Provider Newsletter

August 2024


This quarterly newsletter features current news and resources to support providers and staff in the care of patient communities covered by Medical Associates Health Plans, Health Choices, and Live360.

NEWSLETTER CONTENTS


Current Events

– Change Healthcare Cyber Incident Update


Education

– National Immunization Awareness Month

– Vaccine Recommendations


Quality Improvement

– Understanding the Provider Role in Health Outcomes Survey


Resources

– 2024 Provider Reference Guide

– Updated Online Information

CURRENT EVENTS

Change Healthcare Cyber Incident Update

Update: August 14, 2024


Change Healthcare has resumed the production of Explanations of Payment (EOP) with the paper check attached. Change Healthcare’s turnaround time is back to pre-incident levels, therefore documents are printed and mailed within 2 days from the date of receipt. We process payments Monday-Thursday each week; please allow time for the documents to be printed and mailed to your office. 


Payment at this time will remain in paper check as Change Healthcare is not restoring electronic remittance or payment functionality. We are working diligently to evaluate other options and restore this functionality.


If there are questions on a payment, please call Member Services at 866-821-1365 or utilize the member portal.


We appreciate your patience as we continue to navigate this difficult time. We apologize for any inconvenience in this matter. 

EDUCATION

National Immunization Awareness Month

National Immunization Awareness Month (NIAM) is an annual observance held in August to highlight the importance of vaccination for people of all ages. Together, we can help raise awareness about the importance of vaccination and encourage people to talk to a healthcare provider they trust about staying up to date on their vaccinations.


Patients and parents can feel more confident about vaccinating when everyone in the practice shares the same message. From the front desk to the exam room to checkout, everyone plays an important role in supporting vaccination. Below are best practices to foster support for vaccination in your practice:


1. Make patients and parents aware of your immunization policy.

When you ensure every patient and parent that visits your practice is aware of your immunization policy, you lay the foundation for effective vaccination recommendations.

  • Discuss your policy during each patient’s first visit.
  • Post your policy in the waiting room.
  • Include a copy of your policy in new parent packets.
  • Share your policy on your practice’s website.


2. Make vaccine resources easy to find.

Making immunization information readily available saves time by helping patients and parents get their questions answered before they meet with you.

  • Provide age-appropriate vaccine educational materials and display posters in the waiting room.
  • Include an immunization schedule and other handouts in new patient packets.
  • Provide appropriate Vaccine Information Statements (VIS) at every vaccine visit, as required by law.
  • Syndicate CDC web content on your website.


3. Review each patient’s vaccination status and prepare them to receive vaccines.

By assessing vaccination status at every visit, you can avoid missed opportunities to vaccinate and reinforce that vaccinations are important.

  • Set up a reminder and recall system to prompt clinical staff and let patients and parents know when vaccines are due or when patients miss doses.
  • Before each visit, determine which vaccines are due by checking the patient’s immunization history using the state’s immunization information system and your practice’s electronic medical records (EMR) system.
  • At sign in, remind patients and parents which vaccines are due.
  • Ask parents and patients to complete a screening form or checklist for contraindications and precautions while they’re in the waiting room.


4. Make effective recommendations.

Research has shown an effective recommendation from a healthcare professional is the main reason parents decide to vaccinate.

  • Start childhood vaccine conversations early by reviewing the immunization schedule with pregnant women and parents of young infants.
  • Review the screening checklist and patient records to determine which vaccines can be administered.
  • Start each vaccine conversation with a presumptive statement, assuming patients and parents will choose to vaccinate and explain which vaccines are due.
  • Recommend vaccines from your position as a trusted expert.


5. Answer questions and address concerns.

Patients and parents are likely to have questions, even if they already plan to vaccinate. By welcoming and answering questions, you help patients and parents feel supported.

  • If a patient or parent is hesitant, talk to them about their specific concerns.
  • Listen to any questions from patients and parents and answer them clearly and patiently.
  • Share your own experiences, explaining why you chose vaccination for yourself or your children.
  • If a patient or parent refuses vaccines, explain the implications of refusing or delaying vaccines and discuss a plan to continue the conversation during future appointments.


6. Implement procedures and policies that help staff support vaccination.

Effective administrative procedures, clear policies, and useful training programs can equip your staff to support vaccination and work efficiently.

  • Designate primary and alternative vaccine coordinators to oversee vaccine management in your practice.
  • Obtain vaccine storage equipment and vaccine administration supplier as needed.
  • Put policies and procedures in place to ensure vaccines are stored, prepared, and administered correctly.
  • Keep up to date on CDC immunization recommendations and schedules, published every February and periodically updated throughout the year.
  • Make immunization schedules and other clinical resources readily available to all staff.
  • Integrate comprehensive, competency-based vaccine training into existing staff education programs, such as new staff orientation.
  • Implement standing orders that authorize trained staff to assess immunization status and administer vaccines.


7. Schedule upcoming vaccinations before the patient leaves the office.

Checkout is a key opportunity to reinforce the importance of vaccination and plan for upcoming vaccines.

  • Let the patient or parent know which vaccines will be due at the next appointment.
  • Schedule a follow-up appointment before the patient or parent leaves the practice.
  • Ensure this appointment falls within the recommended timeframe of the CDC schedule.
  • If a patient or parent defers scheduling for any reason, offer to call them a few days later.
  • Reinforce the importance of completing the vaccine series.
  • Offer educational materials to take home and review.


8. Remind patients and parents about upcoming vaccination appointments and missed appointments.

Ongoing communication is essential in making sure patients stay on schedule with vaccinations.

  • Make calls, send texts, send emails, or mail postcards to remind patients and parents about the importance of vaccination and note upcoming appointments.
  • If a patient or parent comes in for a sick visit, remind them about upcoming vaccines.
  • If a patient misses an appointment, call to follow up and remind them about the importance of vaccines.

Vaccine Recommendations

The National Committee for Quality Assurance monitors our MAHP-contracted providers compliance to the recommended vaccines for children, adolescents and adults. The following recommendations will support members in being adequately vaccinated:


By a child’s second birthday:

  • Hepatitis B: 3 vaccines
  • Rotavirus: 2 vaccines of the 2-dose vaccine or 3 vaccines of the 3-dose vaccine
  • DTaP: 4 vaccines
  • Hib: 3 vaccines
  • Pneumococcal: 4 vaccines
  • Influenza: 2 vaccines
  • MMR: 1 vaccine
  • Hepatitis A: 1 vaccine
  • IPV: 3 vaccines
  • VZV: 1 vaccine


By a child’s 13th birthday:

  • Meningococcal: 1 vaccine
  • Tdap: 1 vaccine
  • HPV: 2 vaccines


Adult Vaccines:

  • Influenza: 19 years and older – 1 vaccine each year
  • Td/Tdap: 19 years and older – 1 vaccine within last 10 years
  • Zoster: 50 years and older – 1 herpes zoster live vaccine or 2 herpes zoster recombinant vaccine at least 28 days apart.
  • Pneumococcal: 66 years and older – 1 vaccine of adult pneumococcal

QUALITY IMPROVEMENT

Understanding the Provider Role in Health Outcomes Survey

The Centers for Medicare & Medicaid Services (CMS) Health Outcomes Survey (HOS) gathers patient-reported health outcomes from members enrolled in Medicare Advantage plans to support quality improvement activities and improve the overall health of members.


Increased awareness of all HOS measures can help guide interactions with your patients, as well as positively impact HOS results and can help impact your Star Rating. Selected patients received the survey at the end of July with data collection happening through November.


Your Role in the HOS

  • Ensure your patients have access to regular appointments.
  • Provide timely care and follow up consistently.
  • Talk with your patients about hard issues, such as mental health, bladder control, and physical activity.
  • Pay attention to language, literacy, or cultural barriers.
  • Ensure high-quality communication and address complaints.


For more information, click here.

RESOURCES

2024 Provider Reference Guide


The Provider Reference Guide has been prepared as a daily reference tool for participating practitioners and their office staff. Access the updated guide on each provider website from the links below. This guide is password protected, so for access please use the following password: provider


Online Information


Thanks for working with us to give our members the right care at the right time. We are dedicated to helping you provide excellent quality healthcare.


The following information and resources can be found online:

  • Access to our secure health portals
  • Clinical Practice Guidelines
  • Compliance information
  • Credential documents for providers and locum tenens
  • Electronic claims submission
  • Electronic payments and remittance advice
  • Members Rights & Responsibilities
  • Pharmacy formulary list
  • Prior authorization requirements
  • Reimbursement Policies (Recently updated!)


Participating provider websites:

Provider Portals

Our secure health portals (Medical Associates Health Plans / Live 360 and Health Choices) are wonderful online tools that will save you time! Plus, you can access them 24/7. You have the option to ask questions, review eligibility, review claims that you have submitted, review authorization requests that you have submitted, look at the member subscriber agreement and schedule of benefits to verify coverage. You can also enter CPT/HCPCS codes to see if authorization is needed.


If you have not yet signed up for this time-saving service, you will need your federal tax ID number to create an account. If you have any questions, please e-mail Member Services at mahpmemberservices@mahealthcare.com.

For Reference


Information related to Medical Associates Health Plans' (MAHP's) quality improvement plan, case management services, disease management services, member rights, communications, appeals process, after-hours assistance, accreditation/awards, and privacy/confidentiality may be viewed at www.mahealthplans.com. Persons without access to the internet may request paper copies by contacting MAHP at 1-800-747-8900 or 563-556-8070. Please ask to speak with a member of the QI team for assistance.