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?
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