Passport to health provider newsletter

2004·0.25 MB·English

by  Montana. Dept. of Public Health and Human Services. Passport to Health

PASSPORT
362.104258
P30PH
WIN 2005
MontanaStateLibrary
3 0864 1003 4127 3
Health
Keeping Providers Informed Volume 2, Issue 1, Winter 2005
PASSPORT
Inside This Issue Provider Input Sought at
PASSPORT Summits Summits this Spring
Planned for Spring I
Tobacco Quit Line and Nurse First:
WAhNeantuCrlailenFitts Aren't Right 2 As the PASSPORTto Health program held in Helena during the week ofApril
lorTeam Care 2 enters its twelfth year ofsuccessfully 25, followed by Havre during the week of
Spotlight: Mary Patrick 3 managing the delivery ofhealth care to May 10, Billings during the week ofMay
PASSPORT FAQs 3 Montana's Medicaid clients, the Montana 17, and Kalispell the week ofJune 7. A
PASSPORTReferral Reminders 4 Department ofPublic Health and Human cross-section ofPASSPORT stakeholders
Key Contacts Services (DPHHS) is planning summits to are invited, including: PASSPORT
determine ifthe current operation ofthe providers, specialists and other non-PCPs,
PASSPORTTo PASSPORTto Health program is the most representatives from billing companies,
Health Provider Relations effective way to meet its objectives. hospitals, FQHCs, RHCs, the tribal health
community, and client advocates.
The Department
Forproviderenrollment or
disenrollment. chan.ge ofownership or stresses that Implemented in 1993,
address, increasing/decreasing client providers should look "Our mission has been, and will the PASSPORTprogram
caseload, and claims questions: at the program in a continue to be, maintaining quality has been successful in
truly comprehensive and assuring adequate access to saving over $20,000,000
[phone] In-State way; therefore, no primary care while controlling health annually. These savings
[phone] idea is offthe table care costs. With that in mind, we're allow the program to
[phone] Fax
for consideration. looking for people within the provide services to
PASSPORT Program provider community who are willing people who may not
Mail documentation to: Officer Niki to share innovative ideas and have otherwise received
Provider Relations
PO Box 4936 Scoffield said, "We specific suggestions for them, and also help
Helena. MT .^^9604 felt that it was time to ^^^^imp^ro^ve^me^nt with us." maintain provider
check in with the reimbursement rates.
PASSPORTTo providercommunity about several issues.
Health Client Services Our mission has been, and will continue to In addition to meeting its financial
be, maintaining quality and assuring objectives, the PASSPORT program has
Forenrolling ordisenrolling clients, adequate access to primary care while been well-received by most ofits PCPs
questions about yourmonthly caseload controlling health care costs. With that in and clients.
report, orclient services:
mind, we're looking for people within the
[phone] providercommunity who are willing to Ifyou have ideas and would like to
[phone] Fax share innovative ideas and specific participate in one ofthe summits,
suggestions for improvement with us." contact Program Officer Niki Scoffield
Mail documentation to: at [phone] or [email protected]
PASSPORT Program PASSPORTto Health's objectives include by February 8.
PO Box 2.'i4 assuring adequate access to primary care
Helena. MT .S9624 and fostering a medical home between Visit Montana Medicaid's website at:
providers and clients which promotes www.mtmedicaid.org or watch the Claim
Visit our website:
www.intineclicaid.org appropriate care and reduces costs. Jumper for more details.
One-day facilitated summits are planned for
For newsletter mailing list changes,
contact [email protected] locations across the state. The first will be
PASSPORT To Health Newsletter
Tobacco Quit Line and Nurse First: When Clients
A Natural Fit Don't Belong in
Team Care
Community Health Partners, a Hargraves, a social worker/case
community health center in manager at Community Health
Livingston, is finding that a number of Partners. Team Care is MontanaMedicaid's
Medicaid clients who participate in the utilization control program that
State's Nurse First Disease Nurse First, the State's care promotes the strict adherence to the
Management Program also enroll in management program, provides proper use ofMedicaid services through
the MontanaTobacco Quit Line. health management education and positive case management. Team Care
advice to Medicaid clients with the
Janice Gomersall, M.D., Medical chronic conditions ofasthma, is forclients with a history ofusing
Advisor forthe Nurse First programs, diabetes, heart failure, cancer, and services at an amount or frequency that
says the programs are a natural fit. chronic pain. Program nurses work is not medically necessary, and who
"Nurse First puts the thought into closely with community health require additional assistance when
people's heads that quitting is a good centers to identify Medicaid clients accesing care.
idea in context with theirdisease who might benefit from enrollment in
management. The number one reason the disease management programs. There are three ways clients are
people choose to quit smoking is when indentified forTeam Care.
someone involved in their medical The Tobacco Quit Line and Nurse
well-being talks to them about it. First work well together because the
Nurse First serves that purpose," registered nurses who staffthe • Claims data review (i.e. client visits
explains Dr. Gomersall, who's also a disease management programs provider more than 25 times per year
family practitioner specializing in reinforce the principles ofthe or presents in the ER more than 12
obstetrics at the Lolo Family Practice. Tobacco Quit Line. Because the
times annually);
nurses identify smoking as a medical
The Montana Department ofPublic problem in initial assessments made • DUR Review (Drug Utilization
Health and Human Services sponsors for the disease management program, Review Board Pharmacy Claims Review);
the Tobacco Quit Line and the Nurse they not only encourage use ofthe • Provider referrals.
First Disease Management Program, Tobacco Quit Line, but can follow-up
both ofwhich are free to eligible on the issue in subsequent calls. Ifyou are managing the care ofa client
Medicaid clients. "My take on this exciting develop- who is not appropriate forthe program,
As part ofthe Tobacco Quit Line, ment is that the disease management contact the Medicaid Managed Care
callers work with a counselor who program is working with the Bureau at [phone] ore-mail
helps them pick a quit date, schedules community-based programs to make [email protected] to request a
times to call throughout the quitting the patients successful as they disenroUment. The State can also
process, and provides nicotine patches improve their health. Stopping provide additional information to help
or gum to help reduce nicotine smoking takes a number ofsteps, and you decide ifa client's enrollment is
Nurse First is in a perfect position to
appropriate.
be that first step," Dr. Gomersall said.
In order for the Quit Line to provide
nicotine replacement therapy to For more information regarding the Acurrent list ofyourTeam Care clients
Medicaid clients at no cost, clients Nurse First programs, contact is included with your monthly
must first expend their Medicaid Program OfficerTedd Weldon at PASSPORTenrollment list.
smoking cessation benefits. [phone] [email protected].
For more information about the By working in collaboration, we can
"One thing we are noticing in our Montana Tobacco Quit Line, contact ensure Team Care clients get the right
community is that patients who utilize Tobacco Use Prevention Supervisor
both the Nurse First Programs and the Georgiana (George) Gulden at (406) care in the right place at the right time.
Tobacco Quit Line are moving 444-9617 or [email protected]. For more information, visit our website
forward in their goals at quitting To contact the Quit Line directly, call or contact Program OfficerTedd Weldon
cigarettes. I know that Nurse First is (866) 485-QUIT. at [phone] or teweldon®mt.gov.
really encouraging and educating
patients to stop smoking," said Rie
In The Spotlight: provided no-cost breast and prostate Frequently Asked
cancer screening to qualified
PASSPORT
recipients statewide.
Montana Medicaid
Before moving to Montana with her Questions
Welcomes Quality husband, Willard, Mary worked in
various healthcare organizations as a
Assurance Nurse staffnurse, nurse manager, and Can I use my ProviderEnrollee listas
supervisor in both an acute care and an eligibility verification method?
Managed Care
for long-term care setting for over 20
Programs years. From 1980 to 1991, Mary NMeod;itchaisidliestliwgiabsilniotytvdeersiifgincaetdiotnotboeola.
taught medical-surgical, obstetrical, As a PASSPORT provider, you need to
and mental health nursing at St. verify a client's eligibility using an
Augustine Technical Center in Florida established verification method, such as
forover 10 years. She also held the FaxBack, before providing services or
position ofProgram Director at Santa making a referral to another provider.
Fe Community College in
Gainesville, forits Emergency Rememberto verify eligibility at every
Medical Services programs prior to visit, even for those clients who appear
moving to Montana. on your Provider Enrollee list.
Mary graduated from Pilgrim State Why do Ihave individuals on my
Hospital School ofNursing in ProviderEnrollee list who are
Brentwood, New York in 1968 with a identifiedas "new clients" when I've
diploma in nursing. In 1977, she managedtheircare in thepast?
earned a Bachelor ofScience degree
Mary Patrick, R.N., M.Ed. in Health Care Management from St. The enrollee list identifies those
Francis College in Brooklyn, New individuals who are new to PASSPORT
Mary Patrick, R.N., M.Ed,joined the York. Mary went on to earn her each month. You may have managed the
PASSPORTto Health team last fall as Master ofEducation degree from the client's care before they became
one oftwo Quality Assurance University ofFlorida in Jacksonville Medicaid eligible, or they may have lost
in 1988. In 2000, Mary completed the
Program Officers. She is responsible eligibility for a period oftime.
"Managed Healthcare Professional"
for quality assurance duties that were home study course from the Health
previously performed by acontractor InsuranceAssociation ofAmerica. How can we assistclients in selecting
for the department. MedicaidManaged ourclinic as theirPASSPORT
Care Bureau ChiefMary Angela "I am excited to be doing quality provider?
Cthoaltlilnoscastaiindg, b"oWteh'rqeuaallirtyeaadsysufirnadnicneg aidsesnutriafnyciengagbaoitnhaqnuadliItlyocolkiefnotrcwaarred to Ipfroyvoiudrerc,liheenrte'wsanhtoswaynoeuwcaPnASheSlpP:ORATsk
positions here in the Department and areas ofcare that perhaps need clients to call the Montana Medicaid
results in even better synergy. Mary is more support or better processes in Help Line at 1-800-362-8312. You may
a valuable source ofexpertise and place fordesired positive outcomes," also assist them in filling out the Change
we're excited to have heron board." Mary said. She will work with Jackie ofProvider form. Youroffice can obtair
Thiel, who continues in her role as several copies ofthe form by calling the
Priorto accepting this position, Mary Quality Assurance Manager for Help Line; the form may also be
worked at Blue Cross and Blue Shield PASSPORTto Health as well as the available for downloading soon at our
ofMontana from 1991 to 2002 in rest ofthe PASSPORTTeam. website: www.mtmedicaid.org
several capacities, including Medical
Policy Coordinator, Quality
Improvement Coordinator, and Mary's latest pastime is learning how Please keep in mind that until the change
Preventive Health Coordinator. to play the piano. She enjoys going in providers is complete, you will need
for walks with her husband and their to get a referral, or establish a private
She also helped coordinate the Care Boykin Spaniel, "Ginger." pay agreement with these clients until
Screenings Program through the they appear on yourProvider Enrollee
Caring Foundation ofMontana, which list.
PASSPORT To Health Newsletter
PASSPORT
to providercalls the next business
day to get that number, it cannot be
Referral Reminders taken back.
Ifyou are not a client's PCP, you
An integral component ofmanaging must get the referral prior to
yourclient's healthcare needs is giving providing services. Ifyou do not,
referrals when appropriate and and you provide the service, you run
necessary. This enables you to better the risk ofthe PCP refusing to give
treat yourclient and meet his/her needs. you a referral and your claim will be
When giving referrals, remember: denied.
The PASSPORTreferral is aclinical
referral. It is based on the need ofthe
client, and, as with all clinical issues, Ifyou are a client's PASSPORT
can only be given by the PASSPORT provider, it is not necessary to put
provider (oracovering provider). yourown referral number on the
Although office staffcan relay the claim form (Box 17A). Ifyou find
referral to anotherprovider, it must be that your claims are denying for lack
given by the PCP. ofPASSPORT authorization for your
own PASSPORT clients, please
Sometimes, the on-call provider gives contact Crystal Nachtsheim in
the referral, but does not actually have Provider Relations at l-(800) 624-
the referral number. When the referred- 3958. Your PASSPORT number may
not be set up correctly in our system.
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