Provider spotlight Did you know? ■Eating disorders affect at least 9% of the population worldwide. ■9% of the U.S. population, or 28.8 million Americans, will have an eating disorder in their lifetime. And did you know that Primary Care Providers may be the first to identify eating disorders? They can make referrals for prompt and appropriate care to eating disorders centers or to registered dietitians. Adriana Rascón, Registered Dietitian, has over 26 years of experience in the areas of eating disorders, hear t disease, diabetes, cancer, irritable bowel syndrome, high triglycerides, cholesterol, and weight management. She creates individualized plans for patients, and, to better understand each patient’s unique needs and goals, she checks lab work and physician orders, as well. Rascón has a master’s degree in Family Consumer Sciences in the area of Human Nutrition, with a dietetics internship program through Iowa State University. She has also taught nutrition and dietetics at UTEP and at El Paso Community College. She is now, again, focusing on eating disorders, hear t disease, diabetes, cancer, irritable bowel syndrome, and other health conditions. For more information, you may contact Rascón at 915-276‑3715 or adrianarascon3715@ gmail.com. Her webpage is at elpasonutritionconsultants.com. Lead screening is important Protecting children from exposure to lead is important to their lifelong good health. According to the U.S. Department of Health and Human Services Office of Inspector General, a 2015 to 2018 study showed that California, New York, Ohio, Pennsylvania, and Texas were among the highest (not necessarily in percentage) of elevated blood lead levels (EBLLs). Lead testing should be performed as part of Texas Health Steps checkups to screen for high EBLLs in children 12 and 24 months and 3 years of age. The following chart shows how many Medicaid-enrolled children in Texas did not receive blood lead testing for these 3 age groups: Number of enrolled children Number of enrolled children who did not receive a test Percentage of enrolled children who did not receive a test Lead test not completed at 12-month eligibility 372,776 212,644 57.04% Lead test not completed at 24-month eligibility 386,846 266,397 68.86% Lead test not completed by 3 years of age (3 years of continuous eligibility) 8,013 2,758 34.42% The Centers for Disease Control and Prevention is committed to helping address this threat and improving health outcomes for our nation’s most vulnerable citizens—our children. Source: Centers for Disease Control and Prevention From the Desk of David Palafox, MD, DABFM, El Paso Health Medical Director Provider Newsletter Fall • 2022 CHANGE SERVICE REQUESTED PO Box 971100 El Paso, TX 79997-1100 Nonprofit Org. U.S. Postage PAID Walla Walla, WA Permit No. 44
2 Telemedicine and telehealth claims Coding the location where health services and health-related services are provided or received through telemedicine and telehealth services is very important. You may now use POS 10 for telehealth services provided in a patient’s home through telecommunication technology. If the services are provided anywhere else other than in the patient’s home through telecommunication technology, continue to use POS 02. Remember to also submit modifier 95 with your telemedicine or telehealth claims. Note: Claim will be denied if it is submitted only with modifier 95, and POS 02 or POS 10 is missing, or vice versa. If you have any questions, do not hesitate to contact us. EL PASO HEALTH PORTALS A time-saving alternative for providers and their El Paso Health patients El Paso Health members have access to a member portal equivalent to the Provider portal. Both portals allow access to information that can reduce the amount of time that your staff spends on the phones. resources Providers can: ■View patient’s eligibility and benefit information. ■Verify claim status or view payment amounts. ■Request and verify authorizations. ■Download remittance advice forms. The portals and app are available 24 hours a day, 7 days a week. The app can be downloaded from the Android Google Play Store or iPhone App Store. We encourage the use of these services to promote efficiency that will benefit your in-office staff as well as any billing staff that may be off-site. If you need assistance in creating a portal account or to grant access to your staff, feel free to reach out to your Provider Relations Representative or to contact our Member Services Department at 915-532-3778 or toll-free at 1-877-532-3778. Members can: ■View their eligibility and benefits. ■Print ID cards. ■Find a network Provider. ■Request Primary Care Provider changes. ■View claim and authorization status. Provider portal Member portal Additionally, El Paso Health has a mobile app that members can use for these same functions.
3 Our new Member Advocate El Paso Health would like to introduce our new Member Advocate, Esther VillegasReyes. Esther brings with her 20 years of experience in health care, customer service and community service. As our Member Advocate, Esther will assist and represent our STAR and CHIP members. Some of Esther’s duties include helping the members navigate through their covered services, including preventive services, rights and responsibilities, and the complaint and appeals process, and providing education and support in accessing these services. In addition to the information mentioned above, the Member Advocate also assists with the following: ■Non-capitated services. ■Claims and billing process. ■Eligibility. ■A list of all Providers in the network. ■Writing and submitting of complaints and appeals. ■Monitoring of the complaint or appeal through its process. ■Recommendations to our El Paso Health management on any changes needed to improve either the care provided or the way care is delivered. ■Referrals to community resources that are available to meet our members’ needs if the services are not available from El Paso Health as a covered service. ■Referrals to El Paso Health Case Managers and/or Outreach Coordinators for assistance with community resources that are available through El Paso Health. If at any moment our members need assistance from our Member Advocate, please call 915-532-3778 or toll-free at 1-877-532-3778. You may also see her in person at our office located at 1145 Westmoreland Drive, El Paso, TX 79925. stay informed We want to ensure that resources are being used appropriately, and that means avoiding wasteful practices. Such practices might occur if a reasonably prudent person acts carelessly and allows the inefficient use of resources, items, or services, such as by: If you suspect that a person or entity has acted in a possibly fraudulent, wasteful, or abusive manner, please report such actions to our toll-free Fraud Hotline at 1-866-356-8395 or to HHSC Office of Inspector General toll-free at 1-800-436-6184. Billing for unnecessary services. Allowing more durable medical equipment (DME) supplies per month than the client needs. Upcoding for evaluation and management services to obtain higher reimbursement. What are wasteful practices?
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 EPHP5552206-EPH-PR-FALL 2022 Provider Newsletter 2022 © Coffey Communications, Inc. All rights reserved. Provider satisfaction survey results for 2021 In order to provide the most updated information to El Paso Health members about your practice, please ensure that you submit any changes to your demographic information or practice to the Provider Relations or Contracting Departments. Updates may be made and discrepancies may be corrected using the Provider Demographic Form, which can be found on the El Paso Health website under the forms section. You can also send an email to the Contracting_Dept@elpasohealth.com to update your information. You can also contact us at 915-532-3778. The following elements are reviewed and updated as necessary: ■Provider name ■Address location(s) ■Phone and fax numbers ■Hours and days of operation ■Languages spoken ■Age limitations, if any ■New patient restrictions ■Program participation stay informed Composites and key questions 2020 SPH Medicaid BoB percentile Overall satisfaction 99th Willingness to recommend 98th All other plans (comparative rating) 100th Finance issues 100th Utilization and quality management 100th Network/ coordination of care 100th Pharmacy 100th Health plan call center ser vice staff 100th Provider relations 100th Provider satisfaction is of utmost importance to El Paso Health and is a key element of the quality improvement program. For the last six years, El Paso Health has contracted with SPH Analytics 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 4th year in a row, results of each domain of the 2021 survey significantly outperformed the benchmarks, landing in the 98th 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. Important reminder: Provider directory updates to your practice
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