Transcription
Provider HealthLink LA,LLCQuality and HEDISMay 2015ConfidentialPHL 2015
Contracts Amerigroup will have HEDIS qualitymeasurements to meet to secure financial bonusUnited has more clinical improvementOther plans focused on HEDIS and Practicerequirements
Credentialing Forms It is important to update your providercredentialing sheets monthlyIf you need help with CAQH let us knowNeed to establish a contact with your center forrostersWe are starting delegated credentialing once theplans approve the organization
Why it is so Important? Missed HEDIS servicesIt might be a coding issue? Non compliant members? Could be preformed somewhere else? Better QualityAssures payment from Quality bonusesIts NEW REVENUE for your practice
Sample HEDIS Requirements Adult Access to CareAnnual Dental VisitsHbA1c testingLDL-C ScreeningNephropathy ScreeningChildhoodImmunizations Combo3Immunizations forAdolescents Well-Care Visits 12-21yrBreast Cancer ScreenCervical CancerScreeningLead ScreeningBMIWell-Child Visits 0-15MoWell-Child visits 3-6 yr.
BMI CodingBMI, Nutritional Counseling and Physical Activity Counseling can becompleted at well and/or sick visitAdd Informational diagnosis V codes to claimsBMI Percentile: V85.5X to claim:- Less than 5th percentile for age: V85.51- 5th to less than 85th percentile for age: V85.52- 85th to less than 95th percentile for age: V85.53- Greater than or equal to 95th percentile for age: V85.54Nutritional Counseling: V65.3 to claimPhysical Activity Counseling: V65.41 to claim6
HEDIS Measurements
Clinical Care Measures - United
New Friend - Care Gaps Report
Tools Each Plan provides HEDIS guides to assist youand your staff on codingMonthly and quarterly reportsProvider portalChecking eligibilityPHL staffCall CenterEMR data extracts
Great Reference Material
MCO’s Cheat Sheets
Other Group Type Contracts MedicareHealth ExchangeBlue Cross Patient Medical HomeVA ContractsOther
Questions
Provider HealthLink LA, LLC Quality and HEDIS May 2015 . Contracts Amerigroup will have HEDIS quality measurements to meet to secure financial bonus United has more clinical improvement Other plans focused on HEDIS and Pra
