New Reminder Alerts added to Online Member Health Records

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1 Physician Newsletter, Issue #15 Winter 2011 New Reminder Alerts added to Online Member Health Records To help you provide care for your IEHP patients, we ve added new Reminder Alerts to the Online Member Health Record. With these additions you ll get more detailed information on your IEHP patients preventive care needs and health conditions. What you should know before you administer the flu vaccine Page 2 What s New: The new Reminder Alerts will notify you when your IEHP patients are due for a mammogram screening. For those patients with Diabetes you ll receive a Reminder Alert if they need a retinal eye exam. Other Alerts: These new Reminder Alerts are in addition to our current alerts for preventive health services, such as immunizations, pap tests and well-child or DualChoice annual visits. You ll continue to see alerts if an IEHP Case Manager is assigned to your patient, and your patients health conditions and levels, like Diabetes or Asthma. For your patients under the age of 21, an alert will notify you if they have CCS. How to better serve seniors and people with disabilities Page 4 See why your diabetic patients need retinal exams Page 4 How Alerts help you: Besides keeping track of patient health and preventive care services, using the Reminder Alerts can help to improve care coordination. With real-time access to your IEHP patients information you get a comprehensive understanding of what they need. What else you can view: Our comprehensive Provider Online Services has several tools to support you. Providers can submit claims electronically and choose to get paid directly through an electronic fund transfer (EFT), check eligibility, medical history, claims, authorization status, remittance advice (RAs), Behavioral Health visits and submit a health education referral. How to access Reminder Alerts: 1. Go to the Secure Provider Website Login 2. Click on Eligibility 3. Select by SSN/CIN or by IEHP ID or by Last Name 4. Enter the SSN/CIN or IEHP ID or Last Name then click submit 5. Click on View Medical History on the eligibility screen to see the Reminder Alerts

2 Facts to know before administering flu vaccine For the flu season, the recommendations for using the influenza vaccine remain unchanged, according to the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices (ACIP). However, consider these points from the CDC/ACIP: 1. Routine flu vaccination: Recommended for all adults and children 6 months of age and older. 2. Children: Those 6 months-8 years old require two doses of influenza vaccine administered a minimum of four weeks apart during their first season of vaccination to optimize immune response. In a study of children 5-8 years old who received trivalent inactivated vaccine (TIV) for the first time, the proportion of children with protective antibody responses was much higher after two doses than after one. 3. Flu strains: The seasonal flu vaccine virus strains in the U.S. are the same as those in the vaccine. These include A/California/7/2009 (H1N1)-like, A/Perth/16/2009 (H3N2)- like, and B/Brisbane/60/2008-like antigens. The influenza A (H1N1) vaccine virus strain derives from a 2009 pandemic influenza A (H1N1). 4. Allergic reactions: Allergy to eggs must be distinguished from allergy to influenza vaccine. Severe allergic and anaphylactic reactions can occur in response to a number of influenza vaccine components. However, such reactions are rare. Adverse events in adults: Four deaths caused by anahylaxis following influenza vaccine from were reported to the Vaccine Adverse Events Reporting System (VAERS). The vaccine components potentially responsible for these reactions were never reported. Regardless of the component suspected to be responsible, a prior severe allergic reaction to influenza vaccine is a contraindication to receipt of influenza vaccine. Vaccine choice for persons age 65 and older: As with other influenza vaccines for , Fluzone High-Dose will contain the three recommended virus strains (A/California/7/2009 (H1N1)-like, A/Perth/16/2009 (H3N2)-like, and B/Brisbane/60/2008-like antigens). ACIP recommends all persons aged 65 and over get an inactivated seasonal influenza vaccination. However, ACIP has yet to express a preference for Fluzone High-Dose or any other inactivated influenza vaccine for use in persons aged 65 or older. It is unknown whether the higher post vaccination immune responses observed among fluzone High- Dose vaccine recipients will results in greater protection against influenza illness. High-dose vaccine should not be given to anyone under 65. IEHP criteria for using LAIV and intradermal vaccine: There are no recommendations for prioritization of LAIV or intradermal vaccine use. When considering vaccination of healthy, non-pregnant persons for the appropriate age group, ACIP has expressed no preference for LAIV, intradermal or TIV. In most cases, Providers should use TIV over LAIV or intradermal. Reimbursement: Eligible children age 6 months - 18 years should get a flu vaccine via the Vaccine for Children (VFC) program. IEHP will reimburse practitioners cost of the vaccine for members of IEHP Medi-Cal (over 18 years), Healthy Families, Healthy Kids, Medicare DualChoice (HMO SNP). Dr. William Henning Chief Medical Officer A healthy dose of patient data You expect instant data in today s plugged-in world. That s why we offer you our Provider online services, a one-stop resource of information about your IEHP patients. Look over their health records, check eligibility, see lab reports and more. It s all shared securely and accessible in real time anywhere there s an internet connection. Read more on the front page. The website alerts you, so you can remind your IEHP patients it s time for health preventive care appointments. On this page, find out what you should know before you administer the flu shot...eye exams are crucial for diabetic patients. Find out why in on page 4. 2

3 IEHP Medi-cal (over 18 year old), Healthy Families, Healthy Kids CPT Code Drug name & dose Reimbursement Rate* Vaccine Fluzone 0.25mL $13.80 Influenza virus vaccine, split virus, preservative free, 6-35 months dosage, (single dose) Alfuria 0.5mL, Fluzone 0.5mL, Fluarix 0.5mL, Fluvirin 0.5mL $12.97 Influenza virus vaccine, split virus, preservative free, 3 yrs and above dosage, (single dose) Fluzone 0.25mL $13.80 Influenza virus vaccine, split virus, 6-35 months dosage, for Alfuria 0.5mL, Fluzone 0.5mL, Fluarix 0.5mL,** Fluvirin 0.5mL** $11.60 Influenza virus vaccine, split Fluzone High Dose $27.83 Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for *Cost as of August 2011 (WHolesale Acquisition Cost (WAC) +5%) **FluLaval and Agriflu are indicated for >18 years old IEHP Medicare DualChoice (HMO-SNP) (Part B covered vaccine) Medicare Code Drug name & dose Reimbursement Rate* Vaccine Q2035 Alfuria $11.54 Influenza virus vaccine, split Q2036 Flulaval $8.78 Influenza virus vaccine, split Q2037 Fluvirin $13.65 Influenza virus vaccine, split Q2038 Fluzone $13.06 Influenza virus vaccine, split Q2039 NOS (Not otherwise $13.03 Influenza virus vaccine, split specified. virus, preservative free, enhanced immunogenicity via increased antigen content, for Fluzone High Dose $30.92 Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for *Rate subject ot change based on Medicare payment schedule Reimbursement to practioners: To receive reiumbursement, submit completed CMS1500 claim form with correct CPT code to IEHP Claims Dept., P.O. Box 10129, San Bernardino, CA Go to the IEHP Provider website for a complete list of CDC/ACIP points. For more information regarding influenza, suveillance, prevention, detection and control, go to 3

4 How to better serve seniors and people with disabilities With more seniors and people with disabilities (SPDs) becoming IEHP members, you can polish, update and strengthen your abilities to serve them through our training program. IEHP teaches the vital skills you need to successfully serve and care for this growing segment of our membership who will be seeking out your services. Our training covers Communication, Ways to Make Your Office More Accessible, Local Disability Resources, plus the latest changes in Medi-Cal. What you gain: Develop a fresh perspective on serving people with disabilities Improve the physician-patient relationship Learn how to interact with people with disabilities Make SPDs feel more welcomed by making your office more accessible Lean how to comply with the requirements set by the American with Disabilities Act IEHP provides you this training online or on site. For details, call the Provider Services Team. Changes in claims, encounters for which affects claims and encounter submissions will replace 4010 as the primary healthcare data-sharing format among Providers and health plans nationwide. The change takes effect January 1, The change moves healthcare providers towards adopting ICD-10 which will replace all ICD-9 diagnosis codes in fall of Tips to using 5010: On all claims and encounters, use your correct NPI (Provider identifier) Except for the pay-to address, use a Billing Provider Address (a physical address) only. Remind coders and claims/encounter vendors to use the right address on claims and encounter forms. When reporting Billing Provider and Service Facility locations, use a 9-digit zip code. To find the 4-digit extension to your standard zip code, go to action For more on 5010, go to Providers/Information+Resources/HandbooksandManuals/EDIManual.htm Why your diabetic patients need eye exams Diabetes is the leading cause of new cases of blindness for adults ages 20-74, according to the Center for Disease Control (CDC). Almost all patients with Type 1 diabetes and most of those with Type 2 diabetes, the most common type, will someday experience signs of retinopathy. However, a retinal or dilated eye exam may detect retinopathy before vision loss becomes untreatable. All IEHP members diagnosed with diabetes qualify for a retinal or dilated exam annually. No referral is needed. How you can help: Remind your diabetic IEHP patients to get an eye exam from any IEHP optometrist. How to find an IEHP Optometrist: Direct your IEHP patients to the IEHP website. Under Find a Doctor, there are 183 optometrists to choose from all over the Inland Empire. As an option, your IEHP patients can call IEHP Member Services for assistance. The visit: No prior authorization from a PCP is needed for one visit within a 12-month period. With the patient in the office, the staff of the optometrist calls IEHP to authorize the visit. Then the optometrist can perform the screening exam after authorization. 4

5 The IEHP Care Management Team More seniors and people with disabilities are joining IEHP. This growing segment includes people with multiple chronic conditions like diabetes, obesity and even behavioral health issues. To serve them, we use a coordinated, multidisciplinary approach that looks at the whole person. Our Care Management Team provides tools and resources to help you improve the quality of care and the efficiency of resource use for people with complex health care needs. 1. Health Management Program Who is it for? IEHP high-risk pregnant members and those with asthma or diabetes. How it works: Through encounters, claims, pharmacy data and referrals, we identify members with asthma, diabetes or high-risk pregnancy. These members automatically become eligible for Health Management Programs but can opt out of the program. When your patients sign up for the Health Management program, they receive: A nurse to discuss any problems or questions regarding their condition Educational information for their specific health condition An individualized Care Plan that supports their personal self-management goals Resources from IEHP (or the community) to enhance their health How it benefits you: You get access to a personal Care Plan for your IEHP patients, plus updates on their progress and health conditions. When one of your IEHP patients enroll in the program, we send you a copy of their Personal Care Plan to review. 2. Complex Care Management This department has a program to help you manage your IEHP patients complex healthcare needs. Who is it for? Any IEHP patient with complex care needs. How it works: With you, we coordinate care and services for your IEHP patients, the specialist, any community agencies, and/or the patients caregivers. The CCM staff works with you, the patients and/or their caregiver to develop a care plan and sends you a copy of the plan to review with your patient. How it benefits you: You spend less time planning and coordinating your patients care. Instead, you have more time to treat them. You know their needs are being met. 3. Model of Care Who is it for? IEHP Medicare DualChoice (HMO SNP) members. How it works: To coordinate services, the IEHP Care Management Team works with you, your patients (and any caregivers), specialists and outside community agencies. After conducting a health risk assessment, we stratify your patient into a low, moderate or high risk level. Then we develop a care plan. A care manager focuses on what the patient needs now or for the short and long term. Whether your IEHP patient transitions from home to hospital, transferred to a nursing facility or sent home, a nurse informs the patient of any change in their care plan. We encourage patients to share their discharge instructions with you. How it benefits you: It helps prevent critical care situations by advocating for patients. As a result, we promote healthy lifestyles while reducing costly care. How to refer an IEHP patient: call Provider Relations (909)

6 PO Box San Bernardino, CA Physician Newsletter How the IEDC complements patient care For seniors and people with disabilities (SPD), navigating services and resources from different organizations across a large geographic region can be overwhelming. You can help your IEHP SPD patients find the resources they need through the Inland Empire Disabilities Collaborative (IEDC). What it is: It brings together 324 communitybased organizations that provide services for seniors and people with disabilities. Launched in 2006, the IEDC is powered by a partnership between IEHP, PossAbilities of Loma Linda University, and Rolling Start, Inc. How it works: By joining forces these organizations make it easier for seniors and people with disabilities to receive the full scope of available services from resources located throughout the Inland Empire. Available resources: Housing Transportation Advocacy Employment Education Assistive technology Healthcare Other services The benefits: Your patients receive services that enhance independent living, which can have a positive impact on both their physical and mental health. The IEDC also hosts periodic events, including the Disability Resources Expo, which benefit the community at large. How to contact the IEDC: Voice for TTY users info@iedisabilitiescollaborative.org IEHP Enrollment As of November 2011 Medi-Cal...464,681 Healthy Families...57,153 Healthy Kids...4,464 Medicare DualChoice (HMO SNP)...6,094 Total...532,392 Questions? Provider Relations Phone: (909) Fax: (909) ProviderServices@iehp.org 2011 Inland Empire Health Plan All Rights Reserved. MK