Convenience Care Clinics Expands Member Reminder …...Complete LP Member? With two different Dual...

For more information

Call our Provider Service Centerat 800-557-9933

Visit UHCCommunityPlan.com

In This Issue:

• Convenience Care Clinics ExpandsMember Services . . . . . . . . . . . . . . . . . 1

• Physician Satisfaction SurveyUnderway . . . . . . . . . . . . . . . . . . . . . . . 2

• Prompt Responses to MedicarePart D Prescription Appeals InquiriesEnsure Continuity of Care . . . . . . . . . 2

• New Clinical Guidelinesfor UnitedHealthcare CommunityPlan . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

• National Institute for MentalHealth Resources: Focus onMedications . . . . . . . . . . . . . . . . . . . . . 3

• When Forces Collide: TraumaticBrain Injury Masquerading asADHD in Adolescents . . . . . . . . . . . . 3

• UnitedHealthcare CommunityPlan Provider Portal Online-Authorizations and NotificationProcess . . . . . . . . . . . . . . . . . . . . . . . . . 6

• Getting Started with EDI is simple . . 7

Important information from UnitedHealthcare for physicians and other health careprofessionals and facilities serving UnitedHealthcare Medicaid members

Convenience Care Clinics Expands MemberServicesUnitedHealthcare Community Plan has recently expanded ourprovider network to include walk-in clinics at various TakeCareHealth Clinics (Walgreens) and Minute Clinics (CVS) stores inOhio, Texas, New York,Wisconsin, Mississippi and Delaware.When provided with primary care physician information, theconvenience care clinic will make every attempt to submitnotification to that primary care physician to ensure continuityand quality of care. Convenience care clinic staff do not assistpatients with referrals for specialty care services. Convenience careclinics treat patients over the age of 19 months and will not beoffering immunizations for the vaccine for children (VFC)program in this setting. Convenience Care Clinics offer extendedhours, and in most cases are open until 8:00 pm.

Some common conditions that can be treated in the conveniencecare clinics:

Vaccines• Flu (seasonal)• Hepatitis A (adult)• Hepatitis (adult)• Meningitis• Pneumonia• Td (Tetanus, Diphtheria)

Fall 2012

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Wisconsin | Winter 2012


Reminder Regarding UnitedHealthcare Coverage in Southeastern WisconsinEffective Nov. 1, 2012, UnitedHealthcare Community Plan no longer offers coverage to enrollees participating in BadgerCare Plus Standard and Benchmark Plans in Milwaukee, Waukesha, Racine, Kenosha, Ozaukee, and Washington Counties.

In This Issue:

• Reminder Regarding UnitedHealthcare Coverage in Southeastern Wisconsin ..............1

• System Error May Affect Payments Processing .......................2

• Dual Complete Member or Dual Complete LP Member? ...................3

• Synagis Prior Authorization Process .....................4

• Influenza Vaccination Update and Reimbursement Policy ..............4

• Electronic Data Interchange: Save Time and Money ....................5

• Quality Improvement Program .......6

• Inside the Star Rating Initiative With James Carney, MD, MBA ......7

• Cultural Needs ................................8

• Pharmacy Updates ..........................8

• Global Days Policy Reminder .........8

• Updated Information About 17 Alpha-Hydroxyprogesterone Caproate (17P) Injection .................9

• Recovery and Adherence ...............11For more information

Call our Provider Service Center at 877-651-6677

Visit UHCCommunityPlan.com

January 2012

Price

Dane

Polk

Clark

Vilas

Grant

Iron

Sawyer

Bayfield

Rusk

Oneida

Sauk

Douglas

Forest

Iowa

MarathonDunn

Taylor

Marinette

Dodge

Rock

Oconto

Wood

Jackson

BarronLincoln

Ashland

Monroe

Burnett

Vernon

Juneau

Portage

Chippewa

Shawano

Adams

Buffalo

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Waupaca

Washburn

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Walworth

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Waukesha

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Marquette

Washington

Kewaunee

Green

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Ozaukee

Milwaukee

UnitedHealthcare Community Plan Wisconsin Service Counties

Lake

http://UHCCommunityPlan.com

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Note: UnitedHealthcare will continue serving Medicaid SSI and BadgerCare Plus Core Plan (childless adult) members in Milwaukee, Waukesha, Racine, Kenosha, Ozaukee, and Washington Counties.

We continue to service members throughout the State of Wisconsin in our 47-county service area.

Please contact Provider Services at 877-651-6677 with any questions or concerns.

System Error May Affect Payments ProcessingUnitedHealthcare Community Plan in Wisconsin has discovered a system error resulting in a number of covered service codes being added to non-covered code/service denials. This may result in the denial of certain valid service procedure codes including some routine E&M codes.

The error occurred Oct. 24, 2012 and will affect claims processed on or after Oct. 25, 2012. You may see the effect in payments processed on Nov. 2, Nov. 9 and Nov. 16. We expect the error to be corrected on or before Nov. 19, 2012.

You will not need to resubmit or appeal claims affected by the error. As soon as the error correction is confirmed, UnitedHealthcare Community Plan will make the necessary claim adjustments for you. If you have additional questions or need assistance, please send them to [email protected] with attention to Camille Walton.

We sincerely apologize for the inconvenience caused by this error. We appreciate your understanding and patience while we make the necessary corrections.

WI - Winter 2012 Provider Service Center: 877-651-6677

Important information for health care professionals and facilities

I Fall 2012 2 Provider Service Center: 800-557-9933

Illnesses• Bladder infection treatment (females 12-65)• Bronchitis (ages 10-65)• Laryngitis• Ear infections• Pinkeye and styes• Sinus infections (ages five and up)• Strep throat• Swimmer’s ear

Skin Conditions• Athlete’s foot• Acne• Cold sores (ages 12 and up)• Deer tick bites (ages 12 and up)• Impetigo• Minor burns and rashes• Minor sunburn• Poison ivy (ages three and up)• Scabies• Shingles• Ringworm• Swimmer’s itch (ages three and up)

Other servicesFlu diagnosis (ages 10-64)• Mononucleosis• Pregnancy testing

Physician Satisfaction SurveyUnderway

The annual PhysicianSatisfaction Survey processhas begun, and you shouldhave received your first faxnotification. There willbe two more invitations toparticipate before thesurvey closes in October.

Your response letsUnitedHealthcareCommunity Plan know

how we can improve our working relationshipand better meet the needs of your practice. Welook forward to your participation in the surveyprocess.

Prompt Responses to Medicare Part DPrescription Appeals Inquiries EnsureContinuity of Care

When you or your patient, files an appeal withUnitedHealthcare, we will contact your office viafax or phone to request certain key informationneeded as part of the appeal process.

By federal law, UnitedHealthcare must render anappeal decision within 72 hours for an expeditedrequest and seven calendar days for a standardrequest.

Your assistance in responding to these requestspromptly helps ensure continuity of themember’s treatment plan.

New Clinical GuidelinesUnitedHealthcare Community Plan

UnitedHealthcare Community Plan Pharmacyand Therapeutic Committee has approved a newclinical guideline for Antiemetic ContinuousPump Therapy for the Treatment of Nausea andVomiting in Pregnancy.

Notification - Effective Oct. 1, 2012, the use ofAntiemetic Medication through a continuoussubcutaneous pump in the treatment of nauseaand vomiting in pregnancy will no longer becovered under UnitedHealthcare CommunityPlan.

Providers may request clinical review criteria bycontacting the Pharmacy Prior Notificationdepartment at 800-310-6826.



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WI - Winter 2012




















3 Provider Service Center: 877-651-6677

Health Plan (80840) 911-87726-04Member ID: Group Number:Member:

PCP Name:

PCP Phone: (999) 999-9999

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In an emergency go to nearest emergency room or call 911. Printed: 12/08/11

For Customer Service: 800-396-1942 TDD 711

Mental Health: 888-556-4059 TDD 711

For Providers : www.uhccommunityplan.com 877-651-6677Medical Claims:

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Pharmacy Claims: Prescription Solutions, PO Box 29045, Hot Springs, AR 71903For Pharmacists: 877-889-6510

This card doesn’t guarantee coverage. To verify benefits or to find a physician, visitwww.uhccommunityplan.com or call customer service Monday-Sunday 8:00 a.m. to 8:00 p.m.

PROVIDER BROWN

PO Box 5280, Kingston, NY 12402-5280

UnitedHealthcare Dual Complete® (HMO SNP)Administered by UnitedHealthcare of Wisconsin, Inc.

Dual Complete Member or Dual Complete LP Member?With two different Dual Special Needs Plans in Milwaukee – Dual Complete and Dual Complete LP - and member identification cards that look similar, UnitedHealthcare Community Plan wanted to point out how providers can differentiate

between plans. Identifying to which plan the member belongs at time of visit will ensure claims are paid accurately and on time. Please see the following examples highlighting the differences on the cards to help you identify the correct plan.


WI - Winter 2012





















Synagis Prior Authorization Process

• Health care providers contact the UnitedHealthcare Prior Authorization team by phone at 877-651-6677 or by fax at 800-897-8317.

• If the prior authorization is approved, the provider will work with Bioscrip, a national pharmacy provider, to have the prescription delivered to the office.

• The physician will submit a claim using code 90378 for reimbursement.

• Bioscrip will submit a claim using the same code and authorization for reimbursement.

• The Synagis Season Respiratory Syncytial Virus Enrollment form is available at UHCCommunityPlan.com in the Health Care Professionals section.


Influenza Vaccination Update and Reimbursement Policy

Reminder of Information from ForwardHealth

Vaccines for Children Age 18 or YoungerMost vaccines provided to members 18 years of age or younger are available through the federal Vaccines for Children Program (VFC) at no cost to the provider. Providers are required to use vaccines from the VFC supply for members 18 years of age or younger if they are available. UnitedHealthcare Community Plan reimburses only the administration fee for vaccines supplied by the VFC.




For vaccines that are not supplied by the VFC providers may use a vaccine from a private stock. In these cases, UnitedHealthcare Community Plan reimburses for the vaccine and the administration fee.

Vaccines that are commonly combined, such as MMR or DTaP, are not separately reimbursable unless the medical necessity for separate administration of the vaccine is documented in the member’s medical record.

Vaccines for Members Age 19 or OlderFor vaccines from a provider’s private stock that are administered to members 19 years of age or older, UnitedHealthcare Community Plan reimburses for the vaccine and the administration fee.

Home VaccinationHome health agencies may administer the influenza and

pneumococcal vaccines to members who they are currently serving when there is a physician order for the vaccination.

A nurse is required to administer the vaccine during an already scheduled home health skilled nursing visit. Wisconsin Medicaid does not reimburse for a home health skilled nursing visit if administration of the vaccination is the only purpose for the visit.

Electronic Data Interchange: Save Time and MoneyDid you know by converting 10,000 paper claims, remittance advice, and reimbursements to electronic transmittal (EDI, EFT, and ERA) we could:

• Save 3,729 pounds of paper• Eliminate 148,389 pounds of

greenhouse emissions (Equivalent to 1726 new trees grown for 10 years or 20,451 square feet of forest conserved)

• The average practice can save thousands of dollars per year by converting to electronic transmission.Source: payitgreen.org

Getting Started With EDI is Simple To submit claims electronically simply contact your clearinghouse or software vendor and request that Primary and Secondary UnitedHealthcare Community Plan claims be sent electronically. UnitedHealthcare Community Plan claims Payer ID is 87726.

Submit Claims Directly to UnitedHealthcare Community Plan You can access our Secure Provider Portal by visiting the claims and member section of your state’s home page located on UHCCommunityPlan.com. There is no cost for this service.

COB (Secondary) EDI Claims Submissions are Preferred Electronically

• Please visit the EDI section of your state’s home page and reference the 837 Companion Guide located on UHCCommunityPlan.com. Share the setup guidelines with your clearinghouse or software vendor.

• Do not send paper claim backup for claims that have already been submitted electronically.

Receive Payment for Claims Electronically (EFT)EFT is safe, secure, efficient, and more cost effective than paper claim payments.





















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http://payitgreen.org




If you would like to save money and time, enroll today! Enrollment forms can be found within the EDI section of your state’s home page located on UHCCommunityPlan.com.

Receive Remittance Advice Electronically (ERA)To enroll in ERA contact your software vendor and/or clearinghouse. UnitedHealthcare Community Plan ERA Payer ID is WID01.

UnitedHealthcare Community Plan now offers Real-time 270/271 Electronic Health Care Eligibility Inquiry and Response Transactions and Real-time 276/277 Electronic Health Care Claim Status Inquiry and Response Transactions as a quick and easy way to streamline administrative tasks.

This information is also available through the Secure Provider Portal and by phone; however, real-time transactions save your office that added step.

Please see the Companion Guides located within the EDI section on your state’s home page on UHCCommunityPlan.com for setup guidelines.

For additional information please contact OptumInsight HIN Sales Team at 800-341-6141 option three.

Electronic Claim Submission Tips• Include your tax identification number

(TIN) along with your NPI number. • Member ID numbers are required. • The Payer ID number indicates where

clearinghouses should direct their claims.

Quality Improvement ProgramTo continuously improve the care and services provided to members, UnitedHealthcare Community Plan uses Healthcare Effectiveness Data and Information Set (HEDIS) reporting to measure our health care performance. HEDIS is a set of standardized performance measures that are related to many significant public health issues. Nationwide, our HEDIS 2012 scores demonstrated improvements in the number of our adult members who had their body mass index (BMI) screened, an increase in follow-up visits following hospitalizations for mental illness, and an increase in diabetic HbA1c and LDL testing.

UnitedHealthcare Community Plan will continue to target multiple areas for improvement through national initiatives including, the number of yearly well-visits received by children ages three to six, the number of timely prenatal and postpartum visits, and proper patient use of asthma medications.

We also conduct annual member surveys to see how well we are meeting our members’ needs. Our 2011 Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys showed improvement in how our members rate their personal doctor, the specialists they see most often, and their overall health care. Members told us that they want it to be easy to get approvals for the tests and treatments they need through their health plan. We listened and are working to improve processes in our prior authorization center.

If you would like further information about our Quality Improvement Program, our annual goals or our progress towards meeting our goals, please call 888-362-3368.





















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Inside the Star Rating Initiative With James Carney, MD, MBAAs UnitedHealthcare’s National Medical Director for Physician Engagement for Medicare Solutions, Dr. Carney plays a lead role with others in developing and communicating strategies to aid physicians in supporting their patients to live healthier lives and manage chronic conditions by obtaining recommended preventive care screenings.

Why Star Ratings Matter for Quality of Care “UnitedHealthcare’s mission is to help people live healthier lives. The Centers for Disease Control and Prevention (CDC) report that screenings and preventive care services continue to be under-utilized. Star ratings emphasize patient care and satisfaction, using national clinical quality measures – including

screenings and preventive care and service quality measures – as well as patient feedback, so that health plans, physicians and members can work together to improve individual and total population quality of care and experiences,” said Dr. Carney.

UnitedHealthcare Approach According to Dr. Carney: “UnitedHealthcare has dedicated enterprise-wide resources and personnel to work together to create a proactive member engagement, physician engagement and operational excellence approach to support Star Ratings improvement.

This initiative promotes transparency about Star Ratings and is intended to provide physicians with information, tools such as View 360, and incentives that support the additional time and resources they need to strengthen the physician-patient relationship and to help them deliver high-quality, comprehensive, affordable health care services.

Our approach is patient-centered and focuses on coordinated care for members to help them understand their benefits and receive the care they need to live healthier lives.”

About Dr. CarneyDr. Carney began his career in the National Health Service Corps as an internist working in under-served communities in Kentucky and Maryland. Later, he practiced in a staff model HMO and then a small group practice in Delaware and Pennsylvania. He lives in Richmond, Virginia with his wife and is the father of two adult daughters.

To live a healthier life, Dr. Carney plays golf and tennis. His personal health goals include: maintaining a healthy body weight and an acceptable cholesterol profile to lower the risk for coronary artery disease; eating a well-balanced diet; and promoting overall physical mobility in order to stay active.





















7

A few reminders follow:

• Pre-Operative Visits are not separately reimbursable services when performed within the assigned global period.

• Major Procedures: 90-day global value begins with the day before surgery.

• Minor Procedures (global value other than 90 days): Global period begins the day of surgery.

• Complications following a procedure, including all additional medical and/or surgical services required of the physician (not resulting in a return trip to the operating room) that occur within the designated global period are included in the Global Package.

• Procedures having a zero-, 10- or 90-day global value that are performed during the post-operative period of a procedure having a 10- or 90-day global value are considered to be included in the Global Package of the initial procedure unless an appropriate modifier is appended.

• 58 – Staged or related procedure or service by the same physician during the post-operative period.

• 78 – Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the post-operative period.

• 79 – Unrelated procedure or service by the same physician during the post-operative period.


Cultural NeedsAt UnitedHealthcare Community Plan we believe our members have the right to receive care that is culturally competent and respects their cultural and ethnic backgrounds and origins. Primary language information is obtained from members when they enroll and they are assisted in choosing a Primary Care Physician (PCP) who will meet their cultural needs. UnitedHealthcare provides access to a language line for translation of communication between UnitedHealthcare staff and non-English speaking members. The language line use is tracked by the Customer Service Center and reported regularly to the health plan. Each health plan then assesses its practitioner availability to insure that the cultural, ethnic, racial, and linguistic needs of its members are being met.

The Provider Directory is available at UHCCommunityPlan.com and lists the languages spoken in provider offices.

Pharmacy UpdatesPharmacy Updates are available at UHCCommunityPlan.com. The pharmacy hotline is 800-922-1557.

Global Days Policy Reminder If you have received a denial for ‘Payment Being Included in Allowance for Another Service’ before filing an appeal, please reference the Global Days Policy. The full plan is available online at UHCCommunityPlan.com/assets/Global-Days-Policy-(R0005)-1-1-11.pdf.





















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http://UHCCommunityPlan.com/assets/Global-Days-Policy-(R0005)-1-1-11.pdf

http://UHCCommunityPlan.com/assets/Global-Days-Policy-(R0005)-1-1-11.pdf



• Services of physicians and other health care professionals of the same specialty within and using the same federal tax identification number are deemed as performed by the same physician providing global period services.

UnitedHealthcare Community Plan Evaluation & Management Services included in the global period are listed within policy as well as the global day values. If you have any questions, please contact Provider Services at 877-651-6677 or your local Provider Advocate.

Updated Information About 17 Alpha Hydroxyprogesterone Caproate (17P) Injection

UnitedHealthcare Community Plan has updated its drug policy for use of 17 alpha-hydroxyprogesterone caproate (17P) injection, encompassing both the compounded drug and Makena, effective Oct. 1, 2012.

UnitedHealthcare’s Policy Regarding Compounded 17P and Makena

UnitedHealthcare understands the importance of access to 17P and we continue to support the physician’s discretion to use either compounded preservative-free 17P if the prescribing practitioner has determined that a compounded product is necessary for the particular patient and would provide a significant difference for the patient as compared to the FDA-approved commercially available drug product, or Makena.

Relying on evidenced-based medicine and outcomes-based research, UnitedHealthcare

has updated its drug policy for use of 17 alpha-hydroxyprogesterone caproate (17P) injection, both the compounded drug and Makena, effective Oct. 1, 2012. This policy applies to Commercial, Medicare and Community Plan business.

Options for Providing 17P to Your Patients Who Are UnitedHealthcare Community Plan Members

• State Fee-for-Service Pharmacy Program Some members of UnitedHealthcare Community Plan have pharmacy benefits that are not processed through UnitedHealthcare Community Plan, but through the state’s fee-for-service program. Providers in Louisiana, Tennessee and Wisconsin should contact your state Medicaid agency to determine the state’s requirements, preferred pharmacy vendor and process for ordering 17P or Makena.

• Home Health Services UnitedHealthcare has a preferred relationship with the Women’s and Children’s Health division of Alere Health. This home health service offers a compounded, preservative-free 17P administration program, which includes in-home obstetric nurse administration, education about the risk factors and signs and symptoms of preterm labor, weekly assessments and 24/7 NurseLine support. For more information please contact Alere at 800-950-3963 or alere.com.

• Buy-and-Bill for Compounded 17P Compounded, preservative-free 17P can be located in your area by calling or visiting the International Academy of Compounding Pharmacist Locator Service at 800-927-4227 or iacprx.org. Compounding pharmacies will continue to compound 17P as long as the prescribing practitioner has determined and documented that a compounded product is





















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http://www.alere.com/us/en.html

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WI - Winter 2012























necessary for the particular patient and would provide a significant difference for the patient as compared to Makena.

• Reimbursement for Buy and Bill for Compounded 17PFor providers who administer compounded, preservative-free 17P in their office through the buy-and-bill process, reimbursement is achieved by submitting a medical claim for the medication HCPCS code-J2675 progesterone injection, per 50 mg (bill 5 units per injection-250 mg/injection) with the CPT code-96372 for therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular, and the diagnostic code V23.41- supervision of pregnancy with history of preterm labor. Please contact your local provider relations representative or call provider services if you have questions about reimbursement.

• Pharmacy Direct Bill UnitedHealthcare Community Plan for MakenaMakena can be obtained from either Prescription Solutions by OptumRx, or CVS Caremark Specialty Pharmacy, depending upon the state. Please refer to the table.

Makena Vendors – UnitedHealthcare Community PlanPlease consult the table below to determine which pharmacy is the designated UnitedHealthcare Community Plan vendor for Makena in your state.

Contact informationCVS Caremark Specialty Pharmacy phone: 800-237-2767 fax: 800-323-2445Prescription Solutions by OptumRx phone: 888-293-9309 fax: 800-853-3844

State VendorArizona OptumRx

Delaware CVS Caremark Specialty Pharmacy

District of Columbia CVS Caremark Specialty Pharmacy

Florida CVS Caremark Specialty Pharmacy

Hawaii CVS Caremark Specialty Pharmacy

Iowa OptumRx

Kansas OptumRx Effective Jan. 1, 2013

Louisiana Contact State Medicaid Agency

Maryland OptumRx

Michigan OptumRx

Mississippi CVS Caremark Specialty Pharmacy

Nebraska CVS Caremark Specialty Pharmacy

New Jersey OptumRx

New Mexico OptumRx

New York CVS Caremark Specialty Pharmacy

Ohio CVS Caremark Specialty Pharmacy

Pennsylvania CVS Caremark Specialty Pharmacy

Rhode Island OptumRx

South Carolina CVS Caremark Specialty Pharmacy

Tennessee Contact State Medicaid Agency

Texas CVS Caremark Specialty Pharmacy

Washington OptumRx

Wisconsin Contact State Medicaid Agency



Prior AuthorizationUnitedHealthcare Community Plan requires prior authorization for compounded 17P or Makena whether administered in the office or by a home health service.

• Prior Authorization for Compounded 17P Please submit the UnitedHealthcare Community Plan’s standard medical prior authorization form with supporting documentation (documents regarding prior premature deliveries [e.g., delivery notes, discharge summaries that state gestational age at time of delivery, the reason for the premature birth], current gestational age) to the fax number listed on the form. If authorized, you will be issued an authorization number that you will need to provide to the pharmacy.

• Prior Authorization for MakenaPlease submit UnitedHealthcare Community Plan’s standard medical prior authorization form with supporting documentation (documents regarding prior premature deliveries [e.g., delivery notes, discharge summaries that state gestational age at time of delivery, the reason for the premature birth], current gestational age) to the fax number listed on the form. If authorized, you will be issued an authorization number that you will need to provide to the pharmacy.

Upon completion of the manufacturer’s standard Makena Referral/Prescription form, place the authorization number on the top and submit via fax to the specialty pharmacy provider identified for your state (see table on page 10). These specialty pharmacy providers will bill UnitedHealthcare Community Plan directly.

Direct Billing For a complete list of pharmacies that will ship to you and bill UnitedHealthcare Community Plan directly and for more information on this policy, go to UnitedHealthcare Community Plan 17P and Makena Drug Policy.

Recovery and AdherenceClinicians want individuals in their care to get better and believe that if the treatment plans they offer are followed their patient’s condition will improve. Yet treatment plans don’t work when patients don’t adhere to them. The connection between a lack of adherence and negative outcomes seems obvious, yet the World Health Organization (2003) states that for chronic illness, only 50 percent of patients adhere to their long-term therapy in developed countries.

Do the principles of recovery and resiliency offer any insights and support to approaching this problematic disconnect? There are several insights that can be adapted in most practices to help bridge this gap.

Focus on Strengths, GoalsSpend time on where patients are going and not where they are stuck.

A recovery-directed conversation with a patient focuses on individual strengths and personal goals rather than symptom severity or being sick. A conversation that focuses primarily on symptoms may further the negative self-image and sense of hopelessness contributed to chronic illnesses. When a conversation includes a clear focus on the patient and their personal goals, and frames medication as one strategy toward meeting those goals, the individual is often more motivated and hopeful.





















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Educate More, Direct LessA recovery-oriented interaction in each appointment provides education on treatment — including addressing widely held, but inaccurate beliefs about medication. Of critical importance is putting written educational materials in patients’ hands. Written material supports different learning styles and affords an opportunity to easily share information with support networks.

Acknowledge Challenges and Invite ParticipationIt helps for patients to hear that many people find it very hard to take medicine regularly. Let them know that you want to hear the particular challenges they face in using medicine as a tool in their recovery plan. Inquiring about challenges lets patients know that you are committed to working with them toward solutions.

Support Engagement Through Tools and Community Resources Engagement is not synonymous with compliance. Compliance means an individual obeys a directive from a health care provider. Engagement signifies that a person is involved in a process through which he harmonizes robust information and professional advice with his own needs, preferences and abilities in order to prevent, manage and cure disease1.

Connecting members to local community resources can reduce isolation and increase treatment adherence. Links to reputable support groups can be found on our member portal. Tools like the Wellness Recovery Action Plan® (WRAP) have been shown to significantly enhance skills for coping with prodromal symptoms, use of wellness tools in


their daily routines, and hope for recovery2. A free version of WRAP can be downloaded from the Substance Abuse and Mental Health Services Administration (SAMHSA) website.

SAMHSA recently issued this definition of recovery:

A process of change through which individuals improve their health and wellness, live a self-directed life and strive to reach their full potential.

SAMHSA further states:

Recovery involves individual, family, and community strengths and responsibility: Individuals, families, and communities have strengths and resources that serve as a foundation for recovery. In addition, individuals have a personal responsibility for their own self-care and journeys of recovery. The full article is available on the SAMHSA blog posting March 23, 2012.

These four simple tips reflect a recovery-oriented way to support increased adherence while building a treatment plan that incorporates the patient’s own strengths and goals and providing them with the information and support they need to achieve those goals.

By Sue Bergeson, Vice President of Consumer Affairs

1 A New Definition of Patient Engagement: What is Engagement and Why is it Important?, Center for Advancing Health © 2010 http://www.cfah.org/pdfs/CFAH_Engagement_Behavior_Framework_current.pdf.

2 Cook, J. A., Copeland, M. E., Hamilton, M. M., Jonikas, J. A., Razzano, L. A., Floyd, C. B., et al. (2009). Initial outcomes of a mental illness self-management program based on Wellness Recovery Action Planning. Psychiatric Services, 60(2), 246-249.





















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http://www.cfah.org/pdfs/CFAH_Engagement_Behavior_Framework_current.pdf

http://www.cfah.org/pdfs/CFAH_Engagement_Behavior_Framework_current.pdf

Wisconsin

Provider Service Center: 800-557-9933

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

M47507MS 8/12 © 2012 UnitedHealth Group, Inc. All Rights Reserved.

795 Woodlands ParkwaySuite 301Ridgeland, MS 39157


UnitedHealthcare Community Plan now offers Real-time 270/271 Electronic Health Care EligibilityInquiry and ResponseTransactions and Real-time276/277 Electronic Health Care Claim Status Inquiryand ResponseTransactions as a quick and easy way tostreamline administrative tasks..

This information is also available through the SecureProvider Portal and by phone, however real timetransactions save your office that added step.

Please see the Companion Guides located within theEDI Section on your State’s home page onUHCCommunityPlan.com for setup guidelines.

Electronic Claim SubmissionTips• Include your tax identification number (TIN) alongwith your NPI number.

• Member ID numbers are required.

• The Payer ID number indicates where clearinghousesshould direct their claims.

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M47507WI 11/12 © 2013 UnitedHealth Group, Inc. All Rights Reserved.

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

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