Connect Archives

March 2014

Monday, March 17, 2014

URAC ACCREDITATION AND ASSOCIATED QUALITY IMPROVEMENTS PROGRAMS

The February Connect enewsletter announced the commencement of the URAC accreditation program. This program ensures that HFNI has systems, committees, policies, and procedures in place that assures providers, facilities, contractors, and the like that HFNI is a quality, focused Network with consumer (patient) safety in mind.

As part of the URAC accreditation, HFNI will implement two Quality Improvement Programs (QIP). One program will focus on Patient Falls which includes screening, risk-assessment, and plan of care to prevent future falls. The other program will address Clinical Depression which includes screening, assessing, and care planning. These programs will be implemented concurrently with the initial implementation focused on the Medicare population.

Both QIP programs focus on lowering overall health care cost by improving the quality of care. Reducing overall health care cost through quality, such as, preventing a hospitalization due to a fall or depression, is critical to our success with the evolving changes in health care.

In addition to meeting the requirements of URAC accreditation, these programs will help us improve PQRS scores for Medicare which will improve the shared savings from Medicare. Additionally, these programs allow us to reach out and improve the patient relationship through educational materials and preventive care.

The timeframes and additional details on these QIPs will be communicated in next month’s newsletter.

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CIGNA-HEALTHSPRING – A CMS FIVE STAR PLAN

Cigna HealthSpring Medicare Advantage plans in Florida achieved the highest possible rating – five stars – from the Centers for Medicare & Medicaid Services (CMS), making Cigna-HealthSpring one of 11 five-star plans nationally and the only publicly traded company to achieve a five-star rating for its Medicare Advantage business. In addition to affirming Cigna-HealthSpring’s commitment to quality care, the five-star rating allows for customers to enroll year round rather than waiting for Medicare’s annual enrollment period from October to December. We are pleased to offer this plan in our service area.

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HEALTHSPRING MEDICARE ADVANTAGE HMO TRANSITION FOR CLAIM PROCESSING

Effective 1/1/14 Health First Network, Inc. (HFNI) / MED3000 is no longer responsible for processing claims for Healthspring Medicare Advantage HMO.

Health First Network, Inc. will continue to work with Healthspring, giving support to our providers for that product.

It is very important that all claims with dates of service prior to January 1, 2014 are filed to HFNI / MED3000 no later than June 30, 2014 at the address below.

HealthSpring Medicare HMO
P. O. Box 11547
Pensacola, FL 32524

All claims received after June 30, 2014 for dates of service prior to January 1, 2014 will be denied timely, NO EXCEPTIONS will be made.

All claims for dates of service after December 31, 2013 should be filed to:

Healthspring Medicare Advantage HMO
P.O. Box 981804
El Paso, TX 79998
Electronic claims: Emdeon Payor ID 63092

Please contact Jenny Caillouet at 850-438-4487 if you have any questions.

AMA'S ICD-10 REPORT FINDS HIGHER COSTS FOR IMPLEMENTATION; SOFTWARE UPGRADE CITED

Healthcare providers pushing for a delay in the scheduled Oct. 1 start date for the ICD-10 coding system got support from a new American Medical Association sponsored report finding that indicated implementation will be more expensive than previously estimated. But the report found that costs will vary widely depending on practice circumstances. Click on the link below to learn more.

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MANAGED MEDICAL ASSISTANCE (MMA) - MEDICAID

We are hearing from many of you that you are receiving questions from your Medicaid beneficiary patients regarding the impending move to managed care.

Region I (Escambia, Santa Rosa, Okaloosa, and Walton counties) will “go live” with the managed Medicaid on August 1, 2014. Patients will have to pick a payor thirty (30) days prior to that.

HFNI currently has signed contracts with Humana and Sunshine Health Plan for the Region I Medicaid Medical Assistance Program. We are involved in ongoing negotiations with Integral and Clear Choice.

We will keep you informed as these negotiations move forward.

ID CARDS

To help with the loss of continuity that was unintended but inevitable with the increasing use of Hospitalists to deal with acute inpatient care, Health First Network, Inc. will be distributing to our Primary Care Physicians’ offices cards that should be distributed to all of our patients that will link the patient and Primary Care Physician together, with HFNI contact information on the other side. The card is designed to be shown anytime the patient shows their insurance ID.

Information especially concerning admission to any facilities for Inpatient, Emergency Department, or even Outpatient services can be funneled through HFNI to each of our physicians on a daily basis, allowing for better coordination of care, and initiation of needed transitional care in a real-time environment. The cards are health plan agnostic, and we encourage their use for ALL patients. If you have any questions, please contact Dr. Whibbs at 850-438-8147.

ROBOTIC SURGICAL INSTITUTE

Woodlands Medicals Specialists announces a new division, Robotic Surgical Institute. Follow the link below to learn more.

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CAQH UNIVERSAL PROVIDER DATASOURCE (UPD) REMINDER

The CAQH Universal Provider Datasource (UPD) is the trusted source and industry standard for collecting provider data used in credentialing, claims processing, quality assurance, member service and more. By streamlining data collection electronically, UPD is reducing duplicative paperwork and millions of dollars of annual administrative cost. HFNI supports CAQH as the national resource for provider self-reported data.

To better serve you, if you are currently submitting your credentialing data though CAQH, please submit your CAQH I.D.# to Deborah Gant, Director of Health Services at 850-434-6087 by April 1, 2014. If you are interested in obtaining Information or how to sign-up for CAQH, log-on to www.caqh.org.

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REMINDER FOR PROVIDERS OFFICES

Please remember to notify the Health First Network Credentialing Dept. or Provider Relations Dept. at 850-438-0818 when you have a provider who is joining or leaving the practice, changing office locations, moving out of the area, or taking an extended leave of absence, such as military deployment, or maternity leave. This allows us to keep our Credentialing and Provider Network database current for credentialing letters and re-cred. applications and keeps our health plans updated with the most current information on physicians in our Network.

Please be reminded that the Health First Network website contains a “Provider Updates/Change Request form” which can be completed and submitted online. This page will assist your office in reporting provider updates and changes in a more efficient manner. Please note, an updated W-9 must be faxed to 850-438-0298 in order for the changes to be completed.

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NEW JOB POSTINGS PAGE

HFNI has created a new “Job Postings page” in an effort to help our physician offices fill job vacancies.

If you would like to advertise open employment opportunities on the HFNI website, please contact Jenny Caillouet at 850-438-4487.

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NEW PHYSICIANS JOINING THE NETWORK

Health First Network would like to welcome the most recent physicians to join the Network:

Brent Hazen, M.D. Hospitalist
Richard Hawthorne, M.D. Family Practice
Kevin McIntosh, M.D. OB/GYN
Charles Mayes, Jr., M.D. Cardiology/Cardiovascular Disease
Randy Metcalf, M.D. Thoracic/Cardiac Surgery
James Thomas, M.D. Pathology
Laura Magan, M.D. Hospitalist

** To determine which health plans each physician is participating in check the “Find A Doctor” section on the HFNI website.

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