SelectHealth Provider Relations
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1 SelectHealth Provider Relations
2 Welcome and Agenda Provider Network SelectHealth and St. Luke s A new alliance in healthcare Who is SelectHealth? SelectHealth Advantage Commercial Plans Electronic Data Interchange SelectHealth Member Advocates Physician Portal and Tools
3 A New Alliance SelectHealth and St. Luke s share a similar nonprofit mission, vision, and community pledge. Our relationship is a step toward aligning incentives for participating healthcare providers and their patients and SelectHealth members to achieve important long-term improvements. Better health, better care, and stable premiums. While providing an additional Idaho carrier choice, consumers can still anticipate the exceptional healthcare they have come to appreciate from the healthcare community in Idaho.
4 Who is SelectHealth? SelectHealth is a Salt Lake City-based nonprofit health insurance company serving more than 500,000 members in Utah and southern Idaho. For more than 25 years, SelectHealth has been committed to: Helping members stay healthy Offering superior service Providing access to the highest quality of care SelectHealth is part of one of the nation s top-ranked integrated health systems. 1 SelectHealth is recognized as Utah s top-ranked health plan. 2 1 According to Modern Healthcare magazine, January According to NCQA s Private Health Insurance Plan Rankings,
5 SelectHealth Advantage SM Exciting new plan design - HMO-POS Hybrid of HMO savings and PPO flexibility o Zero premium with attractive copay structure Unique wellness benefit Public response has been remarkable o Enthusiasm for cobranded product
6 SelectHealth Advantage, continued Marketing opportunities Tri-fold brochures for each service area Reports from the field Seminar support Significant number of inbound calls Where can you get more information? selecthealthadvantage.org
7 Medicare Compliance SelectHealth has a Medicare Compliance program to minimize violations of CMS rules and regulations. Our provider partners play a key role in the compliance effort. Providers contract with plans to provide medical services for Medicare patients. As such, providers are an extension of the health plans according to CMS. Being an extension of the Medicare plan means that the quality of service and care that we both provide are directly reflected in the level of benefits that we are able to offer. This translates into more members and more patients.
8 How You Can Contribute to Compliance Training and education Marketing Reporting fraud, waste, and abuse Reporting requirements Documentation and record retention Ask questions and check first
9 Commercial Products SelectHealth will offer a well-balanced and strategically developed product suite in the following market segments: Small and Large Employer Individual and Family FEHB
10 SelectHealth Preference SM SelectHealth Preference plans are traditional plans for individuals. Deductible options from $500 -$7,500 Preventive care covered 100% Most generic drugs covered with a $10 copay Maternity coverage available (with a separate deductible) Optional benefits deductible waiver for office visits and Supplemental Accident coverage
11 SelectHealth Signature SM Signature plans are traditional plans available to both large and small employers. All Signature plans have a swing-out benefit.
12 Small employer Signature plans offer comprehensive coverage with several optional benefits. Deductibles from $250-$5,000 Preventive care covered 100% No deductible for generic drugs Optional benefits deductible waiver for office visits and prescription drugs, Supplemental Accident coverage, maternity buy down ($7,500 deductible), and Mental Health Parity
13 Large employers can choose from a wide range of benefit options that best fit their healthcare needs. They can also choose several funding options, including self-funding with SelectHealth as a third-party administrator.
14 SelectHealth Transition SM Transition plans offer individuals and families next-day coverage for up to six months. They are ideal for people who need coverage on a temporary basis. Very low premiums Deductibles from $250-$2,500 50/50 and 80/20 coinsurance options PEC and limited benefits apply
15 SelectHealth HealthSave SM HealthSave plans give consumers more control over their healthcare dollars by combining a qualified high deductible health plan with a tax-advantaged Health Savings Account (HSA). HealthSave plans are available to large employers, small employers, and individuals.
16 Individual HealthSave Plans Choice between 80/20 plans or 100% coverage plans Deductibles from $1,500/$3,000 to $5,000/$10,000 One deductible applies to all services including Rx Preventive care always covered 100% with no deductible Administration fees for HealthEquity, our preferred HSA vendor, are included in the premium Maternity is not covered except related complications
17 Small Employer HealthSave Plans Choice between 80/20 plans or 100% coverage plans Deductibles from $1,300/$2,600 to $5,000/$10,000 Preventive care always covered 100% with no deductible Mental Health Parity or 80/20 mental health benefits are available
18 Large Employer HealthSave Plans Choice between 80/20 plans and 100% coverage plans Deductibles from $1,200/$2,400 to $5,000/$10,000 Preventive care always covered 100% with no deductible Mental Health Parity required on all large employer offerings
19 FEHB Plans Federal employees have the option to choose a standard or high option plan. The Standard Option plan offers a $200 individual and $400 family deductible. The High Option plan has no deductible. Both plans offer an expanded network in Utah and Idaho. Preventive care covered 100% Complete maternity care coverage
20 SelectHealth ID Cards
21 Electronic Data Interchange (EDI) Provide customer support for EDI transactions Maintain compliance with HIPAA mandates regarding EDI transactions Responsible for the data contained within transactions
22 EDI, continued Electronic Claim (837I/837P/837D) Claims Acknowledgement (TA1/999/277CA) Eligibility Request & Response (270/271) Claims Inquiry/Response (276/277) Electronic Remittance Advice (835) Providers utilizing the 835 may elect to have payments directly deposited into their accounts via Electronic Funds Transfer (EFT)
23 Benefits of EDI Faster Better accuracy Increased traceability Environmentally friendly
24 Pathway of an EDI Transaction Provider Office Software Clearinghouse (e.g., Emdeon, ENS, Gateway EDI) UHIN Utah Health Information Network SelectHealth -NPI Match -Subscriber ID Match -Determines eligibility and if a claim is duplicate
25 Submitting Paper Claims Paper claims, correspondence, and other mail inquiries can be directed to: P.O. Box Salt Lake City, UT SelectHealth Member Services representatives are available at to answer questions
26 SelectHealth Member Advocates Assist with scheduling appointments Help finding the nearest facility or doctor with the soonest available appointment Available during extended hours Weekdays: 7:00 a.m. to 8:00 p.m. Saturdays: 9:00 a.m. to 2:00 p.m. Behavioral Health Advocates specialize in finding the most appropriate mental health provider (This team doesn t schedule appointments.)
27 Provider Benefit Tools ABC FAMILY PRACTICE Main Street Anywhere, UT
28 Provider Information Screen JANE MARY DOE JANE MARY DOE Wife/Spouse 01/01/ Main Street Anywhere, UT (801) JONATHAN DOE ( ) Male JANE MARY DOE JANE MARY DOE
29 Coverage Search JANE DOE
30 Member Payment Summary
31 Viewing Claims ABC FAMILY PRACTICE Main Street Anywhere, UT (801)
32 Viewing Claims, continued 02/17/ /15/2011 JANE MARY DOE BROWN, JOE T. ( ) /24/ /20/2011 JANE MARY DOE BROWN, JOE T. ( ) JANE MARY DOE
33 SelectHealth Provider Website and Tools Selecthealthphysician.org
34 We look forward to serving you!
35 Questions?
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