resources 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 EPHP10642503 – EPH-PR-Spring 2025 Provider Newsletter 2025 © Coffey Communications, Inc. All rights reserved. How audits help prevent fraud, waste, and abuse El Paso Health’s Special Investigations Unit (SIU) conducts regular audits to help prevent fraud, waste, and abuse in health care. These audits ensure that Providers follow proper billing practices and that health-care funds are used correctly. Fraud, waste, and abuse in health care can lead to significant financial losses and affect patient care. By implementing strong internal controls and conducting thorough audits, El Paso Health’s SIU helps identify fraudulent activities and promote accountability among Providers. Regular audits also support compliance with state and federal regulations, reducing the risk of penalties and enhancing overall program integrity. El Paso Health partners with a thirdparty vendor that uses advanced data analytics and investigative techniques to identify anomalies in billing patterns and Provider behavior. Through proactive monitoring and collaboration with regulatory agencies, the SIU ensures that health-care services are delivered efficiently and ethically. Providers must promptly comply with medical record requests during audits or investigations. Complete documentation ensures claim legitimacy, accurate reimbursement, and regulatory compliance. Failure to provide records may result in payment denials, recoupments, or further review by agencies such as the Texas Office of Inspector General (OIG), Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services Office of Inspector General, or the Texas Office of the Attorney General. Noncompliance can lead to sanctions or legal action. Cooperation helps protect Providers and maintain health-care integrity. Always remember: If you suspect fraud or abuse, you can report it confidentially or even anonymously. Report to: ■El Paso Health fraud hotline: 1-866-356-8395 ■Texas OIG: 1-800-436-6184 or oig.hhs.texas.gov Interpreter services available for members Effective communication is essential in providing quality care. If you or your staff members encounter language barriers when communicating with El Paso Health members, we are here to help. El Paso Health offers in-person interpreter services, including sign language interpreters, for office visits. These services ensure that members receive the support they need for a clear and effective health-care experience. To arrange interpreter services, please contact our Member Services hotline: ■STAR Medicaid, CHIP, and CHIP Perinatal members: 1-877-532-3778 ■STAR+PLUS members: 1-833-742-3127 Scheduling requirements: ■Spoken-language interpreters— request at least 24 hours in advance. ■Sign language interpreters—request at least 48 hours in advance. We appreciate your commitment to serving El Paso Health members and ensuring accessible health care for all. 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. If you would like to receive more information about these services for children of traveling farmworkers or to arrange an in-service training for your staff, please call our Outreach Coordinator at 915-532‑3778, ext. 1075.
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