Connect Archives

April 2010

Friday, April 23, 2010

CASE MANAGEMENT & DISEASE MANAGEMENT LETTER

For WellCare members, Health First Network offers a telephonic Case Management Program that utilizes Registered Nurse Case Managers working under the direction of a Primary Care Physician, to work with members with chronic illnesses and/or complex disease states.

On the initial nursing assessment, it is often found that these members need assistance in obtaining medications or locating community resources or services, or need direction in healthcare planning and coordination of healthcare services, or scheduling of appointments or transportation. The Registered Nurse Case Manager serves as an advocate for these members, providing options and interventions to meet an individual’s health needs. Case Managers work with Primary Care Physicians (PCP), a Medical Director and members of an interdisciplinary healthcare team to promote high quality cost-effective outcomes.

Case Management is in the unique position to impact quality of care, patient compliance, resource utilization, patient education, open lines of communication and improve access to quality care.

As a network initiative, Health First Network is getting ready to send out letters to those WellCare members who are not currently in Case Management and may benefit from the services it provides. Attached is a draft copy of the letter that will be going out to members. Health First Network will be sending these letters out on behalf of the member’s Primary Care Physician. If you do not wish your members/patients to receive a copy of the letter, please contact the Health First Network Provider Relations Department or Medical Management Department.

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HEALTHSPRING & WELLCARE INCREASE IN MEMBERSHIP

Medicare Advantage Plans continued their growth in the Panhandle area. As you know every year there is an opportunity for Medicare beneficiaries to join a Medicare Advantage Plan. This is called the Open Enrollment Period and lasts roughly from November 15th until March 31st. During this year’s Open Enrollment Period, the two Plans that Health First Network (HFNI) contracts with had significant membership increases. WellCare went from 5,152 members to 5,422 while HealthSpring went from 579 to 1,107, making a total of almost seven thousand beneficiaries in HFNI associated health plans. We look for this figure to continue to climb during the year as plans are able to add members that 1) turn 65, 2) move into the area and 3) these two plans are always able to market to the Medicare/Medicaid dual eligible population.

UPDATES FROM DR. WHIBBS

With the passage of the Health Care Reform Bill in the late evening of March 21, 2010, prominent questions arose about what the current structure of healthcare entities will look like in 2-3 years, and what uphill battles all Providers and Insurers, as well as our patients will face in coming years to overcome infrastructure challenges that will take time, effort, creativity, financial planning and modification for practices large and small.

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BILLING FOR NON-PHYSICIAN EXTENDERS

Health First Network wants to remind offices that effective July 1, 2010, HFNI will begin processing claims for physician extenders in the same manner as Medicare. If a physician extender performs a service, that service should be billed by that extender using his/her provider identification information.

Previously, Health First Network allowed extenders to bill using the supervising physician’s provider identification information. Beginning July 1, 2010, non-physician extender services will be paid according to Medicare guidelines.

Health First Network will require that all physician extenders working with Health First Network participating physicians and seeing contracted Health Plan patients be credentialed. An application should be filled out for each/every extender in the office. The completed applications will then be reviewed by the Health First Network Credentials Committee. HFNI policies for credentialing extenders are contained in The Credentials Program Policies and Procedures Manual which is located on our website at www.hfni.com.

It will be the responsibility of each office to inform HFNI of any additions/changes to both the physician(s) and any extenders in your office and to keep that information current.

If you have not already done so, contact Jenny Caillouet to receive applications for your extenders. As stated previously, for dates of service July 1, 2010 and beyond, physician extender claims will be processed in the same manner as traditional Medicare.


HFNI SHAREHOLDERS MEETING NOTICE

The Annual HFNI Shareholder’s meeting will be held on Thursday, May 6, 2010 at 6:00 p.m. at Health First Network. All shareholders (and only shareholders – no substitutes) are encouraged to attend. If you are a shareholder, you should have received a notice in the mail along with a ballot to vote in this year’s Board of Directors election. If you did not receive a ballot please contact Michelle Hamilton.