR SERVICES PO BOX 360 TRENTON, N.J. 08625-0360 www.nj.gov/health HEATHER HOWARD Commissioner TO: FROM: New Jersey State Health Planning Board New Jersey
More informationHealth HAPPEN. Make. Prepare now to stay healthy during flu season. Inside
Inside How to lower your blood pressure Make Health HAPPEN Quarter 3, 2017 www.myamerigroup.com/medicare Prepare now to stay healthy during flu season Influenza, also known as the flu, can make you feel
More informationQUALITY IMPROVEMENT Section 9
Quality Improvement Program The Plan s Quality Improvement Program serves to improve the health of its members through emphasis on health maintenance, education, diagnostic testing and treatment. The Quality
More informationHEDIS. Quick Reference Guide. For more information, visit
HEDIS Quick Reference Guide For more information, visit www.ncqa.org HEDIS Quick Reference Guide Updated to reflect NCQA HEDIS 2017 Technical Specifications Michigan Complete Health Medicare-Medicaid Plan
More informationNew Jersey Drug and Alcohol Abuse Treatment Substance Abuse Overview 2016 Passaic County
New Jersey Drug and Alcohol Abuse Treatment Substance Abuse Overview 2016 Passaic County Department of Human Services Division of Mental Health and Addiction Services Office of Planning, Research, Evaluation
More informationNew Jersey Drug and Alcohol Abuse Treatment Substance Abuse Overview 2016 Middlesex County
New Jersey Drug and Alcohol Abuse Treatment Substance Abuse Overview 2016 Middlesex County Department of Human Services Division of Mental Health and Addiction Services Office of Planning, Research, Evaluation
More informationHEDIS. Quick Reference Guide. For more information, visit
HEDIS Quick Reference Guide For more information, visit www.ncqa.org HEDIS Quick Reference Guide Updated to reflect NCQA HEDIS 2018 Technical Specifications Michigan Complete Health strives to provide
More informationNew Jersey Drug and Alcohol Abuse Treatment Substance Abuse Overview 2016 Warren County
New Jersey Drug and Alcohol Abuse Treatment Substance Abuse Overview 2016 Warren County Department of Human Services Division of Mental Health and Addiction Services Office of Planning, Research, Evaluation
More informationUnitedHealthcare NexusACO Frequently Asked Questions
UnitedHealthcare NexusACO Frequently Asked Questions Key Points There are two tiered benefit plans in UnitedHealthcare NexusACO UnitedHealthcare NexusACO R (Referrals Required) and UnitedHealthcare Nexus
More informationKey Behavioral Measures (17 Years and Younger)
2018 HEDIS At-A-Glance Key Behavioral Measures (17 Years and Younger) At WellCare/Harmony, we value everything you do to deliver quality care for our members your patients to make sure they have a positive
More informationTable of Contents. Page 2 of 20
Page 1 of 20 Table of Contents Table of Contents... 2 NMHCTOD Participants... 3 Introduction... 4 Methodology... 5 Types of Data Available... 5 Diabetes in New Mexico... 7 HEDIS Quality Indicators for
More informationKEY BEHAVIORAL MEASURES
2019 HEDIS AT-A-GLANCE: KEY BEHAVIORAL MEASURES (17 Years and Younger) At WellCare, we value everything you do to deliver quality care for our members your patients to make sure they have a positive healthcare
More informationNotification for Outpatient Injectable Chemotherapy for Medicare Advantage Plans Frequently Asked Questions
Notification for Outpatient Injectable Chemotherapy for Medicare Advantage Plans Frequently Asked Questions Key Points Physicians and facilities are required to submit notification to UnitedHealthcare
More informationSubstance Abuse Overview 2015 Passaic County
New Jersey Drug and Alcohol Abuse Treatment Substance Abuse Overview 2015 Passaic County Prepared by Limei Zhu Department of Human Services Division of Mental Health and Addiction Services Office of Planning,
More informationNew Jersey Drug and Alcohol Abuse Treatment Substance Abuse Overview 2008 Warren County
New Jersey Drug and Alcohol Abuse Treatment Substance Abuse Overview 2008 Warren County Prepared by: Department of Human Services Division of Addiction Services Office of Research, Planning, Evaluation
More information2017 HEDIS IET Measure
2017 HEDIS IET Measure Provider Education Webinar Who is MHS Health Wisconsin? MHS Health Wisconsin is one of the State s oldest Medicaid plans, created in 1984, solely to manage the healthcare of the
More informationClinical Quality Measures Summary of Upcoming Enhancements
Upcoming coding enhancements will impact the logic behind the clinical quality indicators applicable to your practice specialty. Please refer to this grid for a summary of the coding enhancements and some
More informationNew Jersey Drug and Alcohol Abuse Treatment Substance Abuse Overview 2016 Essex County
New Jersey Drug and Alcohol Abuse Treatment Substance Abuse Overview 2016 Essex County Department of Human Services Division of Mental Health and Addiction Services Office of Planning, Research, Evaluation
More informationNew Jersey Substance Abuse Monitoring System (NJ-SAMS) Substance Abuse Treatment Admissions 1/1/ /31/2013 Resident of Middlesex County
New Jersey Substance Abuse Monitoring System (NJ-SAMS) Substance Abuse Treatment Admissions 1/1/2013-12/31/2013 Resident of Middlesex County Primary Drug Highest School Grade Completed Alcohol 1,571 32%
More informationDiabetes Quality Improvement Initiative
Diabetes Quality Improvement Initiative Community Care of North Carolina 2300 Rexwoods Drive, Ste. 100 Raleigh, NC 27607 (919) 745-2350 www.communitycarenc.org 2007 Background The Clinical Directors of
More informationAbout UnitedHealthcare Dual Complete Medicare Advantage Plans. Program Highlights. Doc#: PCA _
Understanding UnitedHealthcare Dual Complete RP (Regional PPO-SNP) and UnitedHealthcare Dual Complete (HMO-SNP), offered by UnitedHealthcare Community Plan of Virginia Dual Special Needs Plans (DSNP) Key
More informationPROVIDER Newsletter. Reducing the Risk for Cardiovascular Disease. Screening for Depression JULY 2015
PROVIDER Newsletter Reducing the Risk for Cardiovascular Disease Tufts Health Plan has implemented a chronic care improvement program to identify members with congestive heart failure, to monitor and reduce
More informationSTARS SYSTEM 5 CATEGORIES
TMG STARS 2018 1 2 STARS Program Implemented in 2008 by CMS. Tool to inform beneficiaries of quality of various health plans 5-star rating system Used to adjust payments to health plans (bonus to plans
More information2012 Diabetes. Program Evaluation. Our mission is to improve the health and quality of life of our members
2012 Diabetes Program Evaluation Our mission is to improve the health and quality of life of our members Diabetes Program Evaluation Program Title: Diabetes Program Evaluation Period: January 1, 2012 December
More informationNew Jersey Drug and Alcohol Abuse Treatment Substance Abuse Overview 2016 Hunterdon County
New Jersey Drug and Alcohol Abuse Treatment Substance Abuse Overview 2016 Hunterdon County Department of Human Services Division of Mental Health and Addiction Services Office of Planning, Research, Evaluation
More informationGetting Started Guide Make the most of your health plan.
Getting Started Guide Make the most of your health plan. Look inside for: Getting Help Benefits Extras Getting Care 2018 United Healthcare Services, Inc. All rights reserved. CST18574 3/18 CSIA17MC4222749_001
More informationTotal Care Bulletin Welcome to the Magellan Complete Care Florida newsletter.
WINTER 2016 Total Care Bulletin Welcome to the Magellan Complete Care Florida newsletter. This newsletter is from your health plan, Magellan Complete Care. It has important information about getting and
More informationNew Jersey Substance Abuse Monitoring System (NJ-SAMS) Substance Abuse Treatment Admissions 1/1/ /31/2013 Resident of Union County
New Jersey Substance Abuse Monitoring System (NJ-SAMS) Substance Abuse Treatment Admissions 1/1/2013-12/31/2013 Resident of Union County Primary Drug Highest School Grade Completed Alcohol 1,024 30% Completed
More informationInfluenza Activity Level 3 ILI 5 Activity
Respiratory Virus Surveillance Report 1 New Jersey Department of Health Communicable Disease Service Week ending December 3, 217 (MMWR week 52 2 ) Week 4 Week 45 Week 5 Week 3 Week 8 Week 13 Week 18 Week
More informationSubstance Abuse Overview 2014 Cape May County
New Jersey Drug and Alcohol Abuse Treatment Substance Abuse Overview 2014 Cape May County Prepared by Limei Zhu Department of Human Services Division of Mental Health and Addiction Services Office of Planning,
More informationQuality Measures Desktop Reference for Medicaid Providers
https://providers.amerigroup.com Quality Measures Desktop Reference for Medicaid Providers Please note: The information provided is based on 2019 technical specifications and is subject to change based
More informationACO #44 Use of Imaging Studies for Low Back Pain
Measure Information Form (MIF) DATA SOURCE Medicare Claims Medicare beneficiary enrollment data MEASURE SET ID ACO #44 VERSION NUMBER AND EFFECTIVE DATE Version 1, effective 01/01/18 CMS APPROVAL DATE
More informationPreferred Care Partners. HEDIS Technical Standards
Preferred Care Partners HEDIS Technical Standards 1 HEDIS What is HEDIS HEDIS Overview Adults HEDIS Overview Pediatrics HEDIS is a registered trademark of the National Committee for Quality Assurance 2
More informationInfluenza Activity Level 3 ILI 5 Activity
Respiratory Virus Surveillance Report 1 New Jersey Department of Health Communicable Disease Service Week ending February 1, 218 (MMWR week 6 2 ) Week 4 Week 45 Week 5 Week 3 Week 8 Week 13 Week 18 Week
More information2017 Annual Report Healthcare Effectiveness Data and Information Set (HEDIS) Prepared by the Health Plan s Quality Management Department
2017 Annual Report Healthcare Effectiveness Data and Information Set (HEDIS) Prepared by the Health Plan s Quality Management Department Table of Contents Executive Summary 3 Introduction 5 Description
More informationSUMMARY TABLE OF MEASURES, PRODUCT LINES AND CHANGES
Summary Table of Measures, Product Lines and Changes 1 SUMMARY TABLE OF MEASURES, PRODUCT LINES AND CHANGES General Guidelines for Data Collection and Reporting Guidelines for Calculations and Sampling
More informationHEDIS 2014 MQIC MEASURES SUMMARY LISTING FOR ANNUAL PERFORMANCE REPORTING
HEDIS 2014 MQIC MEASURES SUMMARY LISTING FOR ANNUAL PERFORMANCE REPORTING DIABETES 1. Comprehensive Diabetes Care (CDC): Percentage of members 18-75 years of age with diabetes (type 1 and type 2) who had
More informationTrending Determinations by Measure
1100 13th Street NW, Third Floor Washington, DC 20005 phone 202.955.3500 fax 202.955.3599 www.ncqa.org TO: Interested Parties FROM: Cindy Ottone, Director, Policy DATE: March 2019 RE: HEDIS 1 2019 Measure
More information2015 Chronic Respiratory. Program Evaluation. Our mission is to improve the health and quality of life of our members
2015 Chronic Respiratory Program Evaluation Our mission is to improve the health and quality of life of our members 2015 Chronic Respiratory Program Evaluation Program Title: Chronic Respiratory Program
More informationSubstance Abuse Overview 2014 Cumberland County
New Jersey Drug and Alcohol Abuse Treatment Substance Abuse Overview 2014 Cumberland County Prepared by Limei Zhu Department of Human Services Division of Mental Health and Addiction Services Office of
More informationDivision of Mental Health and Addiction Services
Division of Mental Health and Addiction Services A DAM BUCON, LSW DMHAS Mission DMHAS, in partnership with consumers, family members, providers and other stakeholders, promotes wellness and recovery for
More informationMembership List by Agency
Membership List by Agency Strategic Direction They Represent Agency or Organization # of Representatives County Tobacco Free Living Active Living and Health Eating Increased Use of High Impact Quality
More informationAchieving Quality and Value in Chronic Care Management
The Burden of Chronic Disease One of the greatest burdens on the US healthcare system is the rapidly growing rate of chronic disease. These statistics illustrate the scope of the problem: Nearly half of
More informationQuality Care Plus 2015 Primary Care Physician Incentive Program. Now includes Medicare patients!
Quality Care Plus 2015 Primary Care Physician Incentive Program Now includes Medicare patients! Health Partners Plans (HPP) would like to express our appreciation for the invaluable role our primary care
More informationNew Jersey Drug and Alcohol Abuse Treatment Substance Abuse Overview 2017 Morris County
New Jersey Drug and Alcohol Abuse Treatment Substance Abuse Overview 2017 Morris County Department of Health Division of Mental Health and Addiction Services Office of Planning, Research, Evaluation and
More informationNew Jersey Alliance of Family Support Organizations Annual Membership Report
New Jersey Alliance of Family Support Organizations Annual Membership Report 2011-2012 Helping youth with emotional, behavioral, and mental health needs and their families 1 Why the New Jersey Alliance
More informationThe table below includes the quality measures an ACO is required to submit to CMS as a participant in an MSSP Track 3 ACO
The table below includes the quality measures an ACO is required to submit to CMS as a participant in an MSSP Track 3 ACO ACO-1 ACO-2 Getting Timely Care, Appointments, and Information How Well Your Providers
More informationHealth & Family Medicare Newsletter Fall 2010
Health & Family Medicare Newsletter Fall 2010 We are Here to Help You In This Issue We are Here to Help You pg 1 Flu Season is Here! pg 2 HIV Screening pg 3 Spark a New Healthier You! pg 4 Quality of Care
More informationProviderNews FEBRUARY
ProviderNews FEBRUARY 2017 Reminder: decimal billing required on time-based therapy codes for BadgerCare Plus members In accordance with Forward Health guidelines, Security Health Plan requires decimal
More informationKey Quality of Care Measures. Blue Cross Blue Shield of Michigan Traditional, PPO and POS Members. Fourth Quarter 2003
Key Quality of Care Measures Blue Cross Blue Shield of Michigan Traditional, PPO and POS Members Fourth Quarter 2003 Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee
More informationCOMMUNITY HEALTH GROUP HEDIS MEASURES (CY 2012) MEDICARE QUICK REFERENCE GUIDE FOR BILLING DEPARTMENT
HEDIS MEASURES (CY ) MEDICARE QUICK REFERENCE GUIDE FOR BILLING DEPARTMENT Care for Older Adults Colorectal Cancer Screening Annual Monitoring for Patients on Persistent Medications COA COL MPM Age Description
More informationKeeping your diabetes support as mobile as you are,
Millions of people have diabetes. But we at Novo Nordisk know that managing diabetes is a personal journey. That is why we created the e-book Your guide to better office visits, with valuable insights
More informationDonald K. Hallcom, Ph.D. March 13, 2014
Donald K. Hallcom, Ph.D. March 13, 2014 DMHAS Regional Coalitions Atlantic and Cape May Counties Cape Assist Bergen County The Center for Alcohol and Drug Resources Burlington County Prevention Plus Camden
More informationAdult HEDIS & STARs Measures
HEDIS AND MEDICARE STAR DOCUMENTATION & CODING GUIDE Adult HEDIS & STARs Measures Adult BMI Assessment (ABA) 18 74-year-old Antidepressant Medication Management (AMM) Breast Cancer Screening (BCS) Cervical
More informationQuick-Start Guide. UnitedHealthcare of Minnesota, North Dakota and South Dakota.
Quick-Start Guide. UnitedHealthcare of Minnesota, North Dakota and South Dakota. Welcome. Thank you for joining us! As a new payer in Minnesota, North Dakota and South Dakota, we have an extraordinary
More informationNew Jersey HIV/AIDS Epidemiologic Profile 2010
New Jersey HIV/AIDS Epidemiologic Profile 00 Estimated HIV/AIDS Cases, Deaths and Persons Living with HIV/AIDS -- New Jersey, 989-008 In 008, the latest complete year of diagnosis data, there were 350
More information