Provider Newsletter Summer • 2023 CHANGE SERVICE REQUESTED PO Box 971100 El Paso, TX 79997-1100 Nonprofit Org. U.S. Postage PAID Walla Walla, WA Permit No. 44 Kids need to get vaccinated so that they are protected as they go back to school. Catch-up vaccination requires efforts from health-care Providers, schools, state and local governments, and families. Don’t wait to schedule routine vaccinations. Provider call to action: ■El Paso Health provides Primary Care Providers with a monthly roster of THSteps and Well-Child visits due to help identify and prioritize children who are due or overdue for recommended vaccines. ■Remind all families of the importance of recommended vaccines as children return to school in person. ■Assess the patient’s vaccination status at every visit. ■Be a champion for vaccination in your practice by ensuring that all staff share a consistent message with parents about the importance of childhood vaccines. ■For patients who are eligible for COVID-19 vaccination, you play a critical role in helping vaccine recipients understand the importance of vaccination and that COVID-19 vaccines are safe and effective. ■Enroll as a COVID-19 vaccine Provider and be ready for the authorization of vaccines for children 6 months to 4 years old. Pediatric patients will depend on your readiness when the time comes! Parents put their trust in their medical Provider to be there for their children. A new school year is just around the corner, and that means... Reminder of EPH’s value-added benefits to our members Provider resource: ■https://hhs.texas.gov/providers/ health-services-providers/texas-health -steps/medical-providers A $10 gift card for members 20 and younger who complete a Texas Health Steps checkup on time. A $15 gift card for members ages 3 to 19 who get a checkup when due. Members ages 4 to 18 can get a free physical for sports each year.
2 2022 Provider satisfaction survey results Provider satisfaction is of utmost importance to El Paso Health (EPH) and is a key element of the quality improvement program. For the past 7 years, EPH has contracted with SPH Analytics, now Press Ganey, to conduct annual Provider satisfaction surveys. A random sample of Providers is selected to provide feedback on a variety of domains. Results are compared to the SPH Book of Business Medicaid percentiles. For the 5th year in a row, results of each domain of the 2022 survey significantly outperformed benchmarks, landing in the 95th percentile or higher. As always, we thank you for the quality care you provide our members, and we appreciate your continued cooperation in our ongoing quality initiatives. We look forward to improving our relations with all Providers and providing the best customer service. If you have any questions, please contact the Provider Relations Department at 915-532-3778. Do’s and don’ts of great documentation Great documentation can help keep you out of trouble with CMS, HHSC, and even with the courts if you ever have a malpractice lawsuit on your hands. Always make sure your documentation is complete, correct, and timely. Below are some brief Do’s and Don’ts for documentation: Do ■Check that you have the correct patient’s medical record before you document. ■Document any patient’s AMA or refusal to allow treatment or take a medication. ■Write “Addendum” and the date and time if you forgot to document something or are adding to the progress note. ■Document enough information to tell the whole story. ■Document during or shortly after the visit, not at the end of the day or another day. ■Document legibly, offering concise, clear notes that reflect the facts. ■Document what you report to other health-care Providers. ■Document all significant communication regarding a patient, including orders. ■Document your efforts to answer your patients’ questions. Don’t ■Blindly copy and paste standard entries or entries from the patient’s prior office visit. ■Wait until the end of your shift and rely on memory. ■Change the content of a medical record after the fact in a way that is inconsistent with the original content. HIPAA requires that electronic medical record systems today have an “audit trail” (a mechanism of documenting all changes to a medical record, including identifying when a document is changed, by whom, and what changes were made). ■Be imprecise. Avoid terms like “rule out” and “appears.” ■Write anything in an email, text message, or other electronic message that you would not be comfortable including in the medical record. ■Overuse automatic or pre-filled entries, which can lead to inaccuracies. When in doubt, reach out! If you suspect fraud, waste, or abuse, you can report it anonymously to El Paso Health’s toll-free hotline by calling 1-866356-8395. If you prefer to report directly to the state of Texas, you may do so online at https://oig.hhsc.state.tx.us/wafrep. resources Key Domains 2021 SPH Medicaid BoB percentile Overall satisfaction 95th Willingness to recommend 100th All other plans (comparative rating) 97th Finance issues 97th Utilization and Quality Management 98th Network/coordination of care 100th Pharmacy 100th Health Plan Call Center Service Staff 96th Provider Relations 97th
3 Pediatric urologist brings specialized programs to El Paso Shumyle Alam, MD, joined El Paso Children’s Hospital Physician Specialists in February 2023. He most recently practiced at the Medical University of South Carolina, where he was a Professor of Urology. He also served as the Director of Pediatric Urologic Reconstruction and Medical Director of Urodynamics at Columbia University Medical Center. Prior to this, he served as the Director of the Urogenital Center at Cincinnati Children’s Medical Center. Dr. Alam’s clinic will provide care to patients with: ■Congenital anomalies ■Kidney and urinary tract problems requiring surgical intervention to treat their condition ■Complex urological disorders Dr. Alam and his team have launched a urodynamic program and happy bladder program. He is prepared to provide prenatal consultations, bladder management, and urinary tract reconstruction. Additionally, he will provide a multidisciplinary approach to treating patients through co-management with pediatric surgery, GI, and nutrition for patients requiring bowel management. Caring for the littlest hearts of El Paso El Paso Children’s Hospital Physician Specialists’ board-certified Cardiologists provide fetal echocardiography for pregnant moms with diabetes, autoimmune disorders, and other high-risk indicators. Additionally, they are ready to treat patients exhibiting any of the following conditions: ■Heart murmur ■Palpitations ■Arrhythmia ■Abnormal electrocardiogram ■Chest pain ■Loss of consciousness (syncope) ■Hypertension ■Attention-deficit/hyperactivity disorder ■Kawasaki disease ■Genetic disorders ■Premature infants ■Term infants with: zPatent ductus arteriosus zAtrial septal defect zSmall ventricular septal defect zHyperlipidemia ■Tachycardia ■Pericarditis ■Heart failure 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 for them. 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. stay informed Shumyle Alam, MD
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 EPHP7092305-EPH-PR-SUMMER 2023 Provider Newsletter 2023 © Coffey Communications, Inc. All rights reserved. FDA withdraws approval of Makena products On April 6, 2023, the U.S. Food and Drug Administration (FDA) announced a final decision to withdraw approval of Makena (hydroxyprogesterone caproate) products. Makena products had been approved for use with reducing the risk of preterm birth in women with a singleton pregnancy who have a history of spontaneous preterm delivery. According to FDA, the “drug is not effective, and the benefits of taking it do not outweigh the risks.” Effective April 7, 2023, Makena products and their clinical prior authorization are no longer available. Mental health: Equally as important as physical health El Paso Health cares about the mental health of our members. We offer: ■A behavioral health crisis line. ■Maternal depression screenings. ■Case management to coordinate care. Please call us at 915-532-3778 or toll-free at 1-877-532-3778 for more information. Together, we can support positive mental health. stay informed How do you submit your claims to El Paso Health? El Paso Health accepts electronic claims from Availity and TriZetto Provider Solutions. Payer ID numbers: ■El Paso Health STAR EPF02 ■El Paso Health CHIP EPF03 ■Preferred Administrators UMC EPF10 ■Preferred Administrators EPCH EPF11 ■HealthCARE Options EPF37 El Paso Health also offers a provider portal that allows you to submit claims—primary or secondary professional and institutional claims—at no cost. Filing your claims through the portal can be simple. El Paso Health uses Availity to securely file your claims and receive a notice of submission. Using the claim portal allows you to save money on claim forms, postage and printing. Contact our Provider Relations Department at 915-532-3778, ext. 1514, if you need assistance obtaining access to our provider portal. In loving memory of Dr. David F. Jimenez Our borderland has lost one of its greatest champions of pediatric care with the sudden passing of Dr. David F. Jimenez. He brought innovation and an advanced level of expertise that has changed the lives and futures of many children. Before he arrived in our city, El Paso families had to travel hundreds of miles to get their child the advanced level of care that, in many cases, was required to live. Dr. Jimenez will forever be missed by the patients he served and everyone who knew him at UMC, EPCH and our Foundations, as well as all who knew him or witnessed his kindness and brilliance as a surgeon. A lasting legacy Visit elpasochildrensfoundation.org/dr-david-f -jimenez-memorial-fund if you’d like to contribute.
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