Online Claims Look Up RegistrationThe MedStar Family Choice claims look up website allows providers to check the status of a claim. In order to check claims status online, providers should go to MedStarFamilyChoice.com and click on the Go to online claims look up icon under For Physicians. This quick link will take you directly to the online claims page where you can register and/or sign on and look up claims status. A new feature for claims look up is that each office will initially register for a master account and then register all other users in their office as subaccounts. Subaccounts will allow multiple users to share the same web portal access without sharing the same username and password. The employee who is registered as the master account holder will be responsible for activating and deactivating employee log ins.

Prior to registering, verify that your computer is currently using either a Windows or Apple operating system that includes a supported web browser:

• Microsoft Internet Explorer 7, 8 or 9 • Mozilla Firefox 3.6 x or later • Google Chrome 11.0 x or later • Apple Safari 5.0.1 or later

Once your computer is set up, registration can begin. All identifying information needed for registration must exactly match the information in our database. Therefore, we recommend that offices have an EOB to refer to for accurate data

input of provider name, ID and address information. At this time, users will have the option to register as a:

• Facility: This option allows access to provider information associated with that medical facility, ie: users will only be able to view facility charge.

• Payee: This option allows access to all providers and locations associated with the payee. This is the recommended option if offices wish to view all professional claims billed from multiple office locations, as well as professional charges related to facilities that are associated with the payee’s information.

• Location: This option allows access to provider information for one physical location or clinic. Each location will need to be registered separately.

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• Provider: This option allows access to only their information, ie: the provider’s name used for the initial registration.

After registration is complete, users can set up subaccounts for other employees. To set up subaccounts:

• Click on the Setup > Subaccounts tab• Click Create New Subaccount• In the Create Subaccount window, enter the

name and email address of the new user. (System-generated messages, such as password reset messages, are sent to the email address that you enter for this user. Users can change their name and email address later on the My Profile tab, once they log in.)

• Enter an initial username and password for the user. (Users can change their passwords later on the Change Password tab once they log in.)

• Click Save. The new account is created and added to the Subaccounts tab, where it can be edited, locked or unlocked. (The subaccount user has the same web portal access as its master account, including access to patient rosters, billed amount lists and attached documents)

For additional help, providers can contact the Claims department at 800-261-3371 and/or MedStar Family Choice Provider Relations at 855-210-6203 to request on-site assistance.

Vaccines For Children — Storage and Handling of VaccinesVaccines for Children (VFC) providers should be aware that they are responsible for maintaining the vaccine from the time it is delivered until the vaccine is administered to the patient. Therefore, there are storage and handling guidelines for VFC vaccines. Provider offices should have a written routine and emergency plan for storage that prevents situations that may harm or waste the vaccine. Visit CDC.gov/Vaccines/Recs/Storage/Toolkit for a toolkit.

The District of Columbia VFC program requirements for written routine and emergency vaccine retrieval plans include:

• Designated vaccine personnel

• Checking and receiving shipments (Note: Delivery discrepancies and compromised vaccines should be reported to the VFC program within two hours to McKesson at 877-836-7123.)

• Storage and handling plans (a storage and handling plan worksheet is available in the Vaccines and Handling Toolkit noted above.)

• Vaccine storage equipment and temperature monitoring devices (See the CDC’s Vaccines and Handling Toolkit for detailed information.)

As per the communication from the Government of the District of Columbia Department of Health entitled Providers’ Routine Handling and Emergency Vaccine Retrieval and Storage Plans, providers should keep in mind that refrigerators and freezers should have working digital data loggers-thermometers. Data logger- thermometers should have these characteristics:

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Report Fraud and AbuseMedStar Family Choice and MedStar Health have comprehensive Compliance programs in place to monitor and detect fraud and abuse. Fraud and abuse could be committed by a provider, member or even an employee of the managed care organization. As a MedStar Family Choice provider, it is your responsibility to report fraud and abuse. Providers report fraud by calling the MedStar Family Choice compliance director at 855-210-6203 or the Department of Health Care Finance (DHCF) at 877-632-2873. Providers may also report it in writing to:

Department of Health Care Finance 899 N Capitol Street, NW Washington, DC 20002

A strict nonretaliation policy is in place for reporting suspected fraud and abuse. Some common examples of fraud and abuse are:

• Billing for a service that was never performed• Unbundling of procedures• Upcoding• Performing unnecessary procedures• Altering or forging a prescription• Allowing others to use a member’s ID card

for care

Most billing errors are oversights and not indicators of fraudulent activity. However, fraud and abuse does occur and MedStar Family Choice is responsible for monitoring, identifying and deterring these types of activities. As a result,

Excluded Parties Listing— Payment BanThe United States Health and Human Services Office of the Inspector General (HHSOIG) publishes a list of providers that are excluded from receiving payments from the Medicaid program for any and all reimbursable items or services. The list was created to support and prevent fraud and abuse of the Medicaid program. The payment ban includes contractors, providers, employees of providers, etc. Providers should be aware of and screen all employees and contractors for exclusion since payments may be retracted if reimbursement is directly or indirectly related to the excluded parties for items/services received by a Medicaid recipient. For more information regarding how to access the exclusion lists, providers should refer to the EPLS’s website at ePLS.gov and the OIG List of Excluded Individuals/Entities (LEIE) at oig.HHS.gov/exclusions. Questions and concerns regarding the exclusion lists can be directed to the MedStar Family Choice compliance director at 855-210-6203.

NCCI UpdateThe Centers for Medicare and Medicaid Services (CMS) have updated their NCCI edit list for 2013. One of the notable changes is the edit in place for CPT codes 90460, 90461 and 90471 to 90474 (administration of immunizations). The change now considers most evaluation and management (E/M), as well as preventative medicine services, bundled with these codes. E/M services and Preventative Medicine Services that are billed with these codes will be denied for bundling unless they are billed with an appropriate modifier. The E/M services must also be separate and distinct from the procedure. Please refer to the CMS website for further information on NCCI edits and the use of modifiers.

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CAQHMedStar Family Choice is pleased to announce that we are now a member of the Council for Affordable Quality Healthcare (CAQH). Effective July 1, 2013, providers wishing to participate in the MedStar Family Choice provider networks are required to complete and submit a MedStar Family Choice CAQH Medical Data Sheet that will be used to add you to our CAQH provider roster. This will allow MedStar Family Choice to access your CAQH application and supporting documents for credentialing. Please be sure to update your CAQH record by authorizing MedStar Family Choice to access your credentialing information. Also, please note that a current and signed Standard Authorization, Attestation and Release Form is required every 120 days as part of your CAQH application.

Providers in the recredentialling process can now allow MedStar Family Choice to obtain their application through CAQH as well. CAQH will notify a provider when we obtain their application from the site. Therefore, providers will need to continue to keep all of their information and documents updated in order to avoid a delay in their recredentialling process.

Providers who are not a member of CAQH can complete the Provider Application form. A hard copy of the Provider Application is available online at the department’s website at DiSR.DC.gov or by calling Provider Relations at 825-210-6203. Be sure to include a current and signed Standard Authorization, Attestation and Release Form, as well as supporting documents.

Lead Testing OptionsIn order to help providers meet lead screening mandates, there are a few options for having the lead levels tested. Providers may use LabCorp, MedTox and CLIA Waived Devices.

LabCorp: Lead testing supplies can be ordered at no cost. These supplies are listed on the LabCorp requisition form. When a pediatric lead test is ordered it requires a tan top tube. When an adult lead test is ordered, it requires a royal blue tube. Specimens are then sent to LabCorp for testing.

MedTox: Effective July 1, 2013, primary care providers can use MedTox for D.C. Healthy Families members. MedTox will provide filter paper lead supplies and pre-assembled comprehensive collection kits to providers at no charge. Postage paid and pre-addressed envelopes are included in the kits. Once the samples are placed in the pre-addressed envelopes and sent to MedTox, the results are reported back to the provider and the state within 72 hours. Account set up can be completed by faxing an account set-up form to Mark Johnson at 651-633-1071 or by calling 888-834-8315.

CLiA Waived Devices: Effective Nov. 27, 2011, primary care providers who purchased and are using CLIA waived devices in their office for blood-lead testing can submit claims for CPT 83655 to MedStar Family Choice for processing. Reimbursement for CPT code 83655 is paid at the MedStar Family Choice fee schedule.

Please contact MedStar Family Choice Provider Relations at 855-210-6203, option 5, with questions and or inquiries.

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Enroll in the Vaccines For Children ProgramThe Vaccines For Children Program (VFC) is state-wide and includes the District of Columbia. Providers who prescribe routine vaccines, as per state law, are encouraged to enroll and participate in the VFC program. VFC providers receive vaccines at no charge for VFC-eligible children and adolescents. Therefore, there is no upfront cost for the vaccine and providers can charge an administrative fee. You do not need to participate in Medicaid to participate in the VFC program, but providers who accept Medicaid and routinely prescribe vaccinations are required to enroll in the VFC program.

To request a provider enrollment package, you can contact your state territory VFC coordinator at CDC.gov/Vaccines/Programs/VFC/Contacts-state.html. Medicaid providers who are not presently in the VFC program can also call 202-576-7130, ext. 11 to enroll.

HealthCheck/EPSDT The District of Columbia’s Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit, known as HealthCheck focuses on six key areas:

• Comprehensive health and developmental history, or an update of medical and mental health status

• Comprehensive, unclothed physical examination

• Screening services, including vision, hearing and dental

• Laboratory tests, including lead screening• Recommended childhood and adolescent

immunizations • Anticipatory guidance and health education

Providers are sure to meet EPSDT components by following the D.C. Medicaid HealthCheck Periodicity Schedule. The schedules can be found at DCHealthCheck.net.

we regularly monitor and audit claims submissions and encounter data. In addition, MedStar Family Choice performs routine and random chart audits as a part of the Compliance program. Providers are subject to comply with these audits. If overpayments related to fraudulent or abusive billing have been identified, we may retract those payments made to providers. In addition, under certain circumstances, MedStar Family Choice may be required to notify the Department of Health Care Finance, OIG, DHCF Office of Program Integrity and the District’s Medicaid Fraud Control Unit (MCFU) of the retraction. The DHCF or the District’s MCFU may perform its own investigation. Penalties such as fines, loss of licensure or imprisonment can occur for providers found guilty of fraudulent activity.

(Fraud and Abuse continued from page 3) Mammogram and Pap ProgramOur wellness-preventive care coordinator for the Mammogram and Pap program is Regina DuPree. She conducts outreach to members who are age 40 and older who have not completed their annual breast or cervical cancer screenings. One of her key responsibilities as a wellness preventive care coordinator is to educate MedStar Family Choice members on the importance of getting their cervical and breast cancer screenings annually, as well as to help them find providers and schedule appointments to complete these tests. To help promote healthy living and encourage members to complete these screenings, MedStar Family Choice offers gift card incentives up to $50 once a year for members that have completed their breast and cervical cancer screenings.

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• Calibrated digital data logger-thermometer with bio-safe glycol-encased probe

• Continuous monitoring information with an active display

• High/low (hi/lo) alarm for out-of-range temperatures

• Indicates current temperatures, as well as minimum and maximum temperatures

• Reset button

• Low battery indicator

• Can maintain an accuracy of +/-1 degree Fahrenheit or (0.5) degree Celsius

• Does not stop or rewrite over data when memory is full

Please contact Provider Relations at 855-210-6203 with questions or to request hard copies of written materials, including the Providers’ Routine Handling and Emergency Vaccine Retrieval and Storage Plans transmittal from DCHF.

Update to the MedStar Family Choice FormularyDistrict of Columbia Healthy Families Due to the new Medicaid contract in the District of Columbia that began on July 1, 2013 that transitioned tens of thousands of members to new health plans, MedStar Family Choice has temporarily relaxed many pharmacy edits so that members can fill prescriptions in the first 90 days of enrollment. MedStar Family Choice is faxing and mailing notices to prescribers. Please review these notices, complete the form that was included and return it by fax or mail to MedStar Family Choice. After the 90 days, the edits will be reinstituted and any outstanding medications that are not on the formulary, or require pre-auth, etc. that have not been addressed by the prescriber with a return fax will not fill at the pharmacy. Please prevent this by responding to our Outreach department. See the District of Columbia Transitional Plan on the home page of our website at MedStarFamilyChoice.com.

The information includes a copy of the District of Columbia 90-Day Transition Period Modified Pharmacy Request for Information Form, as well as a copy of the Temporary Pharmacy Authorization Process.

Some general observations about prescribingDue to the higher cost, MedStar Family Choice limits the use of insulin pens to members who cannot physically or mentally use a syringe and vial. MedStar Family Choice covers OTC PPIs rather than the generic PPIs on the market. You may prescribe OTC with a prescription like any other medication along with refills. MedStar Family Choice uses AccuChek brand glucometers and strips. If you have a member

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Health Education Available at MedStar Georgetown University Hospital and MedStar Washington Hospital CenterWe offer health education classes free of charge to MedStar Family Choice members. Classes are designed to appeal to our members on many health levels. For example, prenatal classes are available for moms-to-be, along with education for infant safety and sibling classes. These are just a few classes offered through the birth and family education listings. In addition to these classes, MedStar Health hospitals offer blood pressure screenings, cancer, diabetes and heart disease education, as well as smoking cessation support. Visit MedStarFamilyChoice.com for a complete listing of classes. If you do not have access to the Internet, you may call MedStar Family Choice Provider Relations at 855-210-6203, option 5 for a listing of classes.

Medicaid EHR Incentive ProgramEffective July 1, 2013, eligible healthcare providers who want to receive incentive payments through the Medicare and Medicaid EHR Incentive Program (MEIP) and from the Department of Health Care Finance (DCHF) must first register at the CMS website at Medicare and Medicaid EHR Incentive program. Once on the website, select District of Columbia and complete the attestation. The next step is to apply on the District level at the District of Columbia State Level Registry at DC.Arraincentive.com. For more information regarding eligibility for the EHR Incentive program, please go to the CMS.gov website or contact DCSLR@dc.gov.

Contact UsOn July 1, 2013, our telephone options changed.

option 1 for Outreach for Eligibility Verification and Transportation Assistance or fax to 202-243-5495.option 2 for Pharmacy, Preauthorizations, Inpatient Reviews, Case Management, and Special Needs, or fax to 202-243-5495option 3 for Member Services or Denials and Appealsoption 4 for Claimsoption 5 for Provider Relations or fax to 202-243-5496option 6 for Dental, Vision, Substance Abuse, or Mental Healthoption 7 for Compliance

You may contact MedStar Family Choice at 855-210-6203 Monday through Friday between 8 a.m. and 5:30 p.m. Providers have the option to leave a message or send a fax after the normal business hours. However, any calls and faxes after normal business hours will be addressed the next business day.

901 D St., SW Suite 1050 Washington, D.C. 20024 855-210-6203 PHoNe

The MedStar Family Choice Newsletter is a publication of MedStar Family Choice.

Submit new items for the next issue to Melanie Bodencak, MedStar Family Choice, melanie.bodencak@medstar.net

Kenneth A. Samet, FACHE President and CEO, MedStar Health

Eric Wagner President, MedStar Family Choice

Melanie Bodencak Editor

MedStarFamilyChoice.com

13-MFC-1878.102013

with another meter, they may obtain a new Accu-Chek meter by calling 888-744-3671. Please transition members now to the appropriate formulary medication or supply.

Updates are available quarterly at MedStarFamilyChoice.com and more frequently on eProcrates. Paper booklets of the 2013 formulary have been mailed. Details of prior authorization criteria are available on the MedStar Family Choice website with the other pharmacy protocols. Contact Provider Relations at 855-210-6203 if your office does not have access to the Internet and you would like copies of this information.

At the July 2013 Pharmacy and Therapeutics Committee meeting, the following changes were made:

Additions that have or will go into effect in the next few weeks:

• OTC doxylamine • OTC pyridoxine • OTC Plan B—age restriction removed

Additions with prior authorization effective on or around Aug. 1, 2013:

• Tecfidera (dimethyl fumarate DR) for relapsing multiple sclerosis

Other changes to pharmacy services in the District of Columbia for ALLIANCE MEMBERS only:

D.C. Healthcare Alliance members have used the Unity Pharmacies to obtain their medications. The Unity Pharmacies will close in succession

over the next few weeks. All of the Unity Health Care Pharmacies closed Sept. 21, 2013. Starting on Oct. 1, 2013, Alliance members will need to obtain their medications at one of the expanded network of ADAP pharmacies. A list of the pharmacies has been sent to members, is posted on the DHCF website and on MedStarFamilyChoice.com. Notice that there is a gap between when the Unity Pharmacies close and when the ADAP Pharmacies become available to members. Some medications will be available as 90-day supplies, but not all. (A list of medications eligible for a 90-day supply is not available at this time.)

Members are being told that they will need to bring NEW prescriptions to the ADAP pharmacy. Please consider writing the prescriptions NOW when members come in for office visits to avoid an October crunch.

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