Working with MHS in HIP 2.0

0215.MA.O.PP 3/15

MHS Overview – What Sets Us Apart?

Key Provider Outreach Program

MHS Member ID Cards HIP POWER Account ID Card HIP Maternity ID Card

Hoosier Healthwise ID Card Hoosier Care Connect ID Card

How to Pay POWER Account Contribution

5

MHS Gives Members Many Ways to Pay their Monthly POWER Account Contribution:

• Cash• Check• Money Order• Debit or Credit Card• Electronic Funds Transfer• Western Union • Payroll deductions by your employer• In person at MHS office, downtown Indy• Coming Soon! Walmart Money Center of Customer

Service Desk

6

Online Payments

7

Employer, Non-Profit & Other PayerEmployers, Non-profit organizations or others payers may help a Healthy

Indiana Plan (HIP) member with some or all of their monthly POWER Account contribution. Complete the form on our website to assist with payment.

Complete form and mail to: Managed Health Services Mailstop 14273659PO Box 660160Dallas, TX 75266-0160

*Coming Soon! Online Payment Option!

MHS Educational Programs & Services

MHS offers several programs designed to improve the health of our members through education and personal assistance by our professional staff.

0213.MA.O.PP 2/13

Earn Rewards with Preventive Care. MHS CentAccount® Healthy Rewards Program

MHS will reward members’ healthy choices through our CentAccount Healthy Rewards program. Members can earn dollar rewards by staying up to date on preventive care, like completing their Health Needs Assessment, receiving their annual well visit exam, prenatal care ect. These rewards will be added to a CentAccount card that can be used to buy things like healthy groceries, baby items and clothing as well as over-the-counter drugs (allergy, cold meds, etc.). Members can use their CentAccount card at a select number of retailers including Meijer, RiteAid, Dollar General and Family Dollar.

MHS MemberConnections®

This is an outreach team of MHS staff who can help members one-on-one with understanding their health coverage and other community resources.

MemberConnections can provide in-person or telephonic help.

They will help build a relationship with your doctor, and help you understand your health benefits and put you in touch with community resources. If you are in need of transportation, food, shelter, or other health programs, MemberConnections can help.

To find your MemberConnections Representative, please call 1-877-647-4848 and as for the Rep for your area.

MHS Family Education NetworkMHS and the Indiana Minority Health Coalition have teamed up to

create the MHS Family Education Network.

The network provides free face-to-face and telephonic benefit education to MHS members on a variety of topics. The network representatives can help explain Hoosier Healthwise & Healthy Indiana Plan health plan benefits and coverage as well as an overview of MHS programs and special services available to you.

Call MHS Member Services to schedule a free referral at 1-877-647-4848.

MHS Ombudsman ProgramAn ombudsman is someone who works to help you get a problemsolved. Members can contact an ombudsman for free to discuss anyproblems with:

• MHS • MHS services• MHS doctors • other parts of your healthcare.

The ombudsman is neutral and does not side with MHS orthe Medicaid program. The ombudsman will work with members to gettheir problem solved.

If you want the assistance of an ombudsman, please call them directlyat 1-877-647-5326.

Reliable Cell Phone Programs It is important that MHS members can reach their doctors, care managers and FSSA. That is why MHS offers two programs that provide access to free cell phones called ConnectionsPlus and Safelink.

Qualifying members receive 250 free monthly cell minutes as well as unlimited texting with both programs.

Call MHS member services to learn more at 1-877-647-4848.

TransportationMHS HHW, Hoosier Care Connect, HIP State Plan andPregnant HIP Members can get UNLIMITED free rides

to and from:

• Doctor visits• Medicaid enrollment visits• Pharmacy visits (after a doctor’s visit)

Members need to call MHS Member Services at1-877-647-4848 to schedule their ride at leastthree days before their appointment.

Specialized Health Programs MHS has several programs designed to help improve the health of its membersthrough education and personal assistance by our staff including:

• Pregnancy • Diabetes • Asthma • COPD• Coronary Artery Disease • Chronic Kidney Disease• Congestive Heart Failure• Lead • Behavioral Health • Depression• Hypertension• ADHD• Autism & Autism Spectrum Disorders• Children with Special Needs Unit • Special Healthcare needs

MHS Start Smart for Your Baby & Special Deliveries

MHS offers two educational care management programs for MHS members who are pregnant called Start Smart for Your Baby and MHS Special Deliveries. These programs are designed to match a pregnant member with an OB Nurse Care Manager, who can help the member receive proper care throughout her pregnancy as well as after she delivers.

MHS OB Nurses can:• Help you understand what is happening to your body during the pregnancy• Talk about problems that may come up during your pregnancy• Talk about what to do if you have complications during your pregnancy• Help you make doctor appointments or schedule a free ride to the doctor's office• Help you get a free cell phone if you need one. You can use this phone to reach your doctor,

family and other important people while you are pregnant.• Help you quit smoking or using tobacco• Help you find more ways to earn CentAccount© rewards by going to your OB doctor visits• Answer any other questions about your health and the health of your baby

*By participating in either program, members will be eligible to earn more CentAccount rewards.

First Year of Life This Care Management program is designed to encourage education and compliance with immunizations and well visits for babies.

The First Year of Life program matches a member with a Nurse Care Manager who is here to answer your questions and provide you with helpful information sheets to let you know what to expect as your baby grows.

We will also call you and send reminders to schedule upcoming immunizations (shots) and well-child visits with your baby’s doctor as they are needed.

*By participating in the program, members will be eligible to earn more CentAccount rewards

Children with Special Needs UnitDesigned to support coordination of care for children with chronic conditions, children enrolled in the program receive care management services by a dedicated team of MHS doctors, nurses, social workers and care coordinators, specializing in the healthcare needs of children.

This includes conditions such as:• Cerebral palsy,• Cystic fibrosis,• Developmental disabilities,• Autism,• Traumatic brain injuries,• Congenital syndromes with significant developmental delays, and• Other special healthcare needs

MHS Member Baby ShowerEducation is key to healthy pregnancies. MHS has created a fun and informative event to encourage healthy behaviors for our members who are pregnant or recently delivered.

What is an MHS Baby Shower?• MHS Baby Showers are typically 2-3 hour events held at a provider office or community center.

• MHS members that are expecting or have recently delivered a baby within the past 3 months and live in the general area of the event are invited to come get “showered.”

• We want our moms to feel special because they are!

At the Shower• Members enjoy lunch that includes deli sandwiches, non-caffeinated drinks, cake, fresh fruits and

vegetables.

• We will stress the importance of scheduling and keeping all prenatal and post-partum care appointments, as well as the first year of life immunization schedule. We provide an educational overview of MHS’ programs and services that relate specifically to pregnant women and babies. This will include information on

• OB Case Management services

• Behavioral health services

• Member Benefits like CentAccount, transportation, NurseWise and the Health Library

• The members will learn a lot from our community and clinical partners that present at the shower. Topics such as prenatal and post partum care, well-child visits, safe sleep, car seat safety, breastfeeding and more will be discussed.

• Members can take part in fun, interactive games and win a baby health or safety kit.

• Every member will leave with a gift bag full of goodies, including a pack of diapers for their little one!

MHS Healthy CelebrationsMHS Healthy Celebrations events focus on non-compliant members. MHS partners with a PMP office to schedule a specific day and time (4 hour minimum) for non-compliant MHS members on the PMP’s panel to visit the office and receive specialty visits and screenings for Children’s health: EPSDT/well-child (lead screen age appropriate) and Women’s health: Mammography & Chlamydia.

After the doctor visit, screening or immunizations have occurred, MHS will provide a member benefit overview. Each member will also receive a goody bag full of MHS and educational materials and health related giveaways. Then the family can enjoy games, prizes, healthy snacks and refreshments before they leave the doctor’s office.

21

MHS P4P Program Pay for Performance Scorecards

• Bonus Pay for Performance (P4P) fund written in to PMP contracts

• Measures aligned with HEDIS® and NCQA

• P4P Measures

• Annual Payout

MHS WEBSITE

23

Need to KnowMHS Website• mhsindiana.com

– Provider directory search.– Provider manuals, guides, and tutorials.– Provider and member forms.– Member brochures.– Health Library with over 4,000 free, printable health information sheets

available in English, Spanish, and other languages.

• MHS Secure Provider Portal – mhsindiana.com/login– Account Manager access allows facilities to set up multiple users.– Access for both contracted/non-contracted groups.– Enhanced claim detail.– Submit claims / adjust submitted claims.– Printable explanation of payments.– Submit prior authorization.– Claim auditing tool.– Eligibility verification/listings including TPL information.– View patient care gaps (patients needing services).

1213.PR.P.PP 12/13

0514.PR.P.PP.1 6/14

MHS Provider Portal Home Page

MHS Member Eligibility Check

0514.PR.P.PP.1 6/14

Individual Patient Record

0514.PR.P.PP.1 6/14

MHS Secure Provider Portal provides Member Co-pay

information

• The Patient list will pull up all MHS members for the currently selected tax ID number

• The list can be filtered by– Provider’s NPI– Provider’s Medicaid Number– Member’s Last Name– Disease Management

0514.PR.P.PP.1 6/14

Patient List

Patient List

*Test Data In Use

Patient List

*Test Data In Use

• This screen lists a member’s:– Date of birth– ID number– Address– PMP information– Eligibility Information and History– PMP History– Care Gaps – Clinical Information– ER Visit History

Individual Patient Overview

1213.PR.P.PP 12/13

Individual Patient Overview

1213.PR.P.PP 12/13

• View PCP History information

Individual Patient Overview

1213.PR.P.PP 12/13

• View Eligibility History information– It will show all breaks

in coverage for the

member.

Individual Patient Overview

• View Clinical Information

Individual Patient Overview

1213.PR.P.PP 12/13

• If the member has any copay it will show here (RX, etc)

Cost Sharing

1213.PR.P.PP 12/13

Assessments

1213.PR.P.PP 12/13

Health Records• Visits shows a listing of the member’s healthcare visits,

date, visit type and facility

1213.PR.P.PP 12/13

Health Records

• Medications shows the member’s current medications and fill date

1213.PR.P.PP 12/13

Health Records

• Immunizations shows members’ current vaccinations, date of service, and place of service

1213.PR.P.PP 12/13

Health Records

• If the member has any lab work it would also so in this section

1213.PR.P.PP 12/13

Individual Authorizations

• When you click on the auth tab this will pull up

The authorization number is a link

1213.PR.P.PP 12/13

Authorization• Once you click on the authorization number this

will pull up

1213.PR.P.PP 12/13

Coordination of Benefits

• This screen shows if a member has a primary insurance

1213.PR.P.PP 12/13

Coordination of Benefits

• If they do not have primary it will show like below

1213.PR.P.PP 12/13

Claims on Individual Patient

1213.PR.P.PP 12/13

Secure Messaging

• If you have any questions or experience issues you can always use the Messaging. All messages are answered within one business day.

Click on Create Message to begin a new message.

1213.PR.P.PP 12/13

Secure Messaging

• There are many fields that can be filled in.

1213.PR.P.PP 12/13

Secure Messaging

• After you submit a message you will receive an email acknowledgement in the message center.

Pharmacy Benefits

Pharmacy BenefitsPharmacy - High-Level Overview Managed Health Services (MHS) has contracted with US Script to provide the

appropriate, high quality, and cost effective drug therapy to MHS HIP members. US Script will handle call inquiries for provider and pharmacies.

1-855-772-7121

www.usscript.com/contact For prior authorization questions providers should contact

1-855-772-7125

www.usscript.com/contact Acaria will handle specialty pharmacy

1-855-678-6976 (fax)

MHS works with providers and pharmacists to ensure that medications used to treat a variety of conditions and diseases are covered. MHS covers prescription medications and certain over-the-counter medications when ordered by an MHS provider. The pharmacy program does not cover all medications. Some require Prior Authorization or have limitations on age, dosage, and maximum quantities.

PDLPreferred Drug List

• Level of drug benefit dependent upon package

• Preferred Drug lists can be found on website at http://www.mhsindiana.com/for-providers/hip-pharmacy/

• Contact Pharmacy Benefit Manager (PBM) U.S. SCRIPT for approval for drugs that require a PA

• PA forms can be found on website at http://www.mhsindiana.com/for-providers/hip-pharmacy/

• Confirmation via Fax

• Denials only made by PharmD

Pharmacy Benefits

e-Prescribing Services

MHS will provide e-Prescribing services. e-Prescribing activity is supported by prescribing providers through web and office-based application. A provider can access the services through a secure sign-on via MHS web portal and notify participating pharmacies of a medication dispensing request.

• Provider Questions 1-877-647-4848– Eligibility, copays, claims, prior auth, etc

• Member Questions 1-877-647-4848HIP Payment issues, covered services, provider network, language assistance, scheduling transportation, etc

• mhsindiana.com• Me! Stephen Downing 317-684-9478 ext 20133

Trouble Shooting Issues:

Working Together

Outreach & EducationMHS is always working to meet our members where they live. We are creating,supporting and sponsoring various events and activities to engage with thecommunities we serve. If you have an event you would like MHS to attend orsupport please send a email with the event information tocegreer@mhsindiana.com.

MHS wants to provide you with tools and resources to educate your clients andcommunities on the insurance options available to them. We have developedorder forms that you can fill out and we’ll send you educational materials, at nocharge.

• Ambetter Order Form• Medicaid products Order Form

Community Outreach

Navigators Multicultural

Organizations Schools &

Educational Institutions

SponsorshipsHealthcare Providers

Faith Based Organizations Advocacy

Organizations

Community Organizations

Contact InformationManaged Health Services

1099 N. Meridian Street, Suite 400, Indianapolis, IN 462041-877-647-4848 • mhsindiana.com

Today’s PresenterStephen Downing, MHS Community Outreach Coordinatorsdowning@mhsindiana.com 317-684-9478 ext. 20133

MHS Member Services are available Monday through Friday, 8 a.m. to 8 p.m. at 1-877-647-4848

NurseWise nurse hotline is available 24/7 at 1-877-647-4848.

Hearing impaired should call the Indiana Relay Service at 1-800-743-3333. This number can be used anywhere in Indiana

Our staff is bilingual in English and Spanish. Interpretation services are available for other languages.