Provider Newsletter Summer • 2024 CHANGE SERVICE REQUESTED PO Box 971100 El Paso, TX 79997-1100 Nonprofit Org. U.S. Postage PAID Yakima, WA Permit No. 157 On March 1, 2024, HHSC informed STAR+PLUS members about the managed care organizations that are available in the El Paso service delivery area, which now includes El Paso Health. Members may enroll with El Paso Health for the STAR+PLUS program by calling 211 or via YourTexasBenefits.com. El Paso Health members will receive the care they need along with STAR+PLUS Medicaid benefits, which include both physician services and options for home health services or nursing facility care. Other STAR+PLUS benefits include personal attendant services, minor home modifications, and long-term service support services. El Paso Health valueadded services include: ■Home-delivered meals. ■Extra dental services. ■Extra vision services. ■Extra over-the-counter benefits. ■Extra transportation services. And much more! El Paso Health now serves STAR+PLUS members PROVIDERS INTERESTED IN JOINING our network for STAR+PLUS should contact the Contracting Department at 1-833-742-3127 or contracting dept@elpasohealth.com. The STAR+PLUS program will be effective Sept. 1, 2024. You can learn more at elpasohealth.com/starplus.
2 stay informed Access and Availability Standards for Specialty Providers Timeliness of care is defined by the National Academy of Medicine as “reducing waits and sometimes harmful delays for both those who receive and those who give care.” In accordance with the Texas Health and Human Services Commission and Texas Department of Insurance mandates, El Paso Health must monitor our Providers on an annual basis for office accessibility compliance. Our Quality Assurance and Performance Improvement programs monitor these standards. El Paso Health members must be able to schedule an appointment for covered specialty services within the time frames mandated by TDI and HHSC: ■Specialty routine care must be provided within 21 calendar days of request. ■Specialty therapy (PT / OT / ST) evaluations must be provided within 21 calendar days of submission of signed referral. Having timely appointments for our members aids in their care and may possibly avoid unnecessary emergency room visits and hospitalizations. As always, we thank you for the quality care you provide our members, and we appreciate your continued cooperation in our ongoing quality initiatives. If you have any questions on the requirements, please contact the Provider Relations or the Quality Improvement Department at 915-532-3778. Advantages of billing your claims electronically through a clearinghouse Did you know El Paso Health accepts electronic claims from Availity and Trizetto Provider Solutions, LLC? Billing your claims through a clearinghouse offers several advantages, such as speed, accuracy, cost-effectiveness, transparency, and compliance. Electronic claims are transmitted instantly. This leads to quicker processing and payment from El Paso Health. When you submit your claims electronically, it also reduces errors that can occur during data entry. Clearinghouses validate accuracy, reducing rejections or denials from El Paso Health. When you submit your claims electronically, you can track real-time transmission and your rejections immediately. Also, clearinghouses comply with industry standards, such as HIPAA, which mandate secure electronic transactions for health-carerelated transactions. Securely file your claims electronically and receive a notice of submission. Contact our Provider Relations Department at 915-532-3778, ext. 1507, if you need assistance. Below, please find El Paso Health’s Payer ID Numbers: ■El Paso Health—STAR: EPF02 ■El Paso Health—CHIP: EPF03 ■Preferred Admin. UMC: EPF10 ■Preferred Admin. EPCH: EPF11 ■Healthcare Options: EPF37 El Paso Children’s Hospital Multispecialty Center Set in the heart of El Paso, the new El Paso Children’s Hospital Multispecialty Center is home to some of the most talented surgeons and specialists in the nation, dedicated to providing quality care to patients in a space designed specifically for children and their families. The new space includes 52 exam rooms, 10 infusion bays, audiology services, a state-ofthe-art lab, and radiology services. This model of care brings together El Paso Children’s Hospital, Texas Tech, and community physicians under one roof, providing a multidisciplinary approach to patient care found in larger children’s hospitals across the nation. The center, located at 5400 Alameda Ave. in the former Food City building, was beautifully redesigned and is now home to expert physicians and their care teams, treating a vast number of conditions affecting children across the region. Children’s hospitals across the nation have long provided multidisciplinary clinics for their most vulnerable patients, and that model of care is now available here in El Paso. Clinics like brachial plexus, cystic fibrosis, cranial and facial, spina bifida, and vascular anomalies are designed to have patients come to one clinic visit and be seen by all of their specialists and members of their care team. This service helps eliminate the need for parents to drive all across town, and sometimes out of town, in order for their children to see all the doctors necessary to treat them for various conditions.
3 stay informed El Paso Health welcomes a new pharmacy director We’re thrilled to share some exciting news with our El Paso Health Providers! We’d like to announce the addition of a pharmacy director to our team: Angel Palacios. This marks a significant milestone for us, as it’s the first time we’ve welcomed a pharmacist into our organization. Our new pharmacy director will play a pivotal role in enhancing our services and furthering our commitment to excellence in health care. One of his primary responsibilities will be to assist in the authorization reviews for clinicianadministered drugs, with a key focus on improving turnaround times. This strategic Dr. Angel Palacios Meet El Paso Health’s Special Investigations Unit team In compliance with Texas regulations, managed care organizations like El Paso Health are mandated to establish robust procedures for preventing and detecting waste, abuse, and fraud within the health-care system. At the forefront of this effort is El Paso Health’s Special Investigations Unit (SIU), dedicated to safeguarding the integrity of health-care services. The SIU team includes dedicated professionals committed to upholding the integrity of health-care services. Among them are Alina Macias, a specialized claims auditor holding certifications in billing and coding; Jennifer Herrera, SIU assistant; and Ismael Gamez, an experienced clinical registered nurse. Their combined expertise and vigilance play an essential role in safeguarding against fraud, waste, and abuse and promoting ethical health-care practices within our network. Proactively addressing potential risks and ensuring adherence to regulatory standards, El Paso Health’s SIU team contributes significantly to fostering trust and confidence in the health-care services provided to our members. SIU, along with our organization, remains committed to our mission of delivering high-quality care while maintaining the highest standards of integrity and accountability. SIU audits focus on several key aspects, including ensuring accurate documentation and proper coding, obtaining required authorizations prior to services, and monitoring service frequency within approved limits. Let’s work together to maintain the integrity of our health-care system and prioritize the well-being of our community. initiative underscores our dedication to providing timely and efficient care to our members. By integrating the expertise of a pharmacist into our team, we’re not only elevating our internal capabilities, but also strengthening our relationships with pharmacy providers. At El Paso Health, we’re continuously striving to enhance the quality of care we deliver to our members. The addition of our pharmacy director is another step forward in this journey. We’re confident that our new pharmacy director will bring fresh perspectives, invaluable insights, and a wealth of experience to our organization. This expertise will undoubtedly contribute to our mission of being the region’s trusted health plan. We look forward to the positive impact he’ll make on our organization, and, most importantly, on the lives of our members. Here’s to continued growth, collaboration, and excellence in health care at El Paso Health! Alina Macias Jennifer Herrera Ismael Gamez When in doubt, don’t hesitate to reach out! You can contact our waste, fraud, and abuse hotline at 1-866-356-8395. Remember: You can choose to remain anonymous.
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 1-877-532-3778, 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 1-877-532-3778. Models may be used in photos and illustrations. Member Services 1-877-532-3778 EPHP8862405 – EPH-PR-Summer 2024 Provider Newsletter 2024 © Coffey Communications, Inc. All rights reserved. resources Special services for children of traveling farmworkers 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. El Paso Health is also assisting members with community resources such as housing, food security, utility assistance, and child care assistance. 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 program coordinator to provide an in-service to your staff, please call the Outreach Coordinator at 915-532‑3778, ext. 1075. Patients who are underweight or overweight and those with chronic diseases such as diabetes, high blood pressure, and high cholesterol may benefit from nutrition counseling. Nutritionists can create customized meal plans and provide scientific guidance on food, nutrition, biochemistry, and physiology. Partnering with El Paso Health offers your patients the opportunity to receive nutrition counseling to help identify and set priorities and establish goals! Some topics of identification include: ■ How to reject black-and-white thinking and cultural or societal pressures around food. ■ How to ditch the good food vs. bad food mentality. ■ How to give yourself unconditional permission to eat satisfyingly. ■How to make peace with all foods. ■How to respect and befriend the body. ■ How to get in touch with your hunger and fullness cues. ■ How to rediscover satisfaction and pleasure from food. ■How to cope emotionally. ■ How to practice gentle nutrition to nourish your body. Who needs nutrition counseling? EPH nutrition classes (value-added service) Pregnant El Paso members with STAR who are ages 21 or older and CHIP Perinate members who are 19 or older can receive four additional nutritional counseling / meal planning services. Upon completion, members can receive a $25 Walmart gift card for health food-related items. El Paso Medicaid members 20 years or younger can receive four additional nutritional / obesity counseling and meal-planning services above the current Medicaid benefit. El Paso CHIP members 18 years or younger can receive four additional nutritional and obesity counseling and meal-planning services above the current CHIP benefit. You can visit elpasohealth.com/members/healthy-rewards to learn more. You can visit suncitydietitians.com to learn more about these services.
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