Download Report

June 2014
Issues of Clinical Services Program Update often refer
to several different UCare forms. Please note that all UCare care
management forms can be found on the on the UCare website
under the Care Managers tab.
Direct your UCare questions to your Care System and County
liaisons Jessica Assefa, at 612-294-5057, or Nancy Launderville,
at 612-294-5334. You can email us at our Clinical Liaison
mailbox: [email protected]. Contact us by phone at 612294-5045 or 866-613-1395.
Direct your enrollment questions to the Enrollment Intake line at
612-676-6622, or by email at [email protected].
Welcome Nicole Ferrian
Nicole is the new part-time Clinical Care System Liaison. Nicole will work on this newsletter,
quarterly trainings, and on the Case Management tab of UCare’s provider website.
Nicole previously worked at the University of Minnesota as UCare’s Mobile Dental Clinic
Coordinator. She holds a Bachelor’s degree in Dental Hygiene and a Master’s degree in Community
Health Education, both from Minnesota State University, Mankato.
How to find a member’s care coordinator
UCare’s MSHO or MSC Plus
County-level employees, care coordination delegates, or other professionals involved in a member’s
care should call UCare’s Case Management Central Intake Line at 612-676-6622 or
1-866-242-2497 toll free.
UCare Connect
UCare Connect members and their legal representatives, county-level employees, care coordination
delegates, or other professionals involved in a member’s care should call the Care Navigator
assigned to the member’s county of residence. Find your county’s Care Navigator by visiting Quick
Links on UCare’s provider web page.
Thank you from UCare’s HEDIS team!
Mary Grina & Carol T. Harris with UCare’s HEDIS Team say “thank you” to all of the care
coordinators who helped them during the 2014 Healthcare Effectiveness Data and Information Set
(HEDIS) season.
Some of you were contacted about sending a member’s Plan of Care (POC) for the Care for Older
Clinical Services Program Update June 2014
1
Adults (COA) measure. Others were contacted about sending verification that a member was in the
nursing home from Jan. 1- Dec. 1, 2013, for the Medication Reconciliation Post-Discharge (MRP)
measure. Thanks to your help, we did well in these measures!
Plan of Care reminder
When completing a POC for a member, please remember to add the date of the day you send a
patient’s POC to their primary care provider. If the date is not present, the information cannot be
used for our HEDIS audit.
Reach for the STARS!
Assessment Log Tracking Reminders
When you are completing your monthly assessment log tracking, please be sure to:
Provide an accurate UCare ID number. (We occasionally see PMI numbers being used
instead of the ID number.)
Provide a date of birth for the member.
Provide only assessment dates in 2013 in the column “Date of last assessment completed
in 2013.”
Not provide 6-month assessment dates.
Questions about the log? Please contact Jessica Assefa at 612-294-5057.
Clinical Services Program Update June 2014
2
Mammogram incentive update
Beginning in September, gift cards for members who complete their mammograms will automatically
be sent to the member when the mammogram claim is submitted to UCare for payment. This
process replaces having the member print a voucher form, obtain the provider’s signature, and then
mail the signed voucher to UCare.
Gift cards are generally to major retailers such as Target or Walmart, depending on the retailer
available in the member’s area.
Transition of care resource for care coordinators – 2014 enhancements
2012 CMS QIP/2013 DHS PIP: Improving Transitions Post-hospitalization
Four health plans – Blue Plus, Medica, Metropolitan Health Plan, and UCare – are working together
on a three-year, 2012 Quality Improvement Project (QIP) and 2013 Performance
Improvement Project (PIP) Collaborative. The group seeks to reduce hospital
readmissions by improving member support for the transition from hospital to
home or a care setting for UCare’s MSHO, MSC Plus, and SNBC members as
measured by the HEDIS Plan All-Cause Readmission (PCR) 30-day measure.
The PIP Collaborative added some enhancements to the TOC Care Log that became effective April
15, 2014. TOC documents can be found under “Care Transitions” on UCare’s web site by product
type here.
If you have questions on this QIP/PIP, please contact Lorraine Cummings at [email protected]
or 612-676-3246.
Heart Failure Quality Improvement Project (QIP) update
Spring 2014 member mailing and update for care managers
UCare’s 2012 Quality Improvement Project (QIP) for Minnesota and Wisconsin UCare for Seniors
members is named “Improving Self-care Management and Post-hospitalization Transitions for
Members with Heart Failure.”
This three-year QIP aims to decrease readmissions for all UCare for Seniors members while
improving self-care management for members with heart failure (HF). We provided tools to enhance
care manager support for members with HF following the hospitalization transition management to
home or a care setting. Additionally, our anticipated outcome is to increase the member’s knowledge
of HF, encourage self-care management of their HF condition, improve communication during the
care transition, and clarify “next steps” when discharged from the hospital for a HF inpatient stay.
This QIP has two primary interventions:
1) Based on feedback and the 2013 Transition of Care (TOC) Log audit results, we enhanced
the 2014 TOC Log effective April 15, 2014. You’ll find the 2014 TOC resources are located
on UCare’s Provider Page – Care Managers tab by product line or here.
We will conduct annual TOC Log audits for dates of service April 15-Aug. 15, 2014. TOC Log
audits help us monitor and provide feedback to care managers on the communication
process for managing post-discharge transitions.
2) On April 30, 2014, UCare sent all UCare for Seniors members with heart failure who are not
enrolled in UCare’s disease management HF programs (e.g., Health Journey and
Cardiocom) a HF self-management education mailing. The mailing included a copy of the
Clinical Services Program Update June 2014
3
Healthside® Magazine: Inside Heart Failure to help these members better understand and
self-manage their HF condition. |
These members also may request copies of the 2013 mailing of educational resources:
• My Heart Health: Weight and Symptom Log Book to monitor heart failure
• Understanding Heart Failure brochure
• You Can Live Well with Heart Failure magnet
If you have questions on this QIP/PIP, please contact Lorraine Cummings at [email protected]
or (612) 676-3246.
We appreciate your efforts!
Personal care assistance assessment and service plan notes
As a reminder, all Personal Care Assistant (PCA) service requests, reviews, and
determinations are conducted by UCare, with the exception of UCare Connect, which is
managed at the county level.
An independent assessment is required to begin PCA services for a UCare member; this
includes initial and annual assessments.
If a UCare’s MSHO or MSC Plus member is open to a CADI waiver, the UCare-assigned
case manager is required to coordinate the PCA assessment by contacting UCare directly via
fax (612-884-2094) or phone (612-676-6705, option 2, option 4).
When UCare receives both the assessment request and approval for the assessment, the
UCare Intake Coordinator will contact an independent PHN agency to conduct the
assessment.
Care coordinators will be able to access approved services via the UCare secure website
portal.
In the event a CADI case manager wishes to conduct the PCA assessment, he or she is
required to contact UCare for an authorization prior to the scheduled assessment.
Elderly Waiver Services notification
When approving EW services for which a negotiated rate has been set with the provider, or for
services that require an authorization in the UCare system for claims payment (e.g., Adult Day
Services, CDCS), please ensure the Waiver Service Approval Form indicates the following areas:
Rate Per Unit
Frequency (daily, monthly, number of days per week)
Total Units or Visits
Total Amount Approved
This required documentation will ensure timely and accurate claims payment and reduce
unnecessary phone calls to the case manager/care coordinator for clarification. Your adherence to
this process is appreciated. Questions about this process can be addressed by calling Clinical
Services Intake at 612-676-6705.
Clinical Services Program Update June 2014
4
2014 UCare training schedule
UCare Connect Bi-Annual Case Coordinators Meetings:
Twin Cities Metro Delegates
Tuesday, Nov. 11, 2014; 9-11:30 a.m.
UCare Connect Bi-Annual WebEx Case Coordinators Meetings:
Greater Minnesota Delegates
Tuesday, Nov. 18, 2014; 1-3:30 p.m.
UCare’s MSHO/MSC Plus/UCare for Seniors Quarterly Meetings:
Metro Delegates
Thursday, June 19, 2014; 8:30-11:30 a.m.
Thursday, Sept. 18, 2014; 8:30-11:30 a.m.
Thursday, Dec. 4, 2014; 8:30-11:30 a.m.
UCare’s MSHO/MSC Plus/ UCare for Seniors Quarterly Meetings:
Greater Minnesota WebEx Training; WebEx will be posted on the UCare website.
Wednesday, June 25, 2014
Tuesday, Sept. 23, 2014
Tuesday, Dec. 16, 2014
Information about accessing WebEx will be sent under separate communication.

Is there a topic you’d like covered in this newsletter?
Please send it to Nicole Ferrian at [email protected].

Clinical Services Program Update June 2014
5
UCARE CONTACT NUMBERS
UCare Member Services (Clinic changes, contact information changes, questions on benefits):
612-676-3200 or 1-800-203-7225.
UCare Connect Member Services (Clinic changes, contact information changes, questions on
benefits): 612-676-3395 or 1-877-903-0061 (toll free).
UCare Connect Health Questionnaire Assistance line (Resource for members who need help
completing the health questionnaire): 612-676-6502 or 1-877-903-0062 (toll free).
UCare Connect Waiver Case Manager Provider Line (Resource for County waiver case
managers who have questions on UCare Connect): 612-676-6503 or 1-877-903-0063 (toll free).
UCare’s Health Ride Transportation (transportation to medical appointments for members):
612-676-6830 or 1-800-864-2157 (toll free).
UCare Case Management Central Intake (enrollment questions): 612-676-6622 or
1-866-242-2497 (toll free).
UCare Clinical Authorizations for Services: 612-676-6705 or 1-877-447-4384;
Fax: 612-884-2499.
*For members who designate a Mayo Clinic as their primary care provider, authorization requests
must be faxed to Mayo Clinic Health Solutions at 1-888-889-7822. Providers may contact Mayo
Clinic Health Solutions* at 1-800-645-6296, option "5" (MSHO, PMAP, and Medicare Advantage
claims or billing-related questions should be directed to UCare’s Provider Assistance Center at
612-676-3300 or 1-888-531-1493).
UCare Behavioral Health (mental health and chemical dependency services):
612-676-3300 or 1-888-531-1493 toll free (follow the prompts)/ fax: 1-855-307-6981
UCare Clinical Authorizations for PCA Services: 612-676-3459; fax: 612-884-2094.
*For members who designate a Mayo Clinic as their primary care provider, authorization requests
must be faxed to Mayo Clinic Health Solutions at 1-888-889-7822. Providers may contact Mayo
Clinic Health Solutions at 1-800-645-6296 option "5" (MSHO, PMAP, and Medicare Advantage
claims or billing-related questions should be directed to UCare’s Provider Assistance Center at 612676-3300 or 1-888-531-1493).
UCare’s Provider Assistance Center (PAC) (claims or billing-related questions): 612-676-3300 or
1-888-531-1493 (toll free).
*Formerly known as MMSI.
Clinical Services Program Update June 2014
6