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Maryland | Fall 2015

Practice Matters: MD - Fall 2015 Provider Services Center: 888-362-3368

Important information for health care professionals and facilities

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In This Issue...• UnitedHealthcare Gets Providers Prepped for ICD-10

• Save Time and Money with Electronic Claim Submissions

• A Reminder about Our Satisfaction Survey

• New Referral Process for Specialty Care

• How to Help Members Renew Their Coverage

• “Stat” Exceptions for Outpatient Lab Services

• Preventing Health Care Fraud and Abuse

• Caring for Members with Chronic Conditions

• Cultural Competency

We hope you enjoy the fall edition of Practice Matters. In this issue, you can read about UnitedHealthcare Community Plan’s efforts to prepare providers for the change to ICD-10, new referral requirements for specialty care, prevention of health care fraud and abuse, and much more. Happy autumn!

Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33681 Practice Matters: MD - Fall 2015 Provider Services Center: 888-362-33681

Important information for health care professionals and facilities

“We worked hard to get out to as many providers as possible,” Sapp said before the Oct. 1 rollout of ICD-10. “We have been really dedicated to outreach and making sure we provided support and assistance to guide them through this major change.”

Getting ready earlyUnitedHealthcare had been working on the transition to ICD-10 since before Sapp joined Provider Relations in 2011. An inventory had been completed to determine the required changes, and an implementation plan was put in place to help ensure a smooth and timely transition.

“To address the complexities of our business, we got moving on it very quickly,” Sapp said.

UnitedHealthcare invested heavily in training and technology, allocating significant resources to ICD-10. Hundreds of employees worked to be code-ready, education materials and resources were developed, and testing was done to get systems and providers ready.

Sapp said Provider Relations was particularly concerned about the preparedness of three types of practices: solo practices; rural practices; and resource-sensitive practices that don’t have a large cash reserve. To help reach these and other practices, UnitedHealthcare in 2012 created an ICD-10 service center and posted it online, then spread word through various communications to let providers know about the resource.

“We felt the website was the optimal vehicle to help providers,” Sapp said.

UnitedHealthcare ICD-10 Website The UnitedHealthcare ICD-10 website provides information on ICD-10. The ICD-10 Code Lookup Tool helps providers understand how UnitedHealthcare will interpret and map ICD-9 codes to the new ICD-10 codes. The site is available by going to UnitedHealthcareOnline.com > Tools & Resources > Health Information Technology > ICD-10.

UnitedHealthcare Gets Providers Prepped for ICD-10If you are a health care provider with questions about ICD-10, Aaron Sapp has some answers.

As the UnitedHealthcare National ICD-10 Program

Director, Sapp has traveled across the country to help health care providers get ready for the International Classification of Diseases, 10th Revision (ICD-10), to replace ICD-9 on Oct. 1, 2015 as the coding system used by physicians and other health care professionals to record and identify diagnoses and procedures for claims payments.

ICD-10 affects diagnosis coding and inpatient procedure coding only. It does not affect current procedural terminology (CPT) coding for outpatient procedures.

During the past three years, Sapp spent about every other week traveling around the nation, discussing with providers how UnitedHealthcare was preparing for ICD-10 and offering guidance to help them to get their practices ready. UnitedHealthcare Networks Provider Relations employees were out in force communicating and working with providers at town hall sessions, Medical Group Management Association meetings and medical society gatherings. Since 2012, they have met with more than 92,500 providers nationwide at meetings to share materials and transition plans. In June, for example, Provider Relations conducted 270 such sessions.

In addition to the face-to-face assistance, UnitedHealthcare has devoted a website to ICD-10. UnitedHealthcare launched an online physician practice coding tool in August to help assist with the transition, and online surveys were tabulated to help gauge the readiness of practices.

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Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33682 Practice Matters: MD - Fall 2015 Provider Services Center: 888-362-33682

Important information for health care professionals and facilities

On Aug. 5, UnitedHealthcare launched the Physician ICD-10 Coding Practice Tool on its ICD-10 website. The self-service tool allows providers to practice selecting ICD-10 codes for various clinical scenarios across 35 medical specialties. Each clinical scenario for commonly used diagnosis codes includes a medical example, medical history and office notes, and users can compare codes used by peer physicians within each specialty.

Sapp said visits to the ICD-10 website increased as Oct. 1 drew near. The site had over 2,200 visitors in May, and that grew to about 5,850 in June.

The outreach that UnitedHealthcare has offered to its care providers helped to inform them that ICD-10 will lead to better payment accuracy and improved disease monitoring and management.

Even after Oct. 1, the ICD-10 work for Sapp and the Provider Relations teams won’t end. They will continue to communicate updates to care providers and do anything else needed to make sure practices have adapted to ICD-10 as smoothly as possible.

Once ICD-10 is in place, Sapp said it is his hope that UnitedHealthcare’s relationship with providers will grow even stronger.

“We see ICD-10 as a starting point for deepened relationships with our providers,” Sapp said. “ICD-10 is a critical element in the overall transformation taking place in health care, and it means we will be more collaborative, with our relationships growing and evolving to meet the challenges.”

Save Time and Money with Electronic Claim SubmissionsUnitedHealthcare understands our providers are looking for ways to save time and money. Switching from paper to Electronic Data Interchange (EDI) or increasing your use of EDI, could help you do both.

If you currently file claims on paper:UnitedHealthcare Community Plan has teamed up with a full service clearinghouse, Office Ally, to offer a no-cost electronic filing solution. Office Ally offers a free web-based service allowing you to enter professional (CMS-1500) and institutional (UB-04) claims manually or uploading them through your existing software. You can easily edit claims, view claim history and review claim submission reports online. View our handout for more information on the EDI services supported by Office Ally.

UnitedHealthcareOnline.com offers direct data entry for professional claims, free of charge. View our Quick Reference Guide for step by step instructions on filing claims, our tutorials on using the website or register to attend a variety of training sessions.

If you currently file claims electronically:For care providers who already submit claims electronically, we also have information to help maximize your potential savings with EDI. If you treat members under commercial plans for UnitedHealthcare, Affiliate and Strategic Alliances, you may also reduce your costs by submitting claims electronically for these types

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Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33683 Practice Matters: MD - Fall 2015 Provider Services Center: 888-362-33683

Important information for health care professionals and facilities

of plans. Check your Practice Management System or contact your software vendor or clearinghouse to verify claims for these payers are set for electronic submission with the current payer ID.

Quick Tips for Electronic Claims provides information about successfully managing electronic claims, including filing secondary/COB claim submissions, electronic claim reports and more.

If you have questions, please contact your UnitedHealthcare Provider Advocate or EDI Support at ac_edi_ops@uhc.com 800-210-8315. You can also submit questions online via our EDI Transaction Support Form.

A Reminder about Our Satisfaction SurveyWe are reminding providers to complete our Physician Satisfaction Survey. Survey invitations have been sent by fax to a random sample of physicians. Please complete the survey if you receive a request. Each year, we ask for your participation in the survey, which provides insights about your experiences working with us and helps to improve coordination of care.

New Referral Process for Specialty Care Starts Oct. 15Starting Oct. 15, 2015, members who need specialty care must be referred to in-network specialists by their primary care providers (PCP). The new requirement seeks to improve coordination of care between PCPs and specialty care providers, and help ensure members are directed to the appropriate specialty care for improved health outcomes.

More information about the referral process is available at UHCCommunityPlan.com > For Health Care Professionals > Maryland. Then go to the Referral Information section.

If you have questions, please contact your Network Management representative or call Provider Services at 877-842-3210.

How to Help Members Renew Their CoverageSome UnitedHealthcare Community Plan members will receive a notice from the State that requires them to renew their Medicaid coverage. We want to make sure they keep their coverage and continue to receive the care they need.

If any of your members have received a renewal notice from the Maryland Department of Health and Mental Hygiene (DHMH), please let them know they should follow the renewal instructions as soon as possible to avoid a lapse in coverage. Translation services are available.

Members need to reapply for Medicaid coverage once a year. They can reapply in any of the following ways:

• Online at marylandhealthconnection.gov• Call Maryland Health Connection (MHC) at 855-

642-8572 (TTY: 855-642-8573). Members also can request a paper application by calling the Maryland Health Connection, and then apply by mail.

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Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33684 Practice Matters: MD - Fall 2015 Provider Services Center: 888-362-33684

Important information for health care professionals and facilities

• Visit their local Department of Social Services office or local Health Department and connect with a Certified Application Counselor

Patients can save time by having applicable information ready, including:

• Household monthly income (including pay stubs, W-2 forms or tax returns)

• Social Security numbers or document numbers (for legal immigrants) for each household member reapplying for coverage

• Date of birth for each household member reapplying for coverage

• Immigration information

Effective Aug. 29, 2015, the Maryland Health Connection improved the eligibility process and eligibility determinations for most Medicaid beneficiaries by implementing an automatic Medicaid renewal process. The MHC will use household information to perform a projected eligibility determination and automatically renew those applications that qualify for coverage. Active members will be “auto-renewed” and sent a notice to notify them of the final eligibility determination.

To help ensure claims are processed, we recommend that you check the member’s Medicaid eligibility at the time of service by calling Provider Services at 877-842-3210 or checking online at UnitedHealthcareOnline.com. If members have questions, they can contact Member Services at 800-318-8821.

“Stat” Exceptions for Outpatient Lab ServicesAs a reminder, please refer UnitedHealthcare Community Plan members only to the outpatient laboratory service providers on the most current list of participating laboratories at UHCCommunityPlan.com. Members must be referred to network providers for routine outpatient laboratory services.

Exceptions to this requirement may be made for “stat” tests necessary to perform services at the time of the visit. If you require laboratory results on a “stat” basis, the designated medical lab can tell you how to arrange for pick-up and reporting.

If you must perform a “stat” test in your office and bill for the services for a member, use the “ET” modifier (for emergent/urgent services) with the Current Procedural Technology code for the test. Additionally, the diagnosis indicated on your claims for these services must support the “stat” billing. A list of “stat” lab tests can be found at UHCCommunityPlan.com > For Health Care Professionals > Maryland > Bulletins.

Chemotherapy lab services that do not quality as “stat” but are required to be delivered in office also may be exempted from the lab policy. If you must perform chemotherapy lab services in office and bill the services for a member, please make sure the ICD-10 diagnosis code supports the billing for active cancer.

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Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33685 Practice Matters: MD - Fall 2015 Provider Services Center: 888-362-33685

Important information for health care professionals and facilities

Preventing Health Care Fraud and AbuseWe are committed to working with participating providers to keep health care free of fraud and abuse. Together, we can help prevent payment of fraudulent claims and help detect, investigate, report and recover false claims. It’s all part of our shared obligation to refer suspected fraud and abuse matters to law enforcement, regulatory and administrative agencies.

If you suspect fraud or abuse, please contact us immediately. All reports are confidential, and you are not required to include your name, address or other identifying information.

• Examples of fraud and abuse by HealthChoice providers:

– Billing for services or medications not actually performed or obtained

– Billing for excessive or unnecessary medical services or supplies

• Examples of health care fraud and abuse by HealthChoice members:

– Providing false information or hiding facts for the purpose of obtaining coverage

– Letting someone else use your member ID card – Selling or giving your prescription medicines to anyone else

• How to Report Suspected Fraud and Abuse: – Call the UnitedHealth Group fraud hotline at 866-242-7727

– Call the HealthChoice fraud hotline at 866-770-7175

– Go online to ola.state.md.us. Click on Fraud Hotline, List of Hotlines and then Medicaid Benefits

– Write to Department of Health and Mental Hygiene Medicaid Program Integrity Recipient Fraud and Abuse Unit 201 W. Preston St., Room 520 Baltimore, MD 21201

– Send a fax to 410-333-7194.

Caring for Members with Chronic ConditionsWe take a holistic approach to supporting care providers and their patients with complex needs and chronic conditions who are our members. We want to help keep them in the community with the resources necessary to maintain the highest quality of life possible. Here’s how our case managers can help you and your members:

• Telephone contact with members• Home visits as needed• Disease management programs• Health education and educational materials• Health assessment with diagnosis and severity of

condition and psychosocial needs• Referral to community resources as needed• Assistance with medical transportation• Arrangements for durable medical equipment (DME)

and ancillary services as needed or ordered by the physician

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Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33686 Practice Matters: MD - Fall 2015 Provider Services Center: 888-362-33686

Important information for health care professionals and facilities

• Outreach to members to promote assistance with keeping doctor’s appointments

• Work with members to identify and address barriers to seeking health care and following treatment plans

Case Manager Areas of Expertise• Disease management programs

– Diabetes – Congestive Heart Failure – Asthma – HIV – Chronic obstructive pulmonary disease – Sickle cell

• Special needs case management (adults and children)

• Complex needs case management• Pediatrics/NICU case management• Healthy First Steps Program for pregnant women

If you have any questions, please contact Provider Services at 877-542-9235.

Cultural CompetencyUnitedHealthcare Community Plan’s members have a right to receive care that is culturally competent and respects their cultural and ethnic background and origins. Upon enrollment, information regarding primary language is obtained and members are assisted in choosing a Primary Care Physician who will meet their cultural needs.

UnitedHealthcare Community Plan provides access to a Language Line for translation of communications between UnitedHealthcare Community Plan staff and non-English speaking members. The language line use is tracked by our Member Services Call Center so we can be sure members have access to practitioners who can meet their cultural, ethnic, racial, and linguistic needs. The Provider Directory is available at UHCCommunityPlan.com, and lists the languages spoken in the provider’s office.

You may download a copy of our cultural competency plan at http://www.uhccommunityplan.com/health-professionals/md/cultural-competency-library.html or you may request a print copy by contacting our Provider Services team at 888-980-8728 or TTY 711 for hearing impaired.

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6095 Marshalee DriveSuite 200Elkridge, MD 21075Doc#: PCA18115_20150921 © 2015 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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