El Paso Health | About Your Health | Winter 2019

Why it’s important to keep your Provider office information current DID SOMETHING CHANGE? I n an effort to adhere to the standards of Texas Health and Human Services (HHSC) and the Texas Department of Insurance (TDI), El Paso Health must provide the most current and updated information to members and Providers. It is important to notify El Paso Health of any demographic changes that occur within your organization as this information is utilized by members, Providers, and internal office staff when selecting Primary Care Providers, specialists, hospitals, after-hours clinics, etc. It is also used by the external quality review organization contracted by HHSC to conduct secret shopper calls to assess appointment accessibility (please see “Appointment Accessibility Statewide Studies” above). We often see that Providers fail to notify us when they change phone numbers, move to another location, change banks, etc. This incorrect information impacts a variety of areas, such as survey results, timeliness of payment, and accuracy of Provider selection. Please report all: ■  ■ Practice location changes. ■  ■ Phone and fax number changes. ■  ■ Billing updates. ■  ■ Provider name changes. ■  ■ Practice name changes. ■  ■ Website URL changes. ■  ■ Office hours. Please help us decrease the amount of incorrect information in our directories by reporting all changes to contracting_dept@ elpasohealth.com or fax 915-298-7870 . H HSC contracts with an external quality review organization (EQRO) to monitor all MCOs on appointment accessibility (i.e., how soon an appointment can be scheduled from the time of request). For the past 3 years, the EQRO has implemented studies using secret shopper calls to survey Providers from each MCO. In a recent study by the EQRO, El Paso Health Providers continue to show a high rate of noncompliance with the varying standards set by HHSC and the Texas Department of Insurance (TDI). The standards for appointment accessibility have been provided in a chart for your review. The outcome of the EQRO secret shopper studies is affected by the accuracy of the MCO Provider directories. In the latest study, over 40 percent of information included in Provider directories across the state of Texas was incorrect. See the article below to learn more about why it is important to keep your information up-to-date and how to update your information with El Paso Health. If you have any questions about the requirements, please contact the Provider Relations department at 915-532-3778 . stay informed Appointment type Standard (calendar days from time of request) Emergency services Upon member presentation Urgent care Within 24 hours Routine primary care Within 14 days Specialty routine care Within 21 days Initial outpatient behavioral health Within 14 days Referrals for specialty care Within 5 days Prenatal care—low-risk pregnancy Within 14 days Prenatal care—high-risk pregnancy or new member in 3rd trimester Within 5 days Preventive health—adults (21 years and older) Within 90 days Preventive health—children (under 6 months) Within 14 days Preventive health—children (6 months to 20 years) Within 60 days Appointment accessibility statewide studies 2