SW MI Breast & Cervical Cancer Control Navigation Program (FONDLY KNOWN AS BCCCNP)

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1 SW MI Breast & Cervical Cancer Control Navigation Program (FONDLY KNOWN AS BCCCNP)

2 Program Eligibility Age for breast/cervical screening/diagnostic/treatment services Age for breast/cervical diagnostic services No Insurance coverage or High deductible Insurance Family Income less than 250% of the poverty level Current Michigan Resident (women who plan to receive screening and diagnostic services in Michigan)

3 BCCCNP Enrollment Site Identify Patients for BCCCNP Enrollment by checking eligibility Send Next Payable Screening Dates form to the Local Coordinating Agency (LCA) to verify BCCCNP history Ensure Patient fills out Page 1 & 2 Enrollment forms and signs BCCCNP Consent form (Staff should sign as well) Completes Screening Form to document Office visit and results Fax all forms to BCCCNP LCA within 48 hrs. of Office visit

4 BCCCNP Forms Next Payable Screening Dates Form Enrollment pages 1 & 2 BCCCNP Consent Form BCCCNP Screening Form Referral & Authorization Form

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6 Enrollment Page 1 Documents Patient Eligibility SSN used for billing (or request billing ID) Provide a copy of any insurance card

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8 Enrollment Page 2 Documents Abnormal/cancer history to determine screening protocol

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10 BCCCNP Consent Form Important that patient & Staff sign Consent form Provides information about BCCCNP protocol In effect one year from date signed

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12 Screening Form Screening form documents office visit and results Breast & Cervical Protocol built in to form Example: Abnormal Breast exam-need 2 diagnostic follow-ups

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14 Referral & Authorization Form Use to identify client as BCCCNP for referrals Payment Authorization

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16 All BCCCNP forms can be found on our spotlight on section at:

17 BCCCNP Medical Protocol and Reimbursement info can be found at:

18 Focus on: MAMMOGRAM SCREENING Women enrolled in BCCCNP Age Normal CBE = Screening Mammogram

19 ABNORMAL BREAST EXAM = DIAGNOSIS WITHIN 60 DAYS ABNORMAL CERVICAL EXAM/PAP TEST = DIAGNOSIS WITHIN 90 DAYS

20 Breast Biopsy Process Remind patient of signed Consent info on what is paid and not paid Professional & Facility fees are paid by BCCCNP to Participating Providers Guide patient to apply for financial assistance If Cancer is diagnosed, refer to LCA to apply for BCCPTP Medicaid

21 Pap Protocol (ASCCP guidelines) EFFECTIVE DATE 10/1/2012 REVISED 7/2014

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23 BCCPTP Medicaid Meet BCCCNP eligibility requirements with NO creditable health insurance for Treatment Current Michigan Resident US Citizen or proof of residency Newly diagnosed with breast/cervical cancer and needs to begin treatment NEW: Currently on HMP Medicaid and receiving treatment for breast/cervical cancer can apply for BCCPTP Medicaid

24 Genetic Counseling & BRCA Testing Genetic counseling & BRCA testing is done on a case by case basis. Age yrs, female, <250% FPL, and insurance does not cover genetic testing. Contact BCCCNP Local Coordinating Agency for referral assistance.

25 BCCCNP Wrap-Around Grant Eligibility: WOMEN ANY AGE & MEN WHO CANNOT GET INTO BCCCNP SYMPTOMS OR FAMILY HISTORY REQUIRED FOR PATIENTS UNDER AGE 40 NO INSURANCE COVERAGE OR HIGH DEDUCTIBLE Eligibility: FAMILY INCOME LESS THAN 250% OF THE POVERTY LEVEL RESIDENT OF MICHIGAN Services Provided: CLINICAL BREAST EXAM, SCREENING MAMMOGRAM DIAGNOSTIC SERVICES SPECIFIC TO BREAST CANCER BCCCNP MEDICAID APPLICATION AVAILABLE TO WOMEN WHO MEET BCCCNP ELIGIBILITY, RECENTLY DIAGNOSED BREAST CANCER & NEED TREATMENT

26 Billing & Reimbursement WHAT S NEW: CDC FEDERAL GRANT YEARS ARE FUNDED JUNE TO JUNE. WE MUST CHANGE OUR CLAIM SUBMISSION DEADLINE TO COINCIDE WITH CDC S FISCAL YEAR. DATES WILL REMAIN FIRM AND NO EXCEPTIONS WILL BE GRANTED. WHAT THIS MEANS: CLAIMS WITH DOS 10/1/16 6/30/17 ARE DUE TO MDHHS BY 8/1/17. ANY CLAIMS RECEIVED AFTER 8/1/17 WILL BE REJECTED, INCLUDING CLAIMS AWAITING PRIMARY INSURANCE EOB S. CLAIMS WITH DOS 7/1/17 6/30/18 ARE DUE TO MDHHS BY 8/1/18. ANY CLAIMS RECEIVED AFTER 8/1/17 WILL BE REJECTED, INCLUDING CLAIMS AWAITING PRIMARY INSURANCE EOB S.

27 BILLING & REIMBURSEMENT INFORMATION IS AVAILABLE AT Rate Schedules ICD 10 Codes Revenue Codes Paper & Electronic Claims Submission Guide Procedure Code Reference Chart Billing & Reimbursement Guides Place of Service Codes Hold Codes Questions: Call MDCH contact: Tory or Doneyt@Michigan.gov

28 NAVIGATION WHY FOCUS ON PATIENT NAVIGATION? Introducing: Community Health Worker

29 Navigation to fill the gap. Even though women now have insurance for screening services, women are not receiving screening services that they need. Why???

30 Community Partnerships

31 Thank you for all you do for women in SW Michigan! YOUR LCA STAFF: TAMMY, KATHY