What s New. Don t Forget! There are 2 different influenza vaccines available. Flu Vaccine. Michigan Newsletter Fall 2009

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1 What s New Michigan Newsletter Fall 2009 Flu Vaccine Don t Forget! There are 2 different influenza vaccines available this year (one for seasonal flu and one for Novel H1N1 or swine flu). Both vaccines may be given to your patients if indicated. To free up refrigerator space in your office, you may want to begin immunizing patients with the seasonal flu vaccine. The latest information from the CDC indicates that the Novel H1N1 vaccine should be available around the middle of October. In This Issue Flu Vaccine pg 1 6 New Counties pg 1 Benefits of Molina Healthcare pg 2 Lead Alert pg 3 Payment Updates pg 3 Coordination of Care pg 4 How to Stop Fraud and Abuse pg 5 Well Child Visits pg 6 H1N1 (Swine Flu) Vaccination pg 6 Care for Older Adults pg 7 Contact Information pg 8 Molina Healthcare Gains 6 New Counties Effective October 1, 2009! We are pleased to announce Molina Healthcare will provide coverage in six new counties effective October 1, The six new counties, Alpena, Antrim, Grand Traverse, Kalkaska, Lapeer and Washtenaw increase our service area to 46 counties in Michigan. We want to welcome our new providers to the network and look forward to partnering with you and to provide quality care to Molina Healthcare Members. We would like to take this opportunity to share with all of our providers how your participation in Molina Healthcare is a benefit to you and your patients. MolinaHealthcare.com 1

2 What s New Fall 2009 Michigan The Benefits of Molina Healthcare Competitive PCP Contracts You are paid for performance through: Bill Aboves (payment above capitation for immunizations and well child care) HEDIS bonuses CDPS bonuses Administrative bonuses eportal- Our Online Provider Services Application Status claims Verify eligibility View HEDIS Missed Services Reports Locate a provider Process Service Requests Contact your Provider Services Representative to maximize your pay for performance bonuses Contact your Provider Services Representative to sign up today! No Referrals Needed Molina Healthcare members may get care from a participating Specialist without a referral from your office Experienced Provider Services Representatives dedicated to your success Free non-emergent transportation for your Molina Healthcare patients to medical appointments and pharmacy Health and Wellness Programs Molina supports your outreach efforts to bring patients in for needed well child visits, immunizations, mammograms and more! No Co-pays for your Molina Patients You can provide your Molina Patients with over the counter medications just by writing a prescription Case Management Nurses We ll help you manage your complex cases Molina is financially stable. We always pay capitation in full and on time Sadly, Molina Healthcare will no longer provide coverage to Medicaid recipients residing in St. Clair and Tuscola counties. 2 MolinaHealthcare.com

3 Michigan Fall 2009 What s New Lead Alert! Molina Healthcare supports the Michigan Department of Community Health (MDCH) Childhood Lead Poisoning Prevention Program. In an effort to increase the number of children tested for lead before the age of 2, Molina Healthcare now pays for lead testing performed in the physician s office. This service will be paid fee-for-service at Medicaid fee screens to all providers. Providers are no longer required to use a JVHL laboratory for lead testing. This includes: Lead Blood Draw Test (Venipuncture) Lead Capillary Blood Draw (Finger Stick) Please use procedure code 83655* when billing for both tests Providers are encouraged to report lead test results through the MDCH Childhood Lead Poisoning Prevention Program. Providers who do not perform lead testing in the office may still utilize JVHL laboratories. JVHL will report the lead test result to MDCH. For LeadCare and LeadCare II user information and forms, please contact Courtney Pendleton from the MDCH Childhood Lead Poisoning Prevention Program at Please contact Molina Healthcare s Provider Services Department with questions about this program or other programs. Provider Services can be reached at , ext *Please use current and accurate procedure codes when billing for services. Molina Medicare Program Payment Updates Molina Medicare contracted providers that are paid under the Inpatient Prospective Payment System (IPPS) and the Outpatient Prospective Payment System (OPPS) will see a change in their remittance advices (RA) effective 8/1/2009. Line items that are not separately payable will appear on the RA as a zero pay line. These services are not separately payable or not covered under IPPS and/ or OPPS. A remit message stating the claim was paid according to the specific prospective payment system will appear on the RA. MolinaHealthcare.com 3

4 What s New Fall 2009 Michigan Coordination of Care during Planned and Unplanned Transitions for Molina Medicare Program Members Molina Medicare is dedicated to providing quality care for our Medicare members during planned or unplanned transitions. A transition is when members move from one setting to another, such as when a Molina Medicare member is discharged from a hospital. By working together with providers, Molina Medicare makes a special effort to coordinate care during transitions. This coordination of specific aspects of the member s transition is performed to avoid potential adverse outcomes. To ease the challenge of coordinating patient care, Molina Medicare has resources to assist you. Our Utilization Management nurses and Member Services staff are available to work with all parties to ensure appropriate care. In order to appropriately coordinate care, Molina Medicare will need the following information in writing from the facility within one business day of the transition from one setting to another: Initial notification of admission within 24 hours of the admission Discharge plan when the member is transferred to another setting A copy of the member s discharge instructions when discharged to home This information can be faxed to Molina Medicare at To assist with the discharge planning of Molina Medicare members, please note the following important phone numbers: Medicare Member Services & Pharmacy Behavioral health services and substance abuse treatment for Molina Medicare members can be arranged by contacting CompCare at Transportation services for Molina Medicare Options Plus Members may be arranged by calling MTM at The Nurse Advice Line is available to members 24 hours a day, 7 days a week at Important information you need to know about Molina Medicare Options Plus: All beneficiaries have rights that are defined in our provider manual. They are also available in the member EOC posted on our website at www. molinamedicare.com. Molina Medicare Options Plus members have Medicare and Medicaid benefits designed to meet their special needs, therefore the state agency or its designated health plans have the responsibility for coordinating care, benefits and co-payments. Please be aware of your patients status & Medicaid benefits and bill the correct entity. Health plans and providers can never charge these members more than they would have paid under Original Medicare and Medicaid. Members can also call the Medicaid agency for details and have specific rights with regard to their Medicaid benefits. Providers are responsible for verifying eligibility and obtaining approval for services that require prior authorization as outlined in the Provider contract. Our Medicare Member Services department can assist you in this regard. Please contact the UM Department at or Medicare Member Services if you have questions regarding planned or unplanned transitions. 4 MolinaHealthcare.com

5 What s New Fall 2009 Michigan How Can You Help Stop Health Care Fraud & Abuse? Health care fraud is rising higher and higher every year. Molina and Federal Agencies are working together to help prevent fraud and abuse. Health care fraud takes money from health care programs, which leaves less money for true medical care. What should providers do to assist Molina with its compliance efforts? Exhibit ethical and professional behavior when providing services to Molina members. Ensure billing practices are truthful. Only bill for services that were provided and medically necessary. Notify MOLINA immediately of any concerns about member or provider fraud and abuse. By working together we can make a difference. If you suspect fraud report it today, through one of the following ways: Molina Healthcare of Michigan Attn: Compliance Director 100 W. Big Beaver, Ste. 600 Troy, MI Phone (248) MHMcompliance@MolinaHealthcare.com Or contact the: Michigan Department of Community Health (MDCH), Attn: Program Investigation Unit, Capitol Commons Center Building, 400 South Pine, 6th Floor, Lansing, MI Phone (866) All reports will be thoroughly investigated and verified instances will be reported to the proper authorities. MolinaHealthcare.com 5

6 What s New Fall 2009 Michigan Well Child Visits Just a reminder during this back to school time of the year, when you are performing the well child visit, we encourage you to provide the service, at the point of contact with the member. You do not need to wait for the anniversary date to perform a well child visit. Members 3 17 years of age are only allowed one well child visit for reimbursement per calendar year. Please bill with the following codes: Well Child Visit CPT and Immunizations Immunization Administration Immunizations are to be given in accordance with HEDIS guidelines Molina Healthcare Will Pay Administration Fees for H1N1 (Swine Flu) Vaccination Molina Healthcare will automatically cover the cost of administration of the H1N1 (Swine Flu) vaccine for its members during the flu season. The federal government has indicated it will provide the H1N1 vaccine at no cost, which is why Blues coverage focuses on the administration of the vaccine shots. Good Health from Molina Healthcare! 6 MolinaHealthcare.com

7 Michigan Fall 2009 What s New Molina Medicare Program Requirement: Care for Older Adults HEDIS Measure Many adults over the age of 65 have co-morbidities which often affect his or her quality of life. As this population ages, it s not uncommon to see decreased physical function and cognitive ability, and increase in pain. Regular assessment of these additional health aspects can help to ensure this population s needs are appropriately met. Advance care planning Discussion regarding treatment preferences, such as advance directives should start early before patient is seriously ill. Medication review All medications that the patient is taking should be reviewed, including prescription and over the counter medications or herbal therapies. Functional status assessment This can include assessments, such as functional independence or loss of independent performance. Pain screening - A screening may comprise of notation of the presence or absence of pain. Including these components into your standard well care practice for older adults can help to identify ailments that can often go unrecognized and increase his or her quality of life. MolinaHealthcare.com 7

8 409 E. Jefferson Ave., Suite 600 Detroit, MI Member Name Address City, St Zip Molina Healthcare Contact Information The following is a list of contact information to assist you in making the appropriate contact with the Service Departments of Molina Healthcare. Claims Status Inquiry , Option 1 then 2 CompCare (Behavioral Health Benefit) Eligibility Member Services Option 1 then 2 Interactive Voice Response (IVR) Option 1 then 1 eportal (Provider Self Services)... Netwerkes.com... Fraud and Abuse Prevention Fax Number March Vision Pharmacy Services , Option 1 then 5 Fax Number Compliance Hotline Compliance address... Molina Healthcarecompliance@molinahealthcare.com Provider Services , Option 1, then 7 Utilization Management , Option 1, then 4 Fax Number MolinaHealthcare.com 5884MI0909