2018 IHCP Annual Workshop - IN.gov• Member Health Profile • Quality Reports • Portal...
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Providing health coverage to Indiana families since 1994 2018 IHCP Annual Workshop MDwise Provider Portal HHW-HIPP0583 (9/18)
Transcript of 2018 IHCP Annual Workshop - IN.gov• Member Health Profile • Quality Reports • Portal...
Providing health coverage to Indiana families since 1994
2018 IHCP Annual Workshop
MDwise Provider Portal
HHW-HIPP0583 (9/18)
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• MDwise History
• Updates
• Provider Page
• Accessing the Portal
• Eligibility
• Claim Status
• Member Health Profile
• Quality Reports
• Portal Registration
• Helpful Hints
• Resources
• Questions
Agenda
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• 1994: MDwise founded as Indiana-based nonprofit health care company
Central Indiana Managed Care Organization, Inc. (CIMCO), utilizing a
delivery system model
• 2001: CIMCO teamed up with IU Health Plan and formed into
MDwise, Inc., serving more than 55,000 Hoosier Healthwise members.
• 2007: MDwise begins service Care Select (now Hoosier Care Connect)
members
• 2007: MDwise selected to provide care through the Healthy Indiana
Plan
• 2018: MDwise acquired by Michigan-based McLaren Health Care; one
of Michigan’s largest integrated health systems
MDwise History
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McLaren Health Care:
• Is one of the largest integrated health care systems in Michigan
• Owns 15 hospitals, including Barbara Ann Karmanos, nationally
renowned for their cancer care and outcomes
• Employs over 500 physicians
• Trains over 550 residents annually
• Has a workforce of over 20,000
• Owns McLaren Health Plan, who covers over 265,000
members in Medicaid, commercial, and Medicare Supplemental
markets.
Who Is McLaren Health Care?
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• Sharing Best Practices between MDwise and McLaren Health
Plan, such as:
– Care Management
– Opioid Crisis Management
– Effectively managing inappropriate ER utilization
– Streamlining Prior Authorizations
– Pay for Value Physician Incentive programs
– Claims adjudication
• Results are Demonstrating:
• Improvement in health care outcomes for our members
• Enhanced access for members
• Greater administrative efficiencies, which allow more health care dollars
to be spent on the actual delivery of medical care
MDwise – McLaren Synergies
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Effective 1/1/19:
• MDwise is restructuring it’s Delivery System model to:
– Improve claim payment timeliness and accuracy
– Streamline and reduce administrative redundancy for providers
– Provider greater access for our members
• One standard authorization list
• One point of contact for all authorization requests
• One claim submission address
• Non-Excel Delivery System contracts
– Providers not contracted with MDwise Excel must contract to
stay in network.
Updates
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Updates
Effective 1/1/19:
Eligibility:
When determining eligibility, verify:
• Is the member eligible for services today?
• Which Indiana Health Coverage Program plan are they enrolled?
• If the member is in Hoosier Healthwise or Healthy Indiana Plan, are they
assigned to MDwise?
• Who is the member’s Primary Medical Provider (PMP)?
Provider Healthcare Portal MDwise Provider Portal
• IHCP Program • Delivery System: MDwise Excel
• MCE • Assigned PMP History
• Assigned PMP
• Delivery System: MDwise Excel
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Effective 1/1/19
• One standard authorization list
• One point of contact for all authorization requests
• Submission timelines and process will not change
• Go to MDwise.org for most up-to-date version of PA lists
Prior Authorization
MDwise.orgFor
ProvidersForms
Prior Authorization
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Provider Page
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Provider Page
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Provider Page Features:
• Provider Manuals
• Department Forms
• Pharmacy Resources
• Quality Education Materials
• Contact Guides
• New and Announcements
• Provider Portal Access
• ProviderLink Newsletter
• How to Become a MDwise Provider
• Prior Authorization Lists
• Continuing Education Materials
Provider Page
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Why use the Provider Page?
• Updated versions of forms
• Updated contact guides
• Access to archived materials
• Learn how to earn incentives through Quality
• Print resources for your office to educate members on:
– Smoking Cessation
– Behavioral Health
– Diabetes
– Pregnancy
Provider Page
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How to access the Provider Portal
Accessing the Portal
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Accessing the Portal
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• Access your Portal Profile
• Request an Account
• View Sign-up Guide for Questions
Accessing the Portal
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Features of the MDwise Portal
• Claim Status
• Claim Payment Information
• Member Eligibility
• Quality Reports
• PMP Member Rosters
• Member Health Profile
• Care Management/Disease Management (CM/DM) Request Form
• Secure Messages for Provider Relations
Accessing the Portal
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Accessing the Portal
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• Verifying Eligibility
Eligibility
• Search by member RID or SSN
• Original effective date
• Eligibility Status
• PMP History
• Claim history for last 150 days
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Tip: Search claims by member RID and date of service to see status on
all claims submitted for this date (paid, denied, duplicate, pended)
Claim Status
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• MDwise Provider Portal
Claim Status
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• The Member Health Profile (MHP) is an online tool to help
registered in-network PMP’s and specific Behavioral Health
providers with coordination of care.
• Allows the primary medical provider (PMP) and behavioral
health (BH) provider to view their members medical and
pharmacy claims for all of doctors that see the member.
• The information is displayed in one interface and can be
printed.
• PMP’s can use this information to identify the gaps in care and
better manage the members overall care plan.
Member Health Profile
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How to Request Access to Member Health Profile:
• Complete our online request form
• Only PMP NPI’s should be used, Specialists/non-PMP’s will not be
able to lookup users in the Member Health Profile.
• Allow 5-7 business days for processing
• If providers have technical issues getting registered or accessing the
profile, please send an email to [email protected].
– Please note:
• This is not for claims questions.
• Do not send any PHI
Member Health Profile
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Member Health Profile
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Member Health Profile
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Member Health Profile
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Online Reports
Quality
• Quality Reports • Members in need of services • PMP Panels
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Comparison Report
• Compares individual provider office performance to all of MDwise.
Missed Opportunities Report
• Shows opportunities at member appointments that were missed.
– Example: An acute visit that can also count toward a well visit.
Year to Date Report
• Shows where your office is compared to the previous year.
Quality
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Quality
Request Access
• Complete required fields and submit
• Access granted within 2-3 business days
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Resources
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Resources
Representative Territory Phone Email
Paulette Means Region 1 317-822-7490 [email protected]
Garrett Walker Region 2 317-983-6088 [email protected]
Michelle Phillips Region 3, Hospice, Home Health
317-983-7819 [email protected]
Jamaal Wade Region 4 317-822-7276 [email protected]
David Hoover Region 5 317-983-7823 [email protected]
Tonya Trout Region 6 317-308-7329 [email protected]
Rebecca Church Region 7 317-308-7371 [email protected]
Sean O’Brien Region 8 317-308-7344 [email protected]
Whitney Burnes Region 9 317-308-7345 [email protected]
Nichole Young Behavioral Health(CMHC, OTP, IMD or Residential)
317-822-7509 [email protected]
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MDwise Customer Service
• 1-800-356-1204
MDwise Provider Relations
• 317-822-7300 ext. 5800
• Enrollment submissions & updates go to [email protected]
Provider Relations Territory Map
• http://www.MDwise.org/for-providers/contact-information/
MDwise Website
• www.MDwise.org
Resources
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Questions
