RHODY HEALTH OPTIONS (RHO) IMPLEMENTATION

Nursing Homes Wave 1 and 2October 18, 2013

Rhody Health Options (RHO) Agenda

1. Implementation Timelines2. How to determine eligibility3. Case Management4. Claims Submission and Payment5. Ongoing communication6. Q&A

2

Implementation Timelines• Enrollment Waves 1 and 2

Wave 1 letters sent 9/1 effective 11/1Wave 2 letters sent 10/1 effective 12/1

• NHPRI received 11/1 enrollment file on 10/12 • Total 3489 members; 568 in nursing homes• ID cards will be mailed by 10/25

3

Eligibility

Several ways to check eligibility:

• DHS website= https://www.eohhs.ri.gov

• Navinet = https://navinet.navimedix.com

• Call NHPRI Member Services at 401-459-6601

4

Case Management Collaboration

• Neighborhood to send each facility a monthly roster of members

• Neighborhood to obtain copies of recent MDS forms, review for discharge opportunities, and consult with nursing home staff

• Identified Lead Care Manager contacts:– Lea Doiron 427-8202– Paula Giroud 427-8261– Utilization Department 459-6060

5

Case Management Role

6

• LTSS Waiver application assistance• Develop and monitor individualized Plan of

Care• Collaborate to assess for safe discharge

plan to the community when appropriate• Participate in discharge planning meetings

with members and caregivers• Facilitate referrals to community services to

ensure safe transition plan• Follow member, post discharge, to ensure

needs continue to be met in the community

Nursing Home Requirements• Reconcile monthly admissions roster• Provide access for case managers to meet

member and review medical record, including MDS

• Provide supportive clinical information for those receiving skilled services

• Collaborate in identification of those with potential discharge plan

• Collaborate in ensuring a safe transition to the community when applicable

7

Claims SubmissionIf you have not already done so, contact your software vendor to obtain their established clearinghouse connections. Neighborhood presently trades with these clearinghouses:

Emdeon – Professional & Institutional claimsNavicure – Professional claimsRelay Health – Professional & Institutional

claimsSSI Group – Professional & Institutional claimsViatrack – Professional claims

Contact Mary Harnedy at mharnedy@nhpri.org (401) 459-6659

8

Claims Submission

• Patient share• Timing of claims payments• Claims testing- to begin 10/25/13; test claims

may be forwarded; feed back on results provided to ensure clean claim submission

9

Ongoing Communications• RHO detail on the web by end of month• Provider Manual posted on web by month

end• Email updates-via distribution list• Nursing Home workgroup biweekly

meetings• State updates on this Integrated Care

Initiative (ICI) project can be found at:http://www.ohhs.ri.gov/integratedcare/newsandupdates/

10

Contacts at NeighborhoodMedical Management• Michelle Lupoli, Director of Medical Management, 459-

6035• Kathy Ullrich, Manager of Care Management, Duals 427-

6526Claims Production• Meghan Ruane, Director of Operations, 459-6606Provider Engagement and Contracting• Pat Huschle, Director of Provider Engagement and

Contracting,459-6012• Maureen Brousseau, Manager of Ancillary Network,459-

6033• Paula Lea, Contract Consultant, 459-6037Production Support & EDI• Mary Harnedy, Specialist, 459-6659

11

Questions?

12