El Paso Health | About Your Health | Fall 2019

Help prevent fraud, waste, and abuse Texas requires that all managed care organizations establish a plan and process to identify and prevent fraud, waste, and abuse. El Paso Health’s plan and process includes conducting reviews on Provider billing patterns, edits, and any coding issues. As part of a review, El Paso Health will request specific records. These should include all relevant documentation of the services as rendered and billed. Providers are required to sign a records affidavit when records are submitted that confirms the documentation is complete. If the review identifies services that are not substantiated by the submitted documentation, the payment for those services will be recouped. This is why your documentation is very important. Maintain accurate and complete medical records and documentation of the services you provide, and ensure your documentation supports the claims you submit for payment. Good documentation practices help to ensure your patients get appropriate care and allow other Providers to rely on your records for patients’ medical histories. You may have heard the saying, “If you didn’t document it, it’s the same as if you didn’t do it.” Good documentation helps address any challenges raised about the integrity of your claims. Please report any suspicious activity to: ■  ■ OIG Hotline: 1-800-447-8477 ■  ■ El Paso Health Hotline: 1-866-356-8395 Quality improvement updates H HSC requires that El Paso Health implement performance improvement projects (PIPs) that will drive positive changes in various health outcomes. In CY 2020, El Paso Health will be implementing a new PIP to improve follow-up care for mental health with a specific focus on the following 2 HEDIS measures: ■  ■ FUH ( follow-up care after hospitalization for mental illness): The percentage of discharges from inpatient stays for mental health who had a follow- up visit with a mental health practitioner within 7 days. ■  ■ ADD ( follow-up care for children prescribed ADHD medication): The percentage of children dispensed ADHD medication who had a follow-up visit with a practitioner with prescribing authority within 30 days. El Paso Health has developed varying interventions for these projects to include member and Provider outreach. Also, don’t forget to check out our clinical practice guidelines! To view our clinical practice guidelines, visit our website at elpasohealth.com/ providers/clinical-practice-guidelines . If you would like to obtain a physical copy, please contact the Quality Improvement department at 915-532-3778 . As always, we look forward to your cooperation on all of our quality initiatives! Special services El Paso Health has special Medicaid services for the children of traveling farmworkers. The services include assistance with scheduling their upcoming Texas Health Steps exams, as well as vision, mental health, and transportation benefits. If you have any questions or would like to receive more information about these services for children of traveling farmworkers or would like for the Outreach Coordinator to provide an in-service to your staff, please call the Outreach Coordinator at 915-532-3778, ext. 1075 . Provider Newsletter ABOUT YOUR HEALTH is published as a service for members of the EL PASO HEALTH Provider network. EL PASO HEALTH Executive Offices are located at 1145 Westmoreland Drive, El Paso, TX 79925, 915-532-3778 or 877-532-3778 , elpasohealth.com . Information in ABOUT YOUR HEALTH comes from a wide range of medical experts. If you have any concerns or questions about specific content in this newsletter, call 877-532-3778 . Models may be used in photos and illustrations. Member Services 1-877-532-3778 EPHP1019100–Fall 2019 Provider Newsletter 2019 © Coffey Communications, Inc. All rights reserved. stay informed