ILLINOIS FAMILY HEALTH CENTER 123 MAIN STREET SUITE 100 CHICAGO,IL

Transcription

1 ILLINOIS FAMILY HEALTH CENTER 123 MAIN STREET SUITE 100 CHICAGO,IL

2 Illinois Health Connect Panel Roster Date Printed: 11/13/2013 Enclosed is your panel roster for the Illinois Health Connect Program for the month of. If you have any questions about Illinois Health Connect, please contact the Provider Relations Helpdesk at A staff person is available to assist you Monday through Friday, 8:00am until 7:00pm. Each month, the cover page to the panel roster will contain important updates and announcements. Please review the information on the next page. To all Illinois Health Connect PCPs THE FOLLOWING PAGES CONTAIN UPDATES AND ANNOUNCEMENTS FOR NOVEMBER 2013 Page 2 of

3 2013 IAFP ANNUAL MEETING The Illinois Academy of Family Physicians will be holding their annual meeting on November 8-10, 2013 at the Hilton Hotel in Lisle/Naperville, IL. For more information, go to APPLICATION FOR BENEFITS ELIGIBILITY (ABE): Beginning in October, Illinois now have a new, web-based application system known as the, Application for Benefits Eligibility (ABE). Through ABE, applicants or Assisters can apply online for Medicaid programs. ABE replaces all existing online applications. HFS strongly encourages Medicaid providers to use ABE for all new applications. If you must use paper, a new medical benefits application and multi-purpose paper application will be available for download from the HFS and DHS websites. Remember, if someone has Medicaid today. They should not reapply! As a Medicaid provider, you will continue to have access to the Medical Electronic Data Interchange (MEDI) System and the Recipient Eligibility Verification (REV) System. HFS expects that you will continue to use these tools to check for existing coverage before beginning a new application in ABE. An Introduction to ABE recorded webinar (30 minutes) This supplements the Guides to ABE which are already posted. This recorded webinar can be found on the HFS Affordable Care Act web page under the Illinois Expands Medicaid heading. HFS hopes that as providers get comfortable using ABE, they will help applicants enroll in all of the programs for which they may be eligible, including SNAP and Cash Assistance. For more information visit the HFS provider notices page: URGENT INFORMATIONAL NOTICE: This notice is to clarify the status of the State of Illinois Primary Care Case Management (PCCM) Program, Illinois Health Connect, in light of the recent and upcoming healthcare changes within the Medicaid program. Illinois Health Connect (IHC) is not ending in October IHC will continue to operate as a statewide mandatory health plan choice for those individuals that are not required to participate in an Integrated Care Plan (ICP), Medicaid Medicare Alignment Initiative (MMAI), or a Care Coordination Entity (CCE). As Illinois expands its care coordination programs, the counties where IHC operates may change. If such a change does occur, HFS will release an official notice to providers. The IHC Helpline continues to be a valuable resource to Recipients and Providers. It is available Monday through Friday 8:00am-7:00pm by calling (TTY: ). Important program information and resources are also available on the IHC website: For more information on Care Coordination Entities (CCE), please attend our upcoming webinar led by HFS Molly Siegel on 11/6/2013 and 11/20/2013 at 12pm for registration information, see IHC Webinars below. For more information on Care Coordination Expansion, please refer to the May 15, 2013 HFS Provider Notice: For more information on CCE implementation geographic rollout, please visit the HFS Care Coordination webpage: ILLINOIS HEALTH CONNECT PCCM WEBINARS: IHC hosts Webinars on clinical and administrative topics that are important to Primary Care Providers. Webinars are open to all IHC Primary Care Providers, administrative and clinical staff. To RSVP, contact the IHC Provider Services Help Desk at , extension 3, or register at All Webinar materials are archived online. If you are unable to attend, you can still review the presentation materials. All IHC Webinars are free! Please see list of webinars below: 11/6/2013 at noon CCE Overview Webinar led by Molly Siegel, HFS Don t miss this opportunity to learn about the new Care Coordination Entity (CCE) roll-out and Illinois Health Connect s relationship to the CCE. Also being offered on 11/20/ /7/2013 at noon IHC overview and MEDI Registration 11/14/2013 at noon Bright Futures (HRSA/AAP Initiative) by Dr. Icy Cade-Bell 11/19/2013 at noon Developmental Screening Tools and Risk Assessments 11/20/2013 at noon CCE Overview Webinar led by Molly Siegel, HFS QUALITY IMPROVEMENT (BONUS/PROVIDER PROFILES) ASSISTANCE: Please contact your IHC Quality Assurance Nurse (QAN) if you would like to discuss the Bonus Program for High Performance and/or Fall Provider Profiles. Call the IHC Helpdesk at if you need help contacting your QAN. Page 3 of

4 HFS INFORMATION ON AFFORDABLE CARE ACT IN ILLINOIS HFS is pleased to provide you with additional resources on implementation efforts of the Affordable Care Act in Illinois. Now on the HFS website under Affordable Care Act are: Answers to Frequently Asked Questions (FAQs) This will be continually updated, check the date at the bottom of the document. New FAQs will be added to the beginning of the relevant sections for the next couple of months. Additional sections on Illinois Assisters and Justice-Involved Populations are forthcoming. Visit the following link for HFS FAQs on ACA: TELEHEALTH PRIMER: Illinois Hospital Association (IHA) has created a Telehealth primer to help hospitals with step-by-step instructions to develop a telemedicine program in their communities. Find more information at: Telehealth and Telepsychiatry will be discussed at the next Behavioral Health subcommittee meeting call from 12-1pm on 11/13/13. Please Cari at coutman@automated-health.com to join. PCCM ADVISORY SUBCOMMITTEES: Your participation is needed! Subcommittees include Quality Management, Provider Network, and Behavioral Health. Meetings are held quarterly per teleconference for just one hour each at noon. Go to to visit the Advisory Subcommittee Calendar link, learn more about each subcommittee, and to contact the Chair of the Subcommittee to attend these important meetings. Upcoming: Behavioral Health: 11/13/13 12pm-1pm Provider Network: 12/11/13 12pm-1pm Page 4 of

5 Provider HFS Number: Illinois Health Connect Number: ILLINOIS FAMILY HEALTH CENTER (Fax (847) ) Provider Enrollee Panel Roster Enrollee Information Address/Phone/Alt Phone Begin Link DateClinical Information End Link Date BUSYFAMILY, LAD 5694 RAILROAD AVE. 4/29/1999 Well Child Visit: Screenings - Developmental: Vision: Lead: CHICAGO, IL /29/ y (Male) Phone: (847) (English) Alt Phone: (123) BUSYFAMILY, YOUNGSTER 5694 RAILROAD AVE. 9/10/2003 Well Child Visit: Screenings - Developmental: Vision: Lead: CHICAGO, IL /30/ y (Male) Phone: (847) (English) Alt Phone: (123) HAPPYFAMILY, MALE 100 WINDWEST ROAD APT #10 1/12/ CHICAGO, IL Frequent ED User 2/2/ y (Male) Phone: (847) (English) Alt Phone: (847) Preventive Services 1/5/2010 Claim ILLUSTRATION, TEENAGE 6490 NEWPORT DRIVE 4/13/2004 Due Due Due BRADFORD, IL /8/ y (Female) Phone: (309) (English) Alt Phone: (630) Meets Diabetes Criteria HbA1c Test: 5/26/2009 Claim 7/23/2010 Claim Due 4/8/2010 Claim 9/15/2010 Claim EXAMPLE, MALE 947 RIVER BLVD. 3/29/ GALVA, IL /20/ y (Male) Phone: (309) (Spanish) Meets Diabetes Criteria HbA1c Test: 8/29/2009 Claim 12/10/2009 Claim HAPPYFAMILY, FEMALE 100 WINDWEST ROAD APT #10 10/20/ CHICAGO, IL PAP Test: Due 1/1/ y (Female) Phone: (847) (English) Alt Phone: (847) Meets Diabetes Criteria HbA1c Test: 12/20/2010 Claim 9/28/2010 Claim Status Services Reported to IHC Page 5 of

6 Provider HFS Number: Illinois Health Connect Number: ILLINOIS FAMILY HEALTH CENTER (Fax (847) ) Provider Enrollee Panel Roster Enrollee Information Address/Phone/Alt Phone Begin Link DateClinical Information End Link Date Preventive Services NEWFAMILY, BABY 350 SE 15TH AVE. 6/10/2005 Well Child Visit: Screenings - Developmental: Vision: Lead: BRADFORD, IL /15/2005-8y (Female) Phone: (309) (English) Alt Phone: (847) NEWFAMILY, FATHER 350 SE 15TH AVE. 12/19/ BRADFORD, IL /17/ y (Male) Phone: (309) (English) Alt Phone: (847) Meets Diabetes Criteria HbA1c Test: 1/10/2010 Claim No Claims NEWFAMILY, MOTHER 350 SE 15TH AVE. 12/19/ BRADFORD, IL PAP Test: 00/00/0000 Claim 4/7/ y (Female) Phone: (309) (English) Alt Phone: (847) No Claims SAMPLE, WOMAN 945 CENTER AVE APT #1 9/25/ CHICAGO, IL /00/0000 PAP Test: 00/00/0000 Claim 5/4/ y (Female) Phone: (847) Mammogram: 00/00/0000 Claim (English) Alt Phone: (847) /20/2010 Claim Status Services Reported to IHC 1/15/2011 Claim Page 6 of

7 Questions? Call the Illinois Health Connect Provider Helpdesk at Hours: Monday Friday 8 a.m. to 7 p.m. Your panel roster provides the following information about your patients: ENROLLEE INFORMATION: Illinois Health Connect enrollee s name (last, first, middle init) /HFS Recipient No.(RIN)/ Enrollee s birth date - age / IHC Case Number / Language indicator (if provided by client) for English or Spanish. ADDRESS/PHONE: Enrollee s address and member telephone number and alternate telephone number (if available). BEGIN LINK DATE/END LINK DATE: PCP Linkage Information CLINICAL INFORMATION: Frequent ED User: Enrollee has received services through the ED 6 or more times in the past year without a subsequent inpatient admission. Meets Diabetes Criteria: Enrollee has had office, outpatient, hospital or ED visits in past two years with diagnosis of diabetes. Please confirm with the clinical record. HbA1c Test: Shows date of most recent claim for HbA1c testing. Shows the date of the most recent visit with current PCP based on claims data. PREVENTATIVE SERVICES BY AGE: May show the following services: Well Child Visit, Developmental Screening, Vision Screening, Lead Screening, PAP Test and Mammogram. STATUS: "Due" - if eligible and due for the preventive service listed. Blank - if not eligible or is not due for the preventative service listed. The status is determined by HFS claims data. Please verify enrollee's medical records. HFS preventive services recommendations: Well Child Visit: ages 2 weeks, 1 mon, 2 mon, 4 mon, 6 mon, 9 mon, 12 mon, 15 mon, 18 mon, 24 mon, 3 yr, 4 yr, 5 yr, 6 yr, 8 yr, 10 yr, 12 yr, 14 yr, 16 yr, 18 yr, 20 yr (panel roster shows "due" for all children continuously ages 0 to 18 months). Developmental screening: between ages 0 to 12 months, between ages 12 to 24 months and between ages 24 to 36 months. Mammogram: minimum every other year between ages 40 to 69 yrs. Pap test: every other year between ages 21 and 29 years and then every 3 years for ages 30 yrs and older according to ACOG standards. Lead screening: one test before age 12 months and a second test before age 24 months, if no screening done before age 24 months then screen at any time before age 6 years. Vision screening: yearly ages 3 yr through 6 yr, and then ages 8 yr, 10 yr, 12 yr, 15 yr, and 18 yr. SERVICES REPORTED TO IHC: For each preventive service the following notations can be included: Claim: Date of last claim paid for this service. Scheduled: Enrollee reports a scheduled appointment or was assisted by IHC in scheduling an appointment. Kept: Enrollee (or provider) reports that scheduled appointment was kept. More clinical information about each enrollee can be obtained through the Claims History, which can be accessed through the HFS MEDI Provider Portal. The Claims History contains at least 7 years of immunization data, and 2 years of claims data including pharmacy claims. If you do not have access to MEDI, please contact your Illinois Health Connect Provider Service Representative or the Illinois Health Connect Provider Helpdesk at Additional information can be found on the Illinois Health Connect website at under Quality Tools. Age breakdown of enrollees: Eligible Enrollees Due Enrollees Percent Due Under 1: 0 1-2: 0 3-5: 0 6-9: : : : : : : : 1 Total Active: 9 Well Child Visit: % Developmental Screening: % Vision Screening: % Lead Screening: % Mammogram: % Pap Test: % Page 7 of