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Call our Provider Services Center at 800-600-9007 Visit UHCCommunityPlan.com

Ohio | Winter 2019

Practice Matters: OH – Winter 2019 Provider Services Center: 800-600-9007

Important information for health care professionals and facilities

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In This Issue...• Gold Star Program Ends

• New Respiratory Management Supplies

• Getting Connected with the UnitedHealthcare Doctor Chat App

• 24/7 Mental Health Help

• PreCheck MyScript

• Healthify Connects People and Social Services

• UnitedHealthcare and Ohio American Academy of Pediatrics

• Electronic Visit Verification Implementation

Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33683 Practice Matters: OH – Winter 2019 Provider Services Center: 800-600-90073

Important information for health care professionals and facilities

Gold Star Program EndsOn Dec. 1, 2019, the Gold Start program for the UnitedHealthcare Community Plan of Ohio ended.

What This Means for YouThe most significant impact of this change is that prior authorization and notification requirements will no longer be waived for your Gold Star program-eligible patients (those with a gold star on their member ID cards). These patients will now follow the standard Ohio Medicaid prior authorization requirements for inpatient and outpatient services (excluding emergency or urgent care). You can review the requirements at UHCprovider.com/OH-UHCCPpriorauth.

With this change, we understand that you may be concerned about the additional time it will take for you to meet these requirements. UnitedHealthcare is committed to reducing administrative burden and helping you focus on patient-centered care. UnitedHealthcare has several online tools and resources available through Link to help you manage your practice’s notification and prior authorization requests:

• The Prior Authorization and Notification toolallows you to instantly check requirements andsubmit requests.

• PreCheck My Script gives you patient-specificprescription drug coverage and cost information atthe time of service through Link or your electronicmedical record (EMR) system

QuestionsTo learn more about these and other timesaving, self-service tools, go to UHCprovider.com/link. We’ll also have additional online resources available closer to the effective date of the new requirements.

We’re Here to HelpIf you have questions, contact your Provider Advocate or Network Management contact. If you aren’t sure who to contact, please go to UHCprovider.com > Menu > Contact Us > Find a Network Contact, then search by your state.

Thank you for being a care provider with the UnitedHealthcare Community Plan of Ohio. We look forward to continuing our partnership that helps people live healthier lives.

New Respiratory Management SuppliesAs of Oct. 1, 2019, Medical Service Company is the only vendor for certain respiratory supplies for UnitedHealthcare Community Plan of Ohio. UnitedHealthcare made this change to provide our members with the highest-quality products and services in the industry and better manage member benefits.

Medical Services Company will be the only approved supplier for respiratory management supplies such as oxygen, continuous positive airway pressure (CPAP) machines, concentrators, nebulizers and other related respiratory supplies.

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Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33684 Practice Matters: OH – Winter 2019 Provider Services Center: 800-600-90074

Important information for health care professionals and facilities

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Care providers or members can order products by calling or faxing Medical Service Company’s dedicated intake team. If faxing an order, care providers or members should use the custom respiratory supply fax order form so Medical Service Company gets all of the necessary information to process the order. Waiver plans (WSP) alone are not accepted. Orders must be placed using the appropriate Healthcare Common Procedure Coding System (HCPCS) codes, which doesn’t include the T1999 general waiver code.

The limits on supplies each month are determined by the member’s primary care provider (PCP), service coordinator or the community case management agency, and based on the medical necessity of the member’s condition. This information should be documented in the member’s service plan.

Any respiratory supplies beyond what Medical Service Company can provide will require a prior authorization. If a member requires more supplies per month, they should contact their service coordinator, community case management agency or PCP directly for help and have their service plan updated.

Dual-eligible members, including Dual Special Needs Plan (DSNP) and Medicare/Medicaid plan (Mycare) products are excluded. The following CPT® and HCPCS codes and products are included:

Brand Name Generic Name

A4481 TRACHEOSTOMA FLT

A4483 MOSIT EXCHANGER/

A4604 TUBING W/INTGR H

A4605 TRACHEAL SUCTION

A4606 OXYGEN PROBE USE

A4608 TRANSTRACHEAL OX

A4614 PEAK EXPIRATORY

A4615 CANNULA NASAL

A4616 TUBING PER FOOT

Brand Name Generic Name

A4617 MOUTHPIECE

A4618 BREATHING CIRCUI

A4619 FACE TENT

A4620 VARIABLE CONCENT

A4623 TRACHEOSTOMY INN

A4624 TRACHEAL SUCTN C

A4625 TRACHEOST CARE K

A4626 TRACHEOSTOMY CLE

A4627 SPACR BAG/RESRVO

A4628 OROPHARYNGEAL SU

A4629 TRACHEOST CARE K

A7001 CANISTR NONDISPB

A7002 TUBING USED WITH

A7003 ADMN SET SM VOL

A7004 SM VOL NONFILTR

A7005 ADMN SET SM VOL

A7006 ADMN SET W/SM VO

A7007 LG VOL NEBULIZR

A7008 LG VOL NEBULIZR

A7009 RESRVOR BOTTLE L

A7010 CORUG TUBE DISPB

A7012 WATR CLCT DEVC W

A7013 FILTER DISPOSABL

A7014 FLTR NON-DISPBL

A7015 AEROSOL MASK USE

A7016 DOME&MOUTHPECE W

A7017 NEBULIZR DURABL

A7018 WATR DIST USE W/

A7020 INTERFACE COUGH

A7027 COMB ORAL/NASAL

Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33685 Practice Matters: OH – Winter 2019 Provider Services Center: 800-600-90075

Important information for health care professionals and facilities

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Brand Name Generic Name

A7028 ORAL CUSHION COM

A7029 NASAL PILLOWS CO

A7030 FULL FACE MASK U

A7031 FACE MASK INTERF

A7032 CUSHN NASAL MASK

A7033 PILLW NASL CANNU

A7034 NASL INTRFCE POS

A7035 HEADGEAR USED W/

A7036 CHINSTRAP USED W

A7037 TUBING USED WITH

A7038 FILTER DISPBL US

A7039 FILTER NON DISPB

A7040 ONE WAY CHEST DR

A7044 ORAL INTERFACE U

A7045 EXHALATION PORT

A7046 WATR CHAMB HUMDI

A7047 ORAL INTERFACE U

A7504 FLTR USE TRACHEO

A7507 FLTR HLDR&INTGR

A7508 HOUS&INTGR ADHES

A7509 FLTR HLDR&INTGR

A7520 TRACHEOST/LARYNG

A7521 TRACHEOST/LARYNG

A7522 TRACHEOST/LARYNG

A7524 TRACHEOSTOMA STE

A7525 TRACHEOSTOMY MAS

A7526 TRACHEOSTOMY TUB

A7527 TRACHEOSTOMY/LAR

E0424 STATION COMPRS G

E0425 STATION COMPRS G

E0430 PRTBLE GASEOUS O

E0431 PRTBLE GASEOUS O

E0433 PORTABL LIQUID O

E0434 PRTBLE LIQUID O2

E0435 PRTBLE LIQUID O2

E0439 STATION LIQUID O

E0440 STATION LIQUID O

E0441 STATIONARY O2 CO

E0442 STATIONARY O2 CO

E0443 PORTABLE O2 CONT

Medical Services Company has a dedicated team just for UnitedHealthcare Community Plan members:

• Call 888-506-9842

• Fax 888-526-9842

• Email uhc@medicalserviceco.com

Getting Connected with the UnitedHealthcare Doctor Chat AppWith the UnitedHealthcare Doctor Chat app, your patients can avoid the emergency room and connect with a doctor instantly from their computer or mobile device.

UnitedHealthcare Doctor Chat allows your patients to chat and share photos with a live doctor within 90 seconds, which can reduce readmission to hospitals. With a HIPPA-secure platform and emergency doctors on call from 9 a.m. to 9 p.m. Pacific Time, quality care is streamlined for you and your patients.

Please encourage your patients to download the UnitedHealthcare Doctor Chat app or visit UHCDoctorChat.com to learn more. They can also call Members Services at 800-895-2017 for more information.

Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33686 Practice Matters: OH – Winter 2019 Provider Services Center: 800-600-90076

Important information for health care professionals and facilities

24/7 Mental Health HelpUnitedHealthcare is partnering with Mindstrong to offer access to mental health support at no cost to UnitedHealthcare Community Plan members – 24 hours a day, seven days a week. Mindstrong makes it easy for patients to easily connect with psychiatrists and other mental health professionals through messaging and video – all in one simple smartphone app.

The Mindstrong app provides 24/7 access to a dedicated mental health team, so the patient never has to wait for help. Mindstrong works with the patient’s doctors, care managers and care teams to help detect and solve problems early to avoid an unexpected crisis.

This program is designed to help patients manage mental health on their terms. With Mindstrong, the patient can use the app any time they need it.

Please encourage your patients to call 888-683-7026, Monday through Friday, 9 a.m. to 7 p.m. Eastern Time.

PreCheck MyScriptPreCheck MyScript makes it easier for care providers to get real-time, patient-specific prescription drug data at the point of care.

Use PreCheck MyScript to check current prescription coverage and prices, including out-of-pocket prescription costs for UnitedHealthcare members at a specific pharmacy. It can also be used to get information on lower-cost prescription alternatives, if available, to help your patients save money.

PreCheck MyScript also lets you see which prescriptions currently require a prior authorization or are not covered or non-preferred. It can also be used to request prior authorization and receive status updates and results.

PreCheck MyScript has many benefits for both you and your members. Providers like you save time by reducing the need to fax or call for prescription coverage information, and the tool seamlessly integrates into your workflow. Members will experience less frustration and fewer delays at pharmacies when prior authorizations are needed or in the event that medications aren’t covered – and an increase in satisfaction when medication costs and lower-cost alternatives are suggested if they’re available.

Precheck MyScript is available on Allscripts, AthenaHealth, DrFirst and NewCropRX electronic medical platforms. If it not available on your EMR, you can use Link to access the PreCheck MyScript tool.

If you have questions about the PreCheck MyScript tool, or need help using its features, call the UnitedHealthcare Connectivity Desk at 866-842-3278, option 3, Monday through Friday, 7 a.m. to 9 p.m. Central Time. You can also visit UHCprovider.com/en/resource-library/link-provider-self-service/precheck-myscript.html for more information.

Healthify Connects People and Social ServicesUnitedHealthcare is partnering with Healthify to help our care providers make an even bigger difference in the community. We’re offering Healthify accounts at no cost to help extend the great services you already deliver.

Healthify uses innovative technology that allows you to quickly search through thousands of community-based organizations and social service agencies in seconds. Healthify offers a wide range of services and eligibility requirements to quickly find nearby resources to meet individual’s needs, such as food, housing, employment and other local support services. Local service listings can be accessed by using your email and personalized password by smart phone, tablet or desktop computer. Users can search by service type and location.

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Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33687 Practice Matters: OH – Winter 2019 Provider Services Center: 800-600-90077

Important information for health care professionals and facilities

To get started, you need to first identify the proper people in your organization to receive access. After confirming their accounts, users will be able to sign in to Healthify from any device with an internet connection and start searching.

Healthify develops its database by gathering information found on public resource websites, including services offered, contact information, intake requirements, service hours and languages spoken. Healthify also provides timely re-verification checks to validate that all site information is correct. This helps ensure accuracy in updates on resource changes, user edits and closings.

If you have questions, visit healthify.us. You can also contact your UnitedHealthcare representative if you would like access for your organization.

UnitedHealthcare and Ohio American Academy of PediatricsThe UnitedHealthcare Community Plan of Ohio, in partnership with the Ohio Chapter of American Academy of Pediatrics (AAP), is recruiting pediatric and primary care practices to participate in practice transformation in 2020. This work will be dedicated to our combined population health initiatives related to lead screening, dental care, healthy weight, mental health, depression screening, social determinants of health and immunizations. Practices will receive free coaching and resources from the AAP to achieve improvements in these important areas for Ohio’s children. Quality improvement methodologies will be used to measure success and document outcomes that can be spread to additional practices in the future.

For more information, contact Kristen Stidham Fluitt, Program Manager of the Ohio Chapter of the AAP, at 614-846-6258.

Electronic Visit Verification ImplementationOn Aug. 5, 2019, the Ohio Department of Medicaid (ODM) implemented Phase 2 of the Electronic Visit Verification (EVV) program for services billed directly to managed care organizations for home care services, such as aide and nursing services. EVV is an electronic-based system that verifies when care provider visits occur and documents the precise time services begin and end. It helps ensure that patients receive their medically necessary services and comply with the 21st Century CURES Act.

ODM is administering the EVV program and leading all training on how to use the EVV system and device. Although you are required to participate if you provide home care services to UnitedHealthcare members, there is no cost for the EVV system to you or members receiving services. In addition, there will be minimal changes in the claim submittal process.

Benefits of the EVV System Include: • Helps care providers track individual worker’s activity,

reducing the likelihood of errors or fraud

• Increases efficiency because tracking is automated and claims submission is cleaner

• Improves quality of care by making workers’ activities transparent and measurable

Care providers not using the EVV system or submitting claims with information that doesn’t match the EVV system data will begin to see the N363 remark code on their remittances, which indicates that the claim could be denied in the future.

More information on training can be found at medicaid.ohio.gov/EVV. If you have questions about EVV, contact the ODM EVV Unit at EVV@medicaid.ohio.gov. ODM continues to host informational webinars and care providers can sign up at medicaid.ohio.gov/Portals/0/Initiatives/EVV/Webinar-Tab.pdf.

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

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