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Iowa | Winter 2017

Practice Matters: IA - Winter 2017 Provider Services Center: 888-650-3462

Important information for health care professionals and facilities

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In This Issue...• Our Response to the Opioid Epidemic

• Overcoming Barriers with 270/271 Eligibility and Benefits Transactions

• Reminder for Reporting Critical Incidents

• Help Members Save Out-of-Pocket Costs by Completing Health Risk Assessments

• Goals for 27 Measures Exceeded in HEDIS Survey

• Recommendations for Members with Back Pain

• Establishment of Satisfaction Requirements for Home and Vehicle Modifications

• Guidelines for Discharging Home- and Community-Based Waiver Members

• Cultural Competency’s Critical Role in Health Care

• Peer Support Services No Longer Require Prior Authorization

• Check Out Our New Care Provider Website – UHCprovider.com

We hope you enjoy the winter edition of Practice Matters. In this issue, you can read about our response to the opioid epidemic, reporting critical incidents, the new care provider website – UHCprovider.com, and much more.

Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33681 Practice Matters: IA - Winter 2017 Provider Services Center: 888-650-34621

Important information for health care professionals and facilities

Our Response to the Opioid Epidemic By – Kellyann Light-McGroary, MD Chief Medical Officer

The opioid epidemic is front and center as a challenge and an opportunity for clinical practices. For some, the depth and breadth of this topic can be overwhelming – “What is my responsibility as a care provider, what are the goals and where are my resources?” As a partner in health care, I want to give you some insight to our approach to address the opioid epidemic.

The United States is responsible for about 80 percent of the opioids prescribed worldwide, and we have seen a significant rise in mortality and morbidity across the country. Iowa is certainly not immune to this reality. Sales for opioids have quadrupled in the last 18 years. Meanwhile, the number of opioid-associated deaths has surpassed motor vehicle accidents as the leading cause of accidental death in the U.S. Prescription opioids have served as the gateway drug for about four of five heroin addicts when their supply ran out or they couldn’t afford the price of the opioid. This is truly one of the greatest health crises of our time.

The main goal in the fight against opioid abuse is prevention – and ensuring that care providers are focused on the right treatment for the right patient at the right time with a clear understanding of associated risks and potential alternatives. UnitedHealthcare is committed to working with all care providers to prevent opioid misuse and dependence through:

• Education in the health care community• Limiting early exposure with supply limits and pharmacy lock-in programs when needed• Working to protect the most vulnerable: pregnant women, babies and adolescents• Using our data to better understand trends and work with care providers to assist when possible• Monitoring usage for those currently struggling with opioid use and alerting pharmacists and

care providers, providing medication assisted therapy for treating substance use disorders and providing a 24/7 substance use treatment helpline.

Here are other resources on opioids for care providers:

Centers for Disease Control (CDC)

For more information about appropriate opioid prescribing, please refer to the guidelines posted by the CDC at CDC.gov > Opioid Overdose > Information for Providers

Iowa Care Providers:

The Iowa Board of Medicine website medicalboard.iowa.gov/ has a number of resources to assist with meeting requirements for chronic pain education.

For other advanced practice providers, please contact your licensing boards and professional societies for additional options. Through collaboration, education and a compassionate commitment to the management of pain and substance use disorders, we can make a difference in the country and in the State of Iowa.

Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33682 Practice Matters: IA - Winter 2017 Provider Services Center: 888-650-34622

Important information for health care professionals and facilities

Overcoming Barriers with 270/271 Eligibility and Benefits TransactionsUnitedHealthcare wants to help you overcome barriers to get member eligibility and benefits from your 270/271 Health Care Eligibility and Benefit Inquiry and Response transactions.

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’ll receive an AAA code letting you know what information didn’t 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

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:

UnitedHealthcare Community Plan

EDI issue reporting form or ac_edi_ops@uhc.com or 800-210-8315

Reminder for Reporting Critical Incidents Reporting critical incidents is a requirement for care providers servicing Home- and Community –Based Services (HCBS) waiver and habilitation services members in the IA Health Link program for Iowa Medicaid. Reports should be completed in a timely manner. As a reminder, please review the requirements for reporting critical incidents and completing the necessary forms.

• When to report an incident – Major Incidents: By the end of the next calendar day (24 hours) from the date the incident occurred or was reported to the member’s managed care organization (MCO), UnitedHealthcare.

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Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33683 Practice Matters: IA - Winter 2017 Provider Services Center: 888-650-34623

Important information for health care professionals and facilities

– Minor incidents: Within 72 hours of the incident to a staff member’s supervisor. These do not need reported to the member’s MCO.

• Verify member eligibility – Verify the individual was enrolled with

UnitedHealthcare Community Plan when the incident occurred, not when the incident was discovered.

– If the incident occurred while the individual was a UnitedHealthcare member, please complete the Critical Incident Reporting (CIR) form located at UHCCommunityPlan.com > For health Care Professionals > Iowa> Provider Forms > Critical Incident Reporting Form and submit to us by:

Fax: 855-371-7638

OR

Email: critical_incidents@uhc.com

• Submitting additional information – If you’re waiting for additional information to become

available, please don’t wait to submit the initial CIR form.

– When additional information is available on the incident, submit a new CIR form within five days of the incident. You only need to complete the additional information fields and information that identifies the member.

More detailed information about the critical incident reporting process can be found at UHCCommunityPlan.com:

• CIR Training – For Health Care Professionals > Iowa > Provider Training > Critical Incident Reporting.

• Reference Guide – For Health Care Professionals > Iowa > Billing and Reference Guides > Critical Incident Report Form Reference Guide.

Help Members Save Out-of-Pocket

Costs by Completing Health Risk Assessments Completing a health risk assessment (HRA) can help identify unhealthy behavioral factors of members and create possible outcomes for improvement. Helping ensure UnitedHealthcare Community Plan members fill out an HRA on an annual basis addresses immediate requirements with the Centers for Medicare & Medicaid Services (CMS) and meets long-term needs of a sustainable health care system. In addition to improving personal life choices, this allows members to waive their monthly contribution or premium payment if they are enrolled in the Iowa Health and Wellness Plan, fulfilling one of the Healthy Behaviors program requirements.

According to the Iowa Department of Human Services, the following evidence suggests HRAs are essential to improve the health system:

• 30 percent to 60 percent of patients fail to take medications as prescribed.

• Changing health behavior has the greatest potential for reducing illness and mortality and for improving quality of life across diverse populations.

• 50 percent of mortality is from 10 leading causes of death linked to lifestyle changes such as tobacco use, poor diet, inactivity, alcohol and drug use, and sexual behavior.

For UnitedHealthcare to waive a member’s monthly contribution or premium payment, they must satisfy the following requirements:

• Be enrolled in the Iowa Health and Wellness Plan, and• Get a wellness exam (annual physical) from a health

care provider or a dental exam, and • Complete a health risk assessment.

The form is available at UHCCommunityPlan.com > For Health Care Professionals > Iowa > Provider Forms > Adult HRA Form or Adult HRA Form Spanish.

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Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33684 Practice Matters: IA - Winter 2017 Provider Services Center: 888-650-34624

Important information for health care professionals and facilities

Please mail completed forms to:

Attn: HARC DEPT UnitedHealthcare Community Plan 1001 Brinton Road Pittsburgh, PA 15221 -9920

Postage paid envelopes are available on request. Please contact the member’s Community Outreach Specialist, Community-Based Case Manager or your Provider Advocate to request one. HRAs can also be completed by phone if members call Member Services at 800-464-9484, TTY 711.

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Goals for 27 Measures Exceeded in HEDIS SurveyThank you for participating in our annual Healthcare Effectiveness Data and Information Set (HEDIS) 2017 medical record collection process. We appreciate your time and cooperation throughout the data collection season.

Annually, our HEDIS results are compared to nationally published benchmarks to assess the health plan’s performance and set new goals, improve processes and encourage better care for our members. For HEDIS 2017 (data year 2016), we exceeded our goals for 27 measures and have identified areas in need of improvement. Here is a sample of measures reported:

HEDIS 2017 Results

Measure 2017 Results 2017 Goal Based on 2016 NCQA’s Quality Compass 75th percentile

Adolescent Well Care Visits 62.59% 59.98%

Children’s and Adolescents Access to Primary Care Providers (Ages 25 months - 6 years)

94.56% 91.22%

Children’s Immunization Status - Combo 10(Includes all recommended immunizations through age 2)

52.54% 42.13%

Human Papillomavirus Vaccine 22.30% 25.61%

Prenatal/Postpartum Care-Postpartum Visits 52.80% 68.85%

Weight Assessment Physical Activity Counseling 59.12% 64.43%

*A complete list of HEDIS 2017 results is available by contacting UnitedHealthcare Provider Services. In addition to the above measures, focus areas for HEDIS 2018 (calendar year 2017) include:

• Adult Access to Preventive/Ambulatory Health Services• Comprehensive Diabetes Care and Flu Vaccinations.

Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33685 Practice Matters: IA - Winter 2017 Provider Services Center: 888-650-34625

Important information for health care professionals and facilities

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UnitedHealthcare Community Plan of Iowa’s Clinical Practice Consultant (CPC) Program supports your efforts to help members overcome barriers to health care. Consultants can work with your office and staff to help manage the clinical requirements involved with meeting HEDIS and other quality measures.

Contact information for your dedicated CPC is available at UHCCommunityPlan.com > For Health Care Professionals > Iowa > Clinical Practice Consultant Look Up > Clinical Practice Consultant Coverage Map.

Recommendations for Members with Back PainA HEDIS measure for lower back pain indicates that members without complications should not have imaging within the first 28 days of diagnosis. During the winter, there’s a higher likelihood for back injury from slips or falls on the ice and from shoveling snow. For the majority of people who experience severe low back pain, pain improves within the first two weeks of injury, according to research. Low back pain affects three in four adults some time in their lives1, making it one of the most common reasons for seeking health care.2

A detailed history and exam findings can help rule out complications or diagnoses that may warrant imaging studies. Avoiding imaging for patients when there’s no clinical need can prevent unnecessary harm, unintended consequences and reduce health care costs.3 In addition to instructing members on conservative treatment, educating

them on symptoms that may warrant further intervention can also be helpful.

Sources:

1. Haldeman S., S. Dagenais. 2008. “A supermarket approach to the evidence informed management of chronic low back pain.” Spine Journal. 8: 1–7. ncbi.nlm.nih.gov/pubmed/18164448

2. Institute for Clinical Systems Improvement. 2012. Adult Acute and Subacute Low Back Pain.

3. NCQA. (2016). Retrieved Aug. 8, 2017, from Use of Imaging Studies for Low Back Pain: ncqa.org/report-cards/health-plans/state-of-health-care-quality/2016-table-of-contents/low-back-pain

Establishment of Satisfaction Requirements for Home and Vehicle Modifications UnitedHealthcare Community Plan wants to help ensure our members receive satisfactory home and vehicle modifications (HVM) that also meet top quality health measurements. To continue to meet these measures, we are updating our policy for care providers submitting claims for HVM services. Before you provide HVM services to a member, please review these updates and the appropriate forms to complete.

Here’s What You Need to Know Iowa Medicaid policy requires a contract to be signed by the care provider and member and approved by the managed care organization before HVM services are completed. The contract should include the following:

• Scope of work to be performed and cost • Time required to complete the modification• Supplies needed• Diagrams of the project if applicable • Proof of provider liability and workers’ compensation

coverage in addition to an applicable permit and license.

Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33686 Practice Matters: IA - Winter 2017 Provider Services Center: 888-650-34626

Important information for health care professionals and facilities

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Additional Resources For a list of acceptable HVM services, please review the Iowa Administrative Code (IAC), chapter 78, under “Home and Vehicle Modifications.”

Property Owner Modification NoticeIf you plan to complete a home modification for a member who doesn’t own their home, please complete the Property Owner Modification Notice prior to beginning the project. You can get the form from the member’s Community-Based Case Manager (CBCM). It is also available at:

• UHCCommunityPlan.com > For Health Care Professionals > Iowa > Provider Forms > Home Modification Property Owner Notice Form.

Payment Requirements & Home and Vehicle Modification FormIn accordance with IAC, chapter 78, payment for HVM is made upon satisfactory completion of the service. Effective Dec. 1, 2017, claims for HVM services must be submitted with a completed Home and Vehicle Modification Approval Form. The form is available at:

• UHCCommunityPlan.com > For Health Care Professionals > Iowa > Provider Forms > Home and Vehicle Modification Owner Approval Form.

If you have questions, please contact the member’s CBCM or your Provider Advocate.

Guidelines for Discharging Home- and Community-Based Waiver MembersIf you want to discharge a UnitedHealthcare Community Plan member from your practice, we have prepared a few reminders to help with the process. Reasons for discharging a member must be based on behavioral issues or an inability to treat the member’s medical needs. They should not be discharged for monetary issues.

Please notify the member 30 days before the planned discharge date and before submitting the primary care provider (PCP) discharge request to UnitedHealthcare. After a request is submitted, the member will be notified and allowed five days to select a new PCP. If the member does not choose a new PCP within that time they will be automatically assigned to a new PCP and removed from your panel.

Until the member’s new assignment is finalized, care providers must continue to deliver care to the member or refer them to another care provider in the meantime.

For PCP change and discharge forms, go to UHCCommunityPlan.com > For Health Care Professionals > Iowa > Provider Forms > PCP Change Form or PCP Discharge Form.

Cultural Competency’s Critical Role in Health CareCare providers who are part of the UnitedHealthcare network must follow the Centers for Medicare & Medicaid Service’s guidance for cultural competency standards. Please review our approach to keeping cultural sensitivity a priority for our business and your practice when serving UnitedHealthcare Community Plan members.

UnitedHealthcare Community Plan is committed to helping ensure that we, as well as our care providers, treat members with respect and dignity, regardless of race color creed sex religion age national origin, ancestry marital states, sexual orientation, gender identity, health status, income status, or physical or mental disability.

Our philosophy for helping to ensure cultural competency emphasizes a “whole member” approach that honors member beliefs and cultural diversity and fosters staff and care provider attitudes and personal communication styles with respect to the member’s environment, cultural background and beliefs.

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Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33687 Practice Matters: IA - Winter 2017 Provider Services Center: 888-650-34627

Important information for health care professionals and facilities

For more information about cultural competency, see Chapter 1 of the Administrative Provider Manual at UHCCommunityPlan.com > For Health Care Professionals > Iowa > Provider Administrative Manual.

Peer Support Services No Longer Require Prior AuthorizationAs a reminder, we’ve removed the prior authorization requirement for providing peer support services with dates of services on or after Oct. 1, 2017. When you submit claims for these services, please use CPT code H0038. You may continue to submit claims for peer support services as you would for other services that don’t require prior authorization.

To view the list of services that do require prior authorization, go to: UHCCommunityPlan.com > For Health Care Professionals > Iowa > Provider Information. Scroll to the Prior Authorization List section on the page and choose UnitedHealthcare Community Plan Prior Authorization IA – Effective [select most recent version]. We update the list quarterly.

All out-of-network services will continue to require prior authorization.

Check Out Our New Care Provider Website – UHCprovider.comWorking with UnitedHealthcare means having access to digital tools and content designed to fit your business needs and to help better serve our members. In case you missed the announcement posted in the fall Network Bulletin for all lines of business, including UnitedHealthcare Community Plan, UnitedHealthcareOnline.com has moved to UHCprovider.com to provide you with a better experience.

The website includes the following enhanced features:

• A predictive search function with filtering and sorting capabilities to help you find what you need faster

• A personalized view for signed-in users

• An easy-to-read design that looks great whether you’re on a desktop computer, tablet or smart phone.

We value your feedback to help us prioritize future enhancements. After you’ve visited the site, click the Feedback tab on the right side of each page to send us your suggestions. You also may be randomly selected to take a short survey. If you have questions, call the UnitedHealthcare Connectivity Help Desk at 866-842-3278, option 1.

If you would like monthly announcements about all of UnitedHealthcare’s business, please sign up from the Network Bulletin at UHCprovider.com > Menu > Resource Library > News & Network Bulletin > Sign up to receive Network Bulletin.

For information specifically impacting the Iowa Medicaid (Community Plan), continue to view updates posted on UHCCommunityPlan.com > For Health Care Professionals > Iowa.

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Practice Matters is a quarterly publication for physicians and other health care professionals and facilities in the UnitedHealthcare hawk-i network.

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