Updates from CareOregon

A reminder from DHS: Enroll newborns

We don’t want newborns to miss a single day of care, nor for our providers who care for them to have payment delayed by a single day. So the Department of Human Services (DHS) would like to remind providers who perform delivery services for Oregon Health Plan members to notify DHS of deliveries right away.

The OHP Newborn Notification Form (DMAP 2410) is available on DHS Web site, or download a printable form here. When you’ve filled it out, send it to the OHP Central Processing Branch, P.O. Box 14520, Salem, OR 97309-5044.

Questions?

If you have questions, contact DMAP’s Provider Services at 1-800-336-6016 or by e-mail.

RxAmerica is now CVS Caremark

As you may know, CareOregon’s pharmacy benefit manager, RxAmerica, was acquired by CVS Caremark in 2008. CVS Caremark is assuming many of RxAmerica’s operations, including their Pharmacy and Physician Customer Service Help Desk.

Here are some of the changes (and some things that won’t change):

If you call the CVS Pharmacy and Physician Help Desk at 1-866-549-0998, you will notice a change in their greeting to “CVS Caremark.”
CVS Caremark is using the same CareOregon pharmacy benefit customer service policies and procedures. You should not notice any change in service.
As always, we urge our providers to call CareOregon for pharmacy benefit assistance during our business hours Monday to Friday, 8 a.m.–5 p.m.
We are currently revising our prior authorization (PA) forms to include the CVS Caremark logo and will post them to our web site in the near future. Please continue to check the web site.

If you have questions, please call CareOregon Customer Service, 503-416-4100, or 1-800-224-4840. Also please don’t hesitate to contact the Network Relations Associate assigned to your clinic. You may access the Network Relations assignment list on our web site.

Provider Feedback Process initiated

“Barrier Breakers,” the provider satisfaction process improvement team, has been busy. Recently they developed and launched a new Provider Feedback Process.

“We want to let providers know that although we’re not required to have a formal process to handle provider complaints, we’ve established one because we want to hear from them and resolve issues,” says Teresa Boatright, the team’s process improvement coach.

There are no forms to fill out, or special numbers to call. Just call a regular Customer Service number, 503-416-4100 or 1-800-224-4840.

“If a provider wants to let us know about any kind of issue, make any kind of complaint or give any other feedback, other feedback, the calls will be documented,” Teresa says.

The customer service representatives will try to resolve the issue on that first call, but if that’s not possible, they’ll send it on to the person in the organization that can resolve it. At the same time, they’ll make arrangements for a call to provide a progress report within seven days, if the provider wants one.

All issues should be completely resolved within 30 days, Teresa says.

CareOregon provider e-mail alert system launches

CareOregon is initiating a system of e-mail alerts to get significant information directly to providers in the most expedient way possible.

The project was initiated by “Barrier Breakers,” the process improvement team dedicated to provider satisfaction.

The alert system will not be used for run-of-the mill announcements. Alerts will be limited to significant developments that affect all or most CareOregon providers, are specific to CareOregon and for which CareOregon is the primary source of information.

The team is collecting e-mail addresses so that alerts can be directed to the correct clinic staff members, in these categories: office manager, biller and clinician. Alerts will be directed to the correct people using these and other filter factors such as primary care providers or participation status.

CareOregon Alerts

Here’s a recap of the CareOregon Alerts that already have been sent to subscribers:

It’s time for the CareOregon Annual Provider Satisfaction Survey! (Oct. 6, 2009)—In our ongoing effort to improve our service to you, we would appreciate your participation in our annual provider survey. We will use this information to measure our progress and enhance our services. We know your time is valuable. This survey should take approximately 15 minutes. Please use this link to launch the survey: CareOregon 2009 Provider Satisfaction Survey. If you have questions, please call CareOregon Customer Service, 503-416-4100 or 1-800-224-4840.
New e-mail address for CareOregon claims issues (Oct. 12, 2009)—Effective immediately, the e-mail address for sending claims issues to CareOregon has changed. The new email address is claimshelp@careoregon.org. Issues sent to the old e-mail address (claimsspecialists@careoregon.org) will be forwarded to the new address automatically. Please begin using the new address at this time.

To find out more on the system, please contact your network representative. To subscribe to the service or update your e-mail address, please send a note to careoregonalerts@careoregon.org.

Early childhood cavity prevention

Did you know that you may be able to be reimbursed for the application of dental varnish to children’s teeth?

Who can receive these services?

The Department of Medical Assistance Programs (DMAP) will reimburse for dental varnish for children who meet all of these criteria:

Under 7 years of age
Considered high risk because of medical conditions, poor diet or poor oral hygiene, or are taking medications that contribute to high medical risk.
Have limited access to a dental practitioner

How do I file a claim for reimbursement?

Document the child’s high-risk conditions in the patient chart.
Determine if the child is receiving care from a dentist and whether or not fluoride varnish has been applied in the past 12 months. (If either of these conditions are true, you will not be reimbursed for this service as the child would not be considered as having limited access to a dental practitioner.)
Submit your claims directly to DMAP, not to CareOregon. Use CDT code D1206.

What is the reimbursement rate?

Primary care physicians can be reimbursed $13.65 per application, up to four times per 12 months.

For more information see: OAR 410-123-1260(11)(b).

If you have questions, please call Peggy Parker at CareOregon, 503-416-1776, or e-mail her at parkerp@careoregon.org.

A new TTY/TDD number for CareOregon

CareOregon’s toll-free number for TTY/TDD connection for the hearing impaired has been changed. The new number is 1-800-735-2900. Providers are asked to let their patients know who have need of this form of communication.

CareOregon adopts ADA diabetes guidelines

CareOregon has adopted new diabetes quidelines. CareOregon will follow the American Diabetes Association’s Standards of Medical Care in Diabetes.

The full text of the position statement is downloadable here.

You can also review an executive summary.