Transcript Indiana Care Select Overview - Indiana Medicaid Provider Home

Mitchell E. Daniels, Jr., Governor
State of Indiana
Indiana Family and Social Services Administration
Anne W. Murphy, Secretary; Pat Casanova, Medicaid Director
Indiana Care Select
Overview
Today’s Agenda
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Program Goals & Overview
Member Enrollment Process
Primary Medical Provider (PMP) Overview
Certification Code Policy
Right Choices Program Referral Process
Care Management Overview
Member Support Services
Care Coordination Conferences
HEDIS
On-line CM Portals
Question & Answer
Program Goals
• To more effectively tailor benefits to its
members
• To improve the quality of care and health
outcomes of its members
• To control the growth of health care costs
• To provide a more holistic approach to
member’s health needs
Program Overview
• Care Coordination
– Individualize services for its members
– Assist its members in gaining access to needed medical,
social, educational and other services
• Disease Management
– Population-based
– Target specific diseases
• Utilization Management
– Appropriate use of facilities, services
and pharmacy
Program Overview
• Care Select Care Management Organizations (CMOs)
– ADVANTAGE Health Solutions, Inc.sm
– MDwise, Inc.
• Care Select Members
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Members that are Aged, Blind or Disabled
Wards of the Court and Foster Children
Home & Community-Based Waiver participants
Members who receive Adoption Assistance
M.E.D. Works participants
Will NOT include members in institutional settings, spend down, or
dual-eligibles (Medicare/Medicaid)
Care Select Member Enrollment
Process
Member letter sent
Does
Member
have a PMP?
Yes
Member enrolled in
PMP’s CMO
No
Enrollment Broker
(MAXIMUS) begins to
call members to answer
questions and help enroll
* If Primary Medical Provider (PMP) is in both plans, member will
choose a plan or be auto-assigned to a plan.
Member auto-assigned
to CMO and PMP
Yes
No
Did member
choose a
PMP and
CMO?
The Primary Medical Provider (PMP)
• What is a PMP and why is having one so important?
– Linked to each Care Select member as the member’s medical
home
– Connects primary and specialty health care
• Provides referrals to specialists via telephone or in writing
– Works with member and care manager to improve the health
of the member
• Who can be a PMP?
– Primary care physicians
• i.e. family practice, general practice, internist,
pediatrician, and OB/GYN
– Specialists
The Primary Medical Provider (PMP)
• How does a PMP enroll?
– PMPs in Care Select may contract with one or both CMOs.
• Why are there two CMOs?
– IHCP wants to give both members and providers a choice.
• How does this affect a member’s choice between CMOs?
– The member is enrolled in the CMO with which his or her PMP is
contracted.
– Members with no prior PMP linkage will receive a letter and call from
the enrollment broker to assist in choosing a PMP.
– Members can change PMPs by contacting their CMO or Maximus.
– Those who do not choose a PMP get auto-assigned to one.
Certification Code Policy
• The Care Select PMP is responsible for providing and/or overseeing a
member’s care during the time the member is linked to that PMP
through the PMP assignment process.
• The PMP agrees to provide the necessary primary and preventive
health services directly to their assigned members or agrees to refer
the member to another health care provider for those services
undeliverable by the PMP.
• Each Care Select PMP is assigned a cert code on a quarterly basis. This
code, in addition to the PMP’s National Provider Identifier (NPI) is
needed to allow a specialist or another provider’s claims to be paid
when appropriate
Certification Code Policy
Policy Description Statement:
• While it is always preferable that the assigned PMP authorize
treatment and provide their NPI and cert code, there may be
occasions when this is not possible.
• Appropriate and designated CMO staff will need to provide
this information to another health care provider in order to
allow the Care Select member access to appropriate and
timely care
• The following are specific circumstances in which designated
CMO staff may release to another health care provider a
member’s PMP’s cert code and NPI before or after a service
has been rendered as approved by the State:
Certification Code Policy
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Exceptions
PMP change is still pending after a previously auto-assigned
member has selected a new PMP
Death of PMP
PMP moves out of the region without proper notification to the
program
Newly transitioned members into the program (i.e. wards and
foster children) who are in need of treatment (i.e. EPSDT) within
the first sixty (60) days of enrollment
Auto-assigned member lives in an underserved area and is
unable to select a PMP from that area
Other urgent, emergent, or ongoing issues (i.e. dialysis or
emergent ER admission) where the member is unable to access
necessary services and the assigned PMP is unwilling or unable
to provide services or the appropriate referral
Right Choices Referral Process
formerly known as Restricted Card Program
• ADVANTAGE Health Solutions identifies and monitors individuals in both
ADVANTAGE Care Select and the Traditional or fee-for-service Medicaid
Program
• MDwise Care Select identifies and monitors individuals in the MDwise
Care Select Program
• This includes members who have shown a pattern of potential mis utilization or over - utilization of services
The RCP is:
• Not a loss of benefits
• Not a reduction in benefits
• Not punitive action, but is a legal action
Note: Members are still eligible for all medically necessary IHCP services.
However, those services must be ordered or authorized in writing by the
member’s assigned PMP
Right Choices Referral Process
The RCP identifies members appropriate for assignment and
subsequent “lock-in” to:
– one Primary Care Physician (PCP)
– one pharmacy and
– one hospital
The RCP Program applies to both members in Traditional Medicaid
and Indiana Care Select
• Specialty providers receive written authorization from the PMP
• The CMO’s add those specialists to the member’s provider list in
order for the specialty provider to be reimbursed
Right Choices Referral Process
The PMP manages the member’s care and determines whether
a member requires evaluation or treatment by a specialty
provider
– Referrals are required by the PMP for most specialty medical
providers (except self referral services)
– Referrals should be based on medical necessity and not
solely on the desire of the member to see a specialist
– Emergency services for life threatening or life altering
conditions are available at any hospital, but non-emergency
services require a referral from the PMP
Right Choices Referral Process
Adding Providers to a Right Choices Member’s Lock In List
• Additional providers may be locked-in, either short-term or on
an ongoing basis, if the PMP sends a written referral.
• Providers may be locked-in for one specified date of service or
for any defined duration of time, up to one year.
Right Choices Referral Process
When a Referral is Not
Necessary: Self Referral
• Behavioral health (except
prescriptions)
• Chiropractic services
• Dental services (except
prescriptions)
• Diabetes self-management
services
• Family planning services
• HIV/AIDS targeted case
management
• Home health care
• Hospice
• Podiatric services (except
prescriptions)
• Transportation
• Vision care (except surgery)
• Waiver services
Right Choices Referral Process
Referral Guidelines for the PMP
• Referrals must be faxed or mailed
• Referrals may be handwritten on letterhead or a prescription pad,
however, they must include the following information:
– IHCP member’s name
– IHCP member’s RID
– First and last name and specialty of the physician to whom the
member is being referred
– Primary lock-in physician’s signature (not that of a staff
member)
– Date and duration of referral
Right Choices Referral Process
CMO Right Choices Contact Information
ADVANTAGE
ADVANTAGE Health Solutions –
Traditional FFS
Attn: Right Choices Program
P.O. Box 40789
Indianapolis, IN 46240
1-800-784-3981
Fax: 1-800-689-2759
ADVANTAGE Health Solutions Care Select
Attn: Right Choices Program
P.O. Box 40789
Indianapolis, IN 46240
1-800-784-3981
Fax: 1-800-689-2759
MDwise
MDwise Care Select
Attn: Care Management
P.O. Box 44214
Indianapolis, Indiana 462440214
Phone: 1-866-440-2449 or
317-829-8189 Option 1
Fax: 1-877-822-7187 or
317-822-7517
Care Management Overview
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PHILOSOPHY
Member-centered care management focus
Strong partnerships with community providers to
coordinate behavioral, developmental and medical
services
Utilize assessments and risk stratification tools to
determine needs at the member/provider level
Excel in communication with members, their families
and their caregivers
Care Management Overview
Step 4.
Measure
Results
Step 3.
Coordinate
Care
Step 1.
Assess
Member
Needs
Step 2.
Design Care
Plan
Step 1: Assess Member Needs
• Identify high risk members through medical claims
history/risk stratification
• Identify and reach out to member’s family or facility
case manager
• Share existing assessments/care plans to avoid
duplicative assessment questions or interventions
• Conduct initial interview with member or caregiver
– Assign care management Level 1-4
– Identify the need for more comprehensive
medical, behavioral, psychosocial, and/or
functional assessments
– Identify immediate needs and implement
immediate interventions if needed
– Members are reassessed and care plans updated
as needed (at least annually)
Step 4.
Measure
Results
Step 3.
Coordinate
Care
Step 1.
Assess
Member
Needs
Step 2.
Design Care
Plan
Stratification
Once the assessments are complete, the member is stratified into one
of four need groups
• Level one – minimum provided to all Care Select members
• Level two – all level one services plus more support/guidance
• Level three – all level one and two services plus high level support
as determined by risk issues related to health
• Level four – all level one, two and three services plus support
related to require most services and often face crisis situations
Note: all Care Select members who are pregnant or are seriously
mentally ill are automatically placed into Level two and members
can be re-stratified at anytime depending on condition and need
Step 2: Design Care Plan
• Involve member, caregivers and providers in
developing the member’s Care Select Care Plan:
– Establishing care plan goals that are evidencebased and outcome-oriented
– Taking responsibility for achieving care plan
goals
• Integrate goals/interventions across a member’s
other care plans
– Primary Care
– Family Teaming
– Medicaid waiver program
– Individualized Education Plan (IEP)
– CMHC/behavioral health treatment plan
• Prioritize goals/interventions recognizing the
member’s priorities
Step 4.
Measure
Results
Step 3.
Coordinate
Care
Step 1.
Assess
Member
Needs
Step 2.
Design Care
Plan
Step 3: Coordinate Care
• Share individualized care plan with:
– Member/Caregiver
– PMP
– Waiver/CMHC Case Managers
• Involve members, caregivers, Care Managers,
Care Partners, Care Advocates, Family Case Managers,
and providers in active dialogue about barriers, goals
and progress
– Web-based care plans
– Care conferences
– Ongoing dialogue
• Facilitate communication with health care providers,
i.e. physicians, community organizations, waiver
programs, school-based services, and the Division of
Child Services
Step 4.
Measure
Results
Step 3.
Coordinate
Care
Step 1.
Assess
Member
Needs
Step 2.
Design Care
Plan
Step 3: Coordinate Care (cont.)
• Connect member/caregiver with needed services
• Advocate for member by
– Removing barriers to care
– Providing education about conditions, access
to care, member rights and responsibilities
• Facilitate member/caregiver independence
through teaching and reinforcing selfmanagement skills
• Utilize the member’s comprehensive assessment
and care plan to provide context and support for
PA requests
Step 4.
Measure
Results
Step 3.
Coordinate
Care
Step 1.
Assess
Member
Needs
Step 2.
Design Care
Plan
Step 4: Measure Results
• Member level outcomes
– Achievement of care plan goals
– Annual health needs assessment
• Program level outcomes
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Member and provider satisfaction
Evidence-based practice
Improvement in quality of life metrics
Reduction in inpatient/ER admissions
Complaints, grievances/appeals
Step 4.
Measure
Results
Step 3.
Coordinate
Care
Step 1.
Assess
Member
Needs
Step 2.
Design Care
Plan
Member Support Services
The CMO care management teams are engaged in the provider
community in order to create a well rounded approach to providing
member support, care plan development and improved treatment
outcomes. The CMOs currently partner with several providers to achieve
these goals:
• Community Mental Health Centers (CMHCs) – incorporate behavioral
health treatment plans into the member’s overall plan or care AND
assist the CMHC in accessing physical health services (i.e. primary care
and dental services) for their Care Select population
• Developmentally Disabled (DD) Waiver Providers – incorporate the
member’s plan of care developed by the Waiver case manager as well as
non DD Waiver provider training materials to educate PMPs on best
practices for working with the DD population AND assist the DD Waiver
provider in accessing physical health services (i.e. primary care, dental,
and behavioral) for their Care Select population
Member Support Services
• Hospitals – obtaining notification from hospitals that they are about
to discharge a Care Select member allows the care manager to work
to ensure the member has access to needed post – inpatient
services that reduce the chance of another inpatient admit
• Dental – informing our members on the importance of getting
dental care and reminding those, by mail, if they have not seen the
dentist within the calendar year
• Social Services – supporting members with social crisis (i.e. eviction,
utilities disconnection) and connecting pregnant members with
pregnancy related services (i.e. WIC, parenting classes, etc..)
Care Coordination Conferences
The CMOs will coordinate with its Care Select PMPs to perform
care coordination conferences to review a member’s plan of
care and the progress with that plan of care.
Care Coordination Conference:
• is a covered benefit for Indiana Care Select Program members
assigned PMP
• can occur up to twice per member per rolling calendar year
• will be scheduled on a semi annual basis
• can be held in person at the PMP’s office or via phone
conference
• is a billable service (not applicable to FQHC/RHC providers)
Care Coordination Conference
Care Coordination Conference Purpose:
• open communication and coordination between all healthcare
providers
• to provide a forum for PMPs to interact directly with our care
management teams
• discuss the care plans of your patients and collaboratively decide how
we can effectively facilitate the management of your patients
“We realize that our members often require complex medical care
from a variety of sources, which often extend beyond the confines of
your office. Our goal in care management is to coordinate the efforts
of the healthcare team with other participating government, social and
community agencies working together on behalf of the patient.” –
Indiana Care Select Program CMO Care Management Departments
Care Coordination Conference
How to Schedule/Plan for the Care Coordination Conference :
ADVANTAGE Care Select Program
• Will notify each contracted PMP by mail, when it is time to schedule the
conference
• Mailing will include “How to schedule and complete your Biannual Case
Conference” form where the PMP will:
– Select date and time
– Review a panel listing of your members
• Identify additional concerns
• Note any additional information
– Fax, Email, or direct mail the panel back to ADVANTAGE prior to
scheduled date of conference
• each conference will last no longer than 60 minutes and can be conducted
via phone or an on site visit by request (pending availability)
Care Coordination Conference
How to Schedule/Plan for the Care Coordination Conference:
MDwise Care Select Program
• Will notify each MDwise PMP by mail or phone, when it is time to schedule
the conference
• Mailing will include a member checklist form and member’s care plan where
the PMP will (Please note: Providers can sign up for CareConnect and access
each member’s plan of care there rather than receiving a mailed care plan):
– Review the member’s care plan
• Identify additional concerns on the checklist
• Note any additional information on the checklist
– Fax, Email, or direct mail the member checklist form back to MDwise
prior to scheduled date of conference
• Each conference will last no longer than 60 minutes and can be conducted
via phone or an on site visit by request (pending availability)
Care Coordination Conference
How to Bill for Care Coordination Conferences
• PMPs, or their designated nurse practitioner (NP) or physician
assistant (PA) who works for the PMP or PMP’s employer such
as a group or clinic are eligible to receive reimbursement from
Indiana Health Coverage Programs (IHCP) for their
participation in the care coordination conferences
• Both the CMO and the PMP will be responsible for checking
eligibility on the date of the care coordination conference
• Submit claims for members discussed during the care
coordination conferences to EDS as with all other covered
Care Select services
Care Coordination Conference
How to Bill for Care Coordination Conferences (continued)
• No prior authorization is required for care coordination conferences
• Care coordination conferences are carved out of the Third Party
Liability requirements for Care Select so providers do not need to
submit claims for these services to the member’s private insurance
company prior to submitting them to EDS for reimbursement
• Submit claims on a CMS – 1500 claim form using the CMS – 1500
paper claim format found in Chapter 8, Section 4 of the IHCP
Provider Manual. Providers may also submit these claims
electronically using their proprietary software or using EDS’s web
interChange
Care Coordination Conference
How to Bill for Care Coordination Conferences (continued)
• The primary diagnosis providers should use when billing for care
coordination conferences is either the member’s last known
diagnosis related to the member’s disease state or V70.9
• All PMPs, or NPs must be linked to the billing group
• The CMO and provider will identify via the CMO’s bi-annual Care
Coordination Conference Checklist, potential members to be
reviewed and discussed during the conference. If neither the PMP
nor the CMO have issues resulting in a discussion of the member’s
plan of care, the provider cannot bill for a care coordination
conference for that member
Care Coordination Conference
How to Bill for Care Coordination Conferences (continued)
• The Bi-annual Care Conferences Checklist verifies the PMP’s review
regarding the plan of care. Providers are required to keep a copy of
the Bi-annual Care Conferences Checklist for auditing and
documentation purposes
• PMPs are limited to billing up to two care coordination conferences per
member per rolling calendar year
• The service code to be used to identify billing for care coordination
conferences for each Care Select member is 99211 SC – “Office or
other outpatient visit for the evaluation and management of an
established patient.” Note: Please refer to both IHCP Bulletins
BT200723 & BT200804 for further details
Care Coordination Conference
How to Bill for Care Coordination Conferences (cont.)
• If the PMP’s NP is in the same group or clinic as the PMP who
performs the care coordination conference with the
member’s CMO care manager, the NP’s IHCP provider number
is appended to 99211 SC. If the NP is not enrolled in the IHCP,
providers must append modifier SA
• Services for NPs not linked to the PMP’s clinic or group will be
denied because that practitioner does not participate in the
same group or clinic as the member’s PMP and it will be
assumed that those practitioners have no practical experience
with that member and are not in a position to discuss that
member’s plan of care
Care Coordination Conference
How to Bill for Care Coordination Conferences (cont.)
 PAs cannot enroll in the IHCP, but can participate in the care
coordination conference and be reimbursed. The care coordination
service code 99211 SC must be billed along modifier HN or HO (use
the modifier that corresponds to the PA’s education level)
• The PMP or the PMP’s NP or PA will be reimbursed by the IHCP at a
rate of $40 per member per conference. PMPs, or their NP/PA who
refuse to participate or do not attend a scheduled care coordination
conference cannot bill the IHCP for that conference
Healthcare Effectiveness Data and
Information Set (HEDIS)
• The Healthcare Effectiveness Data and Information Set (HEDIS) is a
widely used set of performance measures in the managed care
industry, developed and maintained by the National Committee for
Quality Assurance (NCQA).
• Set of standardized performance measures based on evidencedbased best practice
• HEDIS was designed to allow consumers to compare health plan
performance to other plans and to national or regional
benchmarks.
• The Indiana Care Select CMO’s both use HEDIS or HEDIS-like
measures to assess the quality outcomes for Indiana Care Select
members.
HEDIS Performance Metrics
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Acute Inpatient Mental Illness 7 Day Follow-up (ages 6+)
Planned Activity
Increasing the Rate of Follow-Up after Hospitalization for Mental
Illness
Scope and Population
Members 6 years of age and older as of the date of discharge.
Discharged alive from an acute inpatient setting with a principal
mental health diagnosis.
Eligible population is based on discharges (not members).
Includes all discharges for members who have more than one
discharge on or between Jan 1 and Dec 31 of measurement year.
HEDIS Performance Metrics
Acute Inpatient Mental Illness 7 Day Follow-up (ages 6+)
RATIONALE
• Over 40% of our Indiana Care Select members have a Behavioral
Health Diagnosis. Selecting this particular HEDIS measure allows us
to improve the health and continuity of care for a large portion of
our population.
• Monitoring and positively affecting this HEDIS measurement allows
us the opportunity to potentially decrease high cost services by
replacing them with community interventions.
HEDIS Performance Metrics
Care Select Initiatives to Increase the Rate of Follow-Up after
Hospitalization for Mental Illness
• Our Care Management staff has been trained and has implemented
new daily communication program between the Prior Authorization
department and the Care Management Department to identify
members who fit criteria.
• Coordinating with providers and members to ensure that follow up
care is being provided in a timely fashion.
• Working in collaboration with the Office of Medicaid Policy and
Planning and all of the Indiana Health Coverage Programs to
increase the performance for this HEDIS metric.
HEDIS Performance Metrics
Adolescent Well-Care Visit (ages 12-21)
Planned Activity
Increasing the Rate of Adolescent Well-Care Visits
Scope and Population
Members 12-21 who had at least one comprehensive well-care visit
with a PMP or OB/GYN practitioner during the measurement year
and have been continuously enrolled with no more than a 45 day
gap in coverage.
HEDIS Performance Metrics
Adolescent Well-Care Visit (ages 12-21)
Rationale
• The Indiana Care Select Program has received a large influx of
members in this age group due to assignment of Ward and Foster
children.
• Establish a medical home-trust, coordination of care, outreach
• Evaluate physical health, emotional health, growth and
development
• Allow for early diagnosis and treatment of chronic conditions,
diseases
• Identify and provide guidance about risky behaviors
HEDIS Performance Metrics
Care Select Initiatives to Increase Rate of
Adolescent Well Child Exams
• Member Incentive to schedule and complete their Well Child
exam
• Provider Incentive to ensure all assigned members are
receiving their Well Child exam
• Initiative to increase transportation access to ensure all
members are able to get their appointments
HEDIS Performance Metrics
Breast Cancer Screening (ages 40-69)
Planned Activity
Increase rate of Breast Cancer Screenings
Scope and Population
Women ages 40 – 69 years of age who have had a
mammogram to screen for breast cancer and continuously
enrolled with no more than a 45 day gap in coverage
HEDIS Performance Metrics
Breast Cancer Screening (ages 52-69)
Rationale
• Early diagnosis of breast cancer allows for less invasive treatment and
is associated with better outcomes.
• Breast Cancer Screenings have shown to reduce breast cancer
mortality rates.
• One in 8 women in the US will be diagnosed with breast cancer in their
lifetime.
• In an effort to improve the overall health of our Indiana Care Select
members, we will target this preventative care measure to improve
timely intervention in order to enhance treatment options.
HEDIS Performance Metrics
Care Select Initiatives to Increase rate of Breast Cancer
Screenings
• Member Incentive to schedule and complete their Breast Cancer
Screening
• Provider Incentive to ensure their assigned members are
completing their Breast Cancer Screenings
• Educational mailings on the importance of women’s
preventative health
• Just-in-time education and assistance with appointments (during
health screening and assessment, mailings, inbound calls for
other reasons).
HEDIS Performance Metrics
Cervical Cancer Screening (ages 21-64)
Planned Activity
Increase rate of Cervical Cancer Screenings
Scope and Population
Women ages 21-64 continuously enrolled with no more
than a 45 day gap in coverage who received one or more
Pap tests to screen for cervical cancer.
HEDIS Performance Metrics
Cervical Cancer Screening (ages 21-64)
Rationale
• Early diagnosis of cervical cancer allows for highly effective
treatment and cure.
• Easiest form of female cancer to prevent with regular screening
tests and follow-up
• Control Studies have found that the risk of developing invasive
cervical cancer is three to ten times greater in women who have
not been screened
• Screenings can detect early changes in the body that may lead to
cervical cancer
HEDIS Performance Metrics
Care Select Initiatives to Increase rate of Cervical Cancer
Screenings
• Member Incentive to schedule and complete their Cervical
Cancer Screening
• Provider Incentive to ensure their assigned members are
completing their Cervical Cancer Screenings
• Educational mailings on the importance of women’s
preventative health
• Just-in-time education and assistance with appointments (during
health screening and assessment, mailings, inbound calls for
other reasons).
HEDIS Performance Metrics
Comprehensive Diabetes Care, Hemoglobin A1c (HBA1c) test
(ages 18-75) & LDL-C Screening (ages 18-75)
Planned Activity
Increasing the Rate of HBA1c Testing & LDL-C Screening for
Diabetics
Scope and Population
Members 18-75 with diabetes (type 1 and type 2) who had
an HbA1C test.
Members 18-75 with diabetes (type 1 and type 2) who had
an LDL-C Screening.
HEDIS Performance Metrics
Rationale
• Hemaglobin A1C
– Hemoglobin A1C is a measure of blood sugar control over time
– Management of blood sugar levels is key to preventing short and long term
complications from diabetes
• LDL-C
– Management of cholesterol levels is a major component for preventing
cardiovascular complications from diabetes
– LDL-C is “bad cholesterol” and is usually measured as part of a panel of lipid
tests
• Regular testing provides the member and the member’s doctor with
important information to guide and measure the effectiveness of
treatment
HEDIS Performance Metrics
Care Select Initiatives to Increase A1C and LDL-C Testing for
Members with Diabetes
• Disease Management (DM) program provides:
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Disease and treatment education
Support for achieving self-management goals
Reminders for regular testing
Coordination with PMP, schools
• Member Incentives
– Active participation in their Diabetes DM program
– Completing their A1C and LDL-C tests
• PMP Incentives
– Active participation in their member’s DM program
– Ensuring their assigned members receive testing
HEDIS Performance Metrics
Annual Dental Visit (ages 3-64)
Planned Activity
Increase rate of Dental Exams
Scope and Population
Members ages 3-64 who have had at least one dental visit
within a calendar year.
HEDIS Performance Metrics
Annual Dental Visit (ages 3-64)
Rationale
• Dental care is one of the most prevalent unmet health
needs in America today.
• Dental health is highly correlated with many other health
concerns:
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Loss of teeth
Abscesses that shed bacteria in bloodstream
Ulcers
Malnutrition
HEDIS Performance Metrics
Care Select Initiatives to Increase rate of Dental Exams
• Member Incentive to schedule and complete their annual dental
exams
• Initiative to increase transportation access to ensure all
members are able to get to their appointments
• Just-in-time education and assistance with appointments (during
health screening and assessment, mailings, inbound calls for
other reasons).
Online CM Provider Portals
ADVANTAGE Care Select - Flexport
What is Flexport?
• Flexport is a (PMP) Primary Medical Provider’s connection to
comprehensive medical utilization information about
ADVANTAGE Care Select members.
• It is a secure web-based portal supplying the designated PMPs
access to important and timely member utilization data.
(Examples: emergency room visits, PMP visits, Specialist visits,
and medications filled)
• Flexport is an efficient tool to view a member’s comprehensive
medical profile and provide input, on the Case Plan, to the Case
Manager
Online CM Provider Portals
ADVANTAGE Care Select – Flexport (cont.)
Why use Flexport?
Flexport’s comprehensive medical utilization information provides a
complete picture of a Care Select patient’s health status. This
reinforces the benefit of having a medical home for ADVANTAGE Care
Select members
You and your staff will be able to save time by:
► Having the care plan in one location
► Being able to view services the member is using
► Providing feedback for patient care plans directly and securely
Online CM Provider Portals
ADVANTAGE Care Select – Flexport (cont.)
What Type of Information Is In Flexport?
The Flexport member profile displays your ADVANTAGE Care Select
patient’s use of services, prescriptions, and providers including:
► Care Plans for each issue or condition
► Number of visits to PMP
► Number of visits to Specialists
► Primary and secondary diagnoses
► Inpatient admissions
► Emergency room utilization
► Durable medical equipment history
► Pharmaceutical history by drug classification
Online CM Provider Portals
ADVANTAGE Care Select – Flexport (cont.)
What Flexport Is Not?
• Flexport is not a replacement for Indiana Care Select panel
rosters. Refer to the roster sent to you twice monthly from
EDS
• Flexport is not used to determine eligibility. Please continue
to check eligibility of Care Select patients through Indiana
Health Coverage Programs eligibility resources
Online CM Provider Portals
ADVANTAGE Care Select – Flexport (cont.)
Enrollment Steps
1. Obtain a Web Portal Agreement
visit the Provider page at: www.advantageplan.com/advcareselect
OR
get the Agreement from your ADVANTAGE Care Select Provider Relations Representative
2. Complete and sign the Web Portal Agreement.
3. Fax or Mail the agreement to:
317-587-8411 or
ADVANTAGE Care Select Attn: Provider Relations
9045 River Road, Suite 200
Indianapolis, IN 46240
4. When the agreement is received you will be sent a confirmation letter with your
user name and password
User Name and Password cannot be changed. They are preset by the system
Online CM Provider Portals
MDwise Care Select – CareConnectNX (CCNX)
What is CCNX?
CCNX provides access for MDwise Primary Medical Provider’s (PMP) to their
assigned member’s Care Plan and medical utilization information. It is a
secure web-based portal supplying the designated PMPs access to important
and timely member utilization data (Examples: emergency room visits, PMP
visits, Specialist visits, and medications filled)
CCNX is an efficient tool to view a member’s comprehensive medical profile,
provide input on the Care Plan to the Case Manager either during the care
coordination conference or at any point
You and your staff will be able to save time by:
► Having the care plan in one location
► Being able to view services the member is using
► Providing feedback for patient care plans directly and securely
Online CM Provider Portals
MDwise Care Select – CareConnectNX (CCNX)
What Type of Information Is In CCNX?
The CCNX member profile displays your MDwise Care Select patient’s
use of services, prescriptions, and providers including:
► Care plans
► Case notes and progress notes
► Initial and full assessments
► Primary and secondary diagnoses
► Inpatient admissions
► Emergency room utilization
► Pharmaceutical history
Note: PMPs will eventually be able to add information to the member’s
profile
Online CM Provider Portals
MDwise Care Select – CareConnectNX (CCNX)
Enrollment Steps
1. Obtain a Web Portal Agreement
visit the Provider page at: www.mdwise.org
2. Complete and sign the Web Portal Agreement
3. Fax or Mail the agreement to:
1-877-822-7188 or 317-822-7519
MDwise Care Select
Attn: Jeff Leathers
1099 N. Meridian St., Suite 320
Indianapolis, Indiana 46204
4.
When the agreement is received you will be sent a confirmation e-mail with
your user name and password
5.
CCNX is not an eligibility verification or panel roster maintenance tool
Question & Answer
Presentation by ADVANTAGE Health Solutions, Inc. and MDwise, Inc. Provider
Relations Team in cooperation with each organization’s Care Management
Department
Janet Edwards – SeniorManager Care Management, MDwise Care Select
Kristin Atkinson – Care Management Manager, ADVANTAGE Care Select
Kelvin Orr – Director of Network Development– ADVANTAGE Care Select
Chris Kern – Provider Relations Manager – MDwise Care Select
•
ADVANTAGE Traditional Medicaid
P.O. Box 40789
Indianapolis, IN 46240
•
ADVANTAGE Care Select
P.O. Box 80068
Indianapolis, IN 46280
•
MDwise Care Select
P.O. Box 44214
Indianapolis, IN 46244