Updates & resources for providers from Molina Healthcare ......iTunes store or get it on Google ......
Transcript of Updates & resources for providers from Molina Healthcare ......iTunes store or get it on Google ......
Dora Wilson
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Updates & resources for providers from Molina Healthcare of South Carolina
Get connected to Molina with
Palmetto Partners
There's a wealth of information forSouth Carolina health care
providers in this third edition ofPalmetto Partners. But you canbenefit even more from receivingthe free enewsletter version ofPalmetto Partners, which allowseasy access to helpful links and
expanded content. You may have already received theenewsletter at the end of June. Ifnot, we encourage you to sign up
for "edelivery." It's moreconvenient, and you will get more
out of it.Just see our notes at the end of
this edition to see how you can joinour growing distribution list for
Palmetto Partners.
Handy health app
Molina has a new mobile app for
Medicaid members.The HealthInHand app allows
them to manage their health infoon personal devices.
They can download it through theiTunes store or get it on Google
Play. An Android app will be available by
summer's end.
June/July 2017
From the desk of our chief operating officer
With four children in elementarythrough high school, my family savorsthe start of summer. But even though itfeels like classes just ended, it'salready the season to schedule backtoschool wellvisits. At Molina Healthcare of SouthCarolina, we encourage providers totake full advantage of this excellentwindow of opportunity to make surepatients are on track for a brightfuture, from the time they are babiesthrough those late teen years, when wellvisits tend to fall offbut are still important. With this edition of Palmetto Partners, you can learn moreabout incentives that MHSC offers including those tied towell visits as we work together to eliminate gaps in care. We also share additional opportunities for us to support eachother including free online CME courses that Molina hasintroduced for providers to learn more about how to properlydocument health conditions. We hope you will take advantage of these convenient coursesand all the valuable information we offer here. After all, weshould never stop learning and making progress even as wesavor these summer days. Sincerely,Dora Wilson, Chief Operating OfficerMolina Healthcare of South Carolina
Career highlights: Dora Wilson
Dora has served as COO of MHSC for three years. She cameto the position with 20 years of payor and provider managedcare experience in both government and commercialinsurance programs. That includes serving as executive VP ofHealth Plan Services for Avesis where she administered itsnational dental, vision and hearing benefit plan and COO ofthe Georgia and Kentucky markets for WellCare Health Plans.Dora also worked at Children's HealthCare of Atlanta andHumana. She has a BA from Florida State University.
Workout Wednesday
Time to join the Molina Healthcare
Movement!
This summer, Molina is giving
away more than a thousand prizes
to the public including Amazon
gift cards and Fitbit Workout Kits
to encourage people to get
moving midweek. You may have
heard about it on the radio.
Make sure to go to
MolinaWorkoutWednesday.com
for details.
Share your photos with both
#WorkoutWednesday and
#MolinaSweepstakes on
Facebook, Instagram and Twitter.
You can enter every week to win.
Partners in Care
offers expanded content
The latest edition of Molina's in
depth newsletter for providers
Partners in Care is available
under the Communications tab of
the providers section of
MolinaHealthcare.com, where
you can find an archive of our
newsletters.
This issue of Partners in Care
includes articles on complex case
management,
practitioner credential rights and
other important topics.
MHSC 2017 Community Champions
Molina spotlights incredible efforts of volunteers
MHSC Plan President Tom Lindquist, top left, with honorees.
Molina Healthcare of South Carolina honored its 2017 CommunityChampions April 27 with a dinner reception at EdVenture Children'sMuseum in Columbia. These extraordinary volunteers selected nonprofits to receive $1,000 grants, which Molina gave in their honor.Standing with our plan president, from left to right, they include:
Lydia Cotton of North Charleston Art Pot MulticulturalCenterRonald Bessant of Loris Chesterfield Missionary BaptistChurch and Mt.Calvary Missionary Baptist ChurchMarjorie Boafo Appiah of Spartanburg Spartanburg CountyFoundationKenneth Joyner and Raymond Nelson of Charleston Boyswith a PurposeKathy Brown of Columbia Community Resources Depot,Inc.Glenn and Dr. Cara O'Neil of Columbia Cure SanfilippoFoundationDr. March E. Seabrook of Columbia Center for ColonCancer Research at University of South Carolina
Pharmacy Corner
Getting complete info even more vital now
Because of changes in federal regulations,effective July 1, 2017, the coveragedetermination turnaround time is within 24hours upon receipt for medicationsrequiring prior authorization. It is vital that you send applicable and current chart/clinic notes,lab/test results, etc. to accompany your initial faxed priorauthorization request form. Coverage determinations will be basedupon the initial information submitted and received. The fax numberto MHSC's Pharmacy Services Department for prior authorizationrequests is (855) 5713011. Note: This change does NOT apply to J code medications submittedto the Healthcare Services UM department fax number: (866) 4233889.
Special Report: Backtoschool well visits & HPV vaccinations
Attention all superheroes: Tap into your lifesaving prevention powers this summerHow does your appointment calendar lookthrough August? If you care for patients age21 or under, we hope it is filling up with wellvisits.The break in the school year is a greattime for kids to see their primary careproviders and for you to make sure yourpatients receive preventive services. Whenpatients wind up visiting for other reasons,maybe for a sports physical or just becausethey are sick, please seize the opportunity toexpand the consultation into a wellvisit andtake care of any unmet needs in theircare, including vaccinations if appropriate. Did you know that Molina offers incentives toproviders for comprehensive well visits andcounseling for nutrition and activity? We faxed providers information about these wellvisit incentives earlier this year. Ifyou have questions about the incentives or need details, contact your provider services representative at MHSC, or ourQuality Department at [email protected]. Strengthen the fight against HPV with wellvisit vaccinations
This summer, MHSC joins the National HPV Vaccination Roundtable campaignto promote HPV vaccinations, which can protect young people for the rest of theirlives against sexually transmitted viruses that might lead to several kinds ofcancer in adulthood. HPV vaccination increases fivefold in August with backtoschool appointments. But we can do better. Key messages to share with yourteam of superheroes:
Consistency is magic: Establish a policy to reduce missed HPVvaccination opportunities.Knowledge is power: Be prepared with answers to succinctly, accurately and compassionately inform parents.Be a super team: Make sure everyone in your practice knows the importance of HPV vaccination. Don't leaveanyone out.
Get your patients vaccinated before they turn 13
A health care provider's recommendation is the single most persuasive reason children get vaccinated.Boost the effectiveness of your recommendation:
Recommend the HPV vaccine for all boys and girls at 11 or 12 years of age the same day, same way yourecommend other vaccines.Try saying, "Your child needs three vaccines today: Tdap, HPV, and meningococcal," or "Today your child shouldhave three vaccines. They're designed to protect your child from the cancers caused by HPV, meningitis, tetanus,diphtheria, and pertussis."Schedule followup appointments for the next doses before the patient leaves your clinic. Remind parents whenit's time for the next doses of the vaccine or the vaccine is overdue for their child. Ensure your privacy statementincludes phone, mail, email and text message as options for communication.
American Cancer Society action guide
Email [email protected] for a copy of "Steps for Increasing HPV Vaccination in Practice."
Staying connected
Before you send mail to Molina Healthcare, make sure you use the right address
All hard copy claims to include new claims, corrected claims or previously denied claims that need an explanation ofbenefits (EOB) from the primary payer should to be mailed to our corporate headquarters:
Molina HealthcareP.O. Box 22664Long Beach, CA 90801
Otherwise, please send correspondence about provider appeals to the following:
Provider Inquiry Research & ResolutionMolina Healthcare of South CarolinaP.O. Box 40309North Charleston, SC 294230309(877) 9018182 fax
Help provide us with uptodate directory information about your practice
We want to make sure demographic details we have on file for you and your practice accurately reflect the following:
Office location, office hours, phone, fax, or emailAddition or closure of office locationAddition or termination of a providerChange in Tax ID and/or NPIOpening or closure of your practice to new patients (primary care providers only)
Please notify Molina Healthcare at [email protected] or by fax at (844) 3052343 atleast 30 days in advance if you have changes like these. If you aren't sure whether we have uptodate directory info foryour practice, we would also love to hear from you. Meanwhile, Molina has put together a special team to reach out andverify contact info we have for practices in South Carolina. Please welcome their requests so we can stay connected andprevent possible glitches, for example, with payments.
Molina offers free continuing medical education for primary care providers
Molina Healthcare is launching online courses to help providers properlydocument health conditions. Learn skills you'll use every day and earnCME credit with these courses, which were created in partnership with theUniversity of California, Irvine. The first module zeroes in on DiabetesMellitus Documentation. Sign up now to:
Ensure your patients receive evidencebased careAccurately report HEDIS® measures more easily than everBecome an expert in approved documentation codes and improveHEDIS® scoresUpon course completion, receive CME credit plus maintenance ofcertification (MOC) for internal medicine board certification.
To get started or learn more, email your NPI numberto [email protected].
Join with Molina Healthcare in guarding against fraud, waste and abuse
Molina maintains a comprehensive Fraud, Waste, and Abuse program. Molina is dedicated to the detection, prevention,investigation and reporting of potential health care fraud, waste and abuse. Molina's Special Investigation Unit supports compliance in its efforts to deter and prevent fraud, waste and abuse byconducting investigations to identify and report findings to the appropriate regulatory and/or law enforcement agencies.The program also addresses fraud prevention and the education of appropriate employees, vendors, providers andassociates doing business with Molina and/or those serving our members. If you have concerns or something to report, Molina AlertLine can be reached toll free at (866) 6063889, or you may usethe service's website to make a report at any time at MolinaHealthcare.AlertLine.com.
Behavioral healthcare
State benefits to include psychiatric residential treatment and autism services
Effective July 1, 2017, the South Carolina Department of Health andHuman Services (SCDHHS) includes psychiatric residential treatmentfacility (PRTF) services as part of the Medicaid managed care benefit. Providers will be required to file claims for PRTF services to managedcare organizations (MCOs) for enrolled members. Providers must verifyeligibility and contact the applicable MCO for prior authorization, whenrequired, before rendering services. Both Medicaid and managed careeligibility can be verified at the SC Medicaid Web Portal. Additionally, effective July 1, 2017, the South Carolina Title XIX StatePlan includes covered autism spectrum disorder (ASD) services formedicallyeligible individuals up to 21 years old. These services are intended to provide medicallynecessary and evidencebased behavioral and psychologicaltreatment to individuals with a confirmed diagnosis of ASD. These services may be provided in the member's home, intheir community, in their school or in a psychiatric residential treatment facility (PRTF).
Tap into community resources for help with mental illness and chemicaluse disorders
It can be difficult to find additional help for your patients struggling with behavioral healthcare needs. Other resources inthe community besides community mental health centers, treatment centers and clinics can provide additionalassistance for patients and families. Below is a list of some of organizations, unrelated to Molina Healthcare, wherepatients can seek additional support.
The National Alliance on Mental Illness (NAMI) is "the nation's largest grassroots mental health organizationdedicated to building better lives for the millions of Americans affected by mental Illness." NAMI provideseducation, advocacy, and support groups to individuals and families. You can direct your patients to call the NAMIHelpline at (800) 950NAMI or go to nami.org. Patients can locate the affiliate nearest them on the website or bycalling (800) 7885131.The National Institute for Mental Health provides informational resources and supports the National SuicidePrevention Lifeline (800) 2738255. The institute publishes free and easy to read publications on various mentaldisorders. They can be found at nimh.nih.gov/health/topics/index.shtml.The Substance Abuse and Mental Health Services Administration (SAMHSA) has a Treatment Referral Helpline:(800) 6624357. See samhsa.gov for more resources.Service members and veterans may face different mental health issues than the general public. MilitaryOneSource is a free Department of Defense resource to service members and their families for a range ofconcerns. The help line is available 24/7 at (800) 3429647. Visit militaryonesource.mil online.The US Department of Veteran's Affairs Mental Health Resources provides information about mental health andsupport services specifically for veterans. Coaching Into Care offers free coaching to veterans via (888) 8237458. This VA website can be found at mentalhealth.va.gov/index.as.
Emphasis on Quality
MHSC offers its providers incentive payments
for specific women's health screenings
We want to team up with you to achieve our goals for women's health withpreventive care. In 2017, Molina is once again offering incentive paymentsto providers for specific women's health screenings for MHSC members.Service for the two incentive measures must be rendered betweenJanuary 1, 2017, and September 30, 2017, and will only be paid if this ifthe first eligible service on file in 2017. We faxed providers informationabout these wellvisit incentives this spring. If you have questions aboutthe incentives or need the details again, contact your provider servicesrepresentative at MHSC, or our Quality Department [email protected].
Members can receive gift cards for screenings in Molina's Diabetes Rewards Program
MHSC has a Diabetes Rewards Program for members who complete diabetic exams and screenings. Through theprogram, a member with diabetes can earn $25 CVS Select gift cards for completing each of the following:
HbA1c blood testNephropathy screeningRetinal eye Exam
Each member is eligible for up to $75 of gift value rewards per calendar year. Members in the program are mailedpostcards, each with a chart for providers to fill out at the time of screenings. The member returns the postcard by mail toMHSC, which will confirm the appointment through claims data or medical records before sending the member anyrewards. Providers with questions may contact us at [email protected].
MHSC news
Molina recognized for environmental efforts
For many decades, the Annual Community Pride Awards in CharlestonCounty have honored those who are committed to environmentalimprovement, and this year, Molina Healthcare of South Carolinareceived a Captain Pride Award. Keep North Charleston Beautifulnominated MHSC for recognition because of our ongoing assistancewith the North Charleston nonprofit's environmental educationprograms. Community Pride, Inc. of Charleston County sponsors theawards, which were given out May 26 at the Felix C. Davis CommunityCenter in North Charleston. At left: Molina volunteers tend to milkweed plants as part of KeepNorth Charleston Beautiful's gardening efforts.
MHSC's David Irizarry, middle right, and Johanna Perez next to him,
receive a plaque from CareFIRST Carolina Foundation.
Partnership will help detect
lead exposure in SC children
A CareSouth Carolina team that visits counties inthe northeastern part of the state now has a newlead testing unit for kids thanks to a donation byMolina Healthcare. CareSouth Carolina is a community healthcenter with a Reaching Out and DeliveringServices (ROADS) team that treats children inLee, Chesterfield, Dillon, Darlington andMarlboro counties.The new equipment will allowthe ROADS team to identify elevated levels oflead in a child's system within four minutes. Molina Healthcare of South Carolina providedthe donation through CareFIRST CarolinaFoundation, the supporting organization of CareSouth Carolina. At the start of June, CareFIRST presented a plaque toMHSC's Community Engagement team to commemorate the donation. "We are so glad that Molina recognized the needfor this new unit," said CareFIRST Carolina President Karen Currin. "Our area children will benefit greatly from thesetesting services."
Getting involved
Molina makes community engagement a cornerstone of its organization
At Molina, we pack our calendar with events that help communities across South Carolina, and we encourageemployees throughout our organization to pitch in by giving them paid time off to volunteer. We love to involve providers,too. Connect with Community Engagement Field Supervisor Johanna Perez, (864) 2881399, or email usat [email protected] to learn about the possibilities.
Signature event: Care kit giveaway
Joshua Bowman from U.S. Sen. Tim Scott's staff rolled uphis sleeves to help the MHSC team at Molina's PersonalCare Kit Distribution signature event in Columbia June 27.Molina distributed 200 free personal care kits to homelessindividuals and other local residents in need. Each kit ispackaged in a reusable bag and has hygiene essentialslike shampoo, tissues, soap, toothbrush, antiseptic wipesand more. Molina also provided lunch for attendees.
Painting a dream
MHSC's Community Engagement team members put onan allday painting party in May to help launch Megiddo'sKids Dream Station, a new nonprofit daycare inGraniteville outside Aiken. "While it rained the whole dayoutside, the climate indoors was full of camaraderie andenergized by our mission," reports Member EngagementProject Coordinator Rebecca Shealy. Molina Healthcarealso donated $1,000 to the Dream Station.
Help us spread the news
Connect with Molina Healthcare of South Carolina
Signup for email delivery of Palmetto Partners by emailing [email protected]. Giveus your first and last name, plus your organization's name and the city or county where you are located. We are glad toteam up with you and encourage you to stay connected with us. Visit MolinaHealthcare.com/Providers/SC.
Molina Healthcare of South Carolina | | [email protected] |
The MHSC Communications team produced this monthly enewsletter, which is designed for South Carolina health careproviders. We welcome your feedback, news and ideas for content.Contact us at [email protected].