Provider Newsletter Spring • 2022 CHANGE SERVICE REQUESTED PO Box 971100 El Paso, TX 79997-1100 Nonprofit Org. U.S. Postage PAID Walla Walla, WA Permit No. 44 As physicians, conducting your daily responsibilities has become quite the conundrum in recent years. Our frequent flyers have expressed frustration, since they are not allowed to sit in the waiting room in most cases. But how do we continue serving our patients and still adhere to our current CDC guidelines to help keep everyone safe? Thankfully we have options. El Paso Health has launched VeMiDoc, a mobile health platform where patients can connect via video chat with a medical Provider. The service is available through an app that enables local Providers to schedule and provide telemedicine and telehealth services to El Paso Health members. VeMiDoc is an El Paso-based, physician-led technology company. It has been in use since Jan. 12, 2020, and has released version 2.0 of its HIPAAcompliant, bilingual mobile app. This latest version of the mobile application simplifies the interface between patients and doctors by allowing interface participation and seamless transfer of medical information from patients to physicians and their staff. "VeMiDoc’s new 2.0 version will have a lasting positive impact on value-based health care for El Paso’s Latino population,” says VeMiDoc CEO Aldo Maspons, MD. The VeMiDoc app helps ensure that all patients have an opportunity to receive safe and convenient care without VeMiDoc 2.0 is now available! the hassle of taking time off from work, transporting ill family members, or sitting in traffic or crowded waiting rooms. The VeMiDoc app allows patients to easily schedule and connect to trusted doctors from the safety and comfort of their homes. For more information, please contact El Paso Health at 915-532-3778. You can also visit vemidoc.com/el-paso -startup-vemidoc-releases-mobile -health-app-version-2-0. From the Desk of David Palafox, MD, DABFM, El Paso Health Medical Director
2 Why you should submit electronic claims El Paso Health offers a Provider portal that allows you to view patients' eligibility and benefit information, verify claims, download reports, and submit primary or secondary professional and institutional claims at no cost. By submitting electronic claims, you can track your claims, cut down on paper, minimize any cash flow disruptions, and minimize turnaround time. 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. 1507, if you need assistance obtaining access to our Provider portal. What is Payment Integrity? El Paso Health is proud to announce its new Payment Integrity solution. But what exactly is Payment Integrity, or PI? In a nutshell, the role of a good PI program is to increase the accuracy and automation of a health claim being paid correctly. It also ensures that the claim is paid by the responsible par ty for an eligible member; paid according to contractual terms and policy; not in duplicate or error; and free from fraud, waste, or abuse. A good PI program helps Providers like you avoid the associated risks of costly billing mistakes and keep more of the money you are entitled to for the valuable ser vices you provide to our members. Source: clarishealth.com/faq Pay for Quality (P4Q) HHSC implements a medical Pay-for-Quality (P4Q) program that creates incentives and disincentives for managed care organizations based on their performance on quality measures. This program holds up to 3% of our capitation rate at risk if certain benchmarks are not met. Below are the quality measures that are included. AT-RISK MEASURES STAR CHIP PPV – POTENTIALLY PREVENTABLE ED VISITS ED visits for conditions that are preventable or treatable with appropriate primary care (like URI, fever, etc.) X X PPA – POTENTIALLY PREVENTABLE ADMISSIONS Admissions for conditions that are considered preventable with appropriate primary care. X URI – APPROPRIATE TREATMENT FOR CHILDREN WITH UPPER RESPIRATORY INFECTION The percentage of visits for members 3 months of age and older who were given a diagnosis of upper respiratory infection (URI) and were not dispensed an antibiotic prescription. X CIS – CHILDHOOD IMMUNIZATION STATUS The percentage of children 2 years of age who had 4 DTaP, 3 IPV, 1 MMR, 3 HiB, 3 HepB, 1 VZV, 4 PCV, 1 HepA, 2 or 3 RV, and 2 flu vaccines by their second bir thday. X X PPC – TIMELY PRENATAL CARE The percentage of deliveries that received a prenatal visit within the first trimester or 45 days of enrollment with EPH. X PPC – TIMELY POSTPARTUM CARE The percentage of deliveries that received a postpar tum care visit within 7 to 84 days from date of delivery. X WCC – WEIGHT ASSESSMENT AND COUNSELING FOR NUTRITION AND PHYSICAL ACTIVITY BMI SUB-MEASURE The percentage of members 3 to 17 years of age who had an outpatient visit with a PCP or OB-GYN and who had proper documentation of BMI percentile in the medical record during the measurement year. X ADD – FOLLOW-UP CARE FOR CHILDREN PRESCRIBED ADHD MEDICATION The percentage of children newly prescribed ADHD medication with at least 1 follow-up visit with a practitioner with prescribing authority within 30 days of prescription fill date. X resources
3 As of Feb. 1, 2022, autism services are a benefit of the Texas Health Steps-Comprehensive Care Program (CCP) for Medicaid children or youth who are 20 years old and younger and meet the criteria outlined below. This benefit includes applied behavior analysis (ABA). Autism spectrum disorder (ASD) is a condition characterized by restricted, repetitive patterns of behavior, interests, or activities and deficits in social communication and social interaction, with onset of symptoms occurring in early childhood. ABA is the scientific study of the principles of learning and behavior. Texas Medicaid acknowledges that research and clinical practices in interventions for ASD are an evolving and dynamic field. As such, documentation to support the medical need for ASD services, including ABA services, may include intervention techniques with a sound basis in discipline-specific peerreviewed literature, when available; interventions with specific applicability to If you have any questions regarding the ABA benefit or any other covered ser vices, please do not hesitate to contact your Provider Relations Representative. To become a Provider for ABA ser vices, please contact our Contracting Depar tment at 915-532-3778 or via email at Contracting_Dept@elpasohealth.com. stay informed Autism services are now covered the person’s clinical and functional profile (including comorbid conditions); and an individualized, person-centered treatment plan that aligns with the values and preferences of the person with ASD and their family. How to get ASD services El Paso Health will require authorization for all ASD services. El Paso Health will accept the Texas Standardized Form for Health Care Services or the CCP Form as a method of requesting prior authorization for ASD services. Not all services may be clinically appropriate for all people, families, or situations; El Paso Health will review these requests individually and decide based on medical necessity. Services must be evidence-based; person-centered; delivered by personnel of appropriate training and credentialing; and oriented to functional, attainable, and measurable goals. These services may include, but are not limited to, one or more of the following: ■Applied behavior analysis (ABA). ■Case management / care coordination (with parent permission). ■Early childhood intervention (ECI). ■Nutrition, when provided by a licensed dietitian. ■Occupational therapy (OT). ■Outpatient behavioral health services. ■Physician services, including medication management. ■Physical therapy (PT). ■Speech-language pathology (SLP); also called speech therapy.
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 EPHP4942202-EPH-PR-SPRING 2022 Provider Newsletter 2022 © Coffey Communications, Inc. All rights reserved. Enhancing patient and Provider interaction Patients misunderstand health communications more often than we might think. Using clear communication strategies can help your patients better understand health information. Communicating clearly also helps patients to feel more involved in their health care and increases their likelihood of following through on their treatment plans. To learn about patient communication tools you can use in your practice, refer to the links at right. If you would like additional support in relation to patient communication, please email ProviderServicesDG@elpaso health.com. Resources ■Health Literacy Universal Precautions Toolkit Volume 2: ahrq.gov/sites/ default/files/publications/files/ healthlittoolkit2_3.pdf ■EPH-How to Provide Culturally Sensitive Care: elpasohealth.com/articles/El%20 Paso%20Health%20-%20Cultural%20 Competency%20Presentation.pdf Featured Provider: David F. Jimenez, MD Dr. Jimenez provides a wide range of pediatric neurosurgical care and proudly ser ves not only our El Paso families but families from all over the world. His depar tment provides advanced pediatric neurosurgical care in highly specialized areas. Dr. Jimenez is board-certified in pediatric and adult neurosurgery. He is the world’s most experienced doctor in treating a condition called craniosynostosis, for which he developed a minimally invasive way to treat the condition. Dr. Jimenez has countless honors and awards, including America’s Top Doctors and Best Doctors of America. He has dedicated himself to research, writing, and training the next generation of neurosurgeons, and he is committed to El Paso Children’s Hospital and our members. For more information, reach out to his office or visit elpasochildrens.org/ neurosurgery. Special services for children of traveling farmworkers El Paso Health has special Medicaid ser vices for the children of traveling farmworkers. The ser vices include assistance with scheduling upcoming Texas Health Steps exams as well as vision, mental health, and transpor tation benefits for them. If you have any questions or would like to receive more information about these ser vices for children of traveling farmworkers or would like for the program coordinator to provide an in-ser vice to your staf f, please call the Outreach Coordinator at 915-532-3778, ext.1075. stay informed
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