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What's New for Providers Core competency training for first-time community health managers and supervisors Northwest Regional Primary Care Association will offer this class September 14-16 in CareOregon’s downtown Portland office, 315 SW Fifth Avenue. Using research-based content and engaging learning experiences, highly acclaimed trainer Angela B. Prater will lead a small group (maximum 25) through a curriculum focusing on:
The $800 registration fee includes course materials; breakfast, lunch and break refreshments; and continuing education credits for CME and CPE. Go to www.nwrpca.org/images/DL/CoreCompetencyBrochureV1-1.pdf for details. Visit the event website for online registration. Questions? Contact Karry Donnelly, CareOregon Network Relations Supervisor, 503-416-1483 or donnellyk@careoregon.org. Note: Through July 15, 2009, registration is open to community health center staff only. Beginning July 16, any new manager or supervisor in the healthcare industry may register. CMS Issues Scam Alert to Physicians To Medicare FFS providers, including physicians and non-physician practitioners: The Centers for Medicare & Medicaid Services (CMS) warns physicians of a scam where perpetrators send faxes to medical offices. The faxes claim to be sent by a Medicare carrier or Medicare Administrative Contractor (MAC) and may have the CMS logo and/or a contractor logo. The fax tells physicians to return a questionnaire to provide an account information update within 48 hours in order to prevent a gap in Medicare payments to the physician. If you receive a fax of this type, check with your contractor before submitting any information. Medicare providers should only send information to a Medicare contractor using an address in a download section of the CMS.gov website at http://www.cms.hhs.gov/MLNGenInfo/ or http://www.cms.hhs.gov/MedicareProviderSupEnroll. For more Medicare contact information, visit Medicare Fee-For-Service Contact Information [PDF, 63 KB]. More information on your Primary Care Physician roster Check your June PCP monthly roster for an “R” in the far left column under the “New PCP” heading. An asterisk * in that column identifies a new member assigned to your clinic. Starting with the June roster, you may see an “R” in this column to identify reinstated members. Reinstated members were assigned to your clinic but lost OHP eligibility. If they become eligible again, we assign them to their original PCP if it’s been two years or less since the member was last enrolled. Check your July PCP monthly roster which now indicates your patients who are engaged with our health plan-based care management program, CareSupport. If a member is enrolled in this program you will find the following information listed under their name : date enrolled in program, name of the case manager, condition and phone extension of case manager (In this order). CareOregon members in this program are usually those with complex medical, social and behavioral needs who have been identified by their medical providers or state case workers and referred for supportive care coordination or coaching. We also screen for and contact those who appear to be struggling with the health care system or their health conditions and have repeat hospitalizations, ED use or other indicators of medical instability. Legacy Bone Clinic has moved! In 2004 CareOregon and Legacy Health System began collaborating to address orthopedic care needs. They formed the Legacy Bone Clinic for CareOregon/OHP and CareOregon Advantage/Medicare patients. The Bone Clinic recently moved to the Legacy Emanuel Hospital campus, 3001 N. Gantenbein Avenue, in north Portland. The clinic is staffed by Robert Earl, PA. The Bone Clinic welcomes referrals for the following services:
Prior authorizations are not required to refer members to the Bone Clinic. Please click for additional clinic details. Complete the referral form and follow instructions. If you have questions about the Bone Clinic, contact your CareOregon Network Relations Associate. Eligibility Alert Since early December 2008, CareOregon and other Medicaid managed care plans have experienced an interruption in eligibility downloads from DMAP. We are working with the State of Oregon to correct the issues as soon as possible so that our member files will show current enrollment data. For our primary care physicians’ offices, this means your monthly member rosters could be delayed as we continue to update members’ records. For eligibility inquiries and verifications, please continue to contact the CareOregon Customer Service team, 1-503-416-4100, or access this information from the DMAP system, now called MMIS. If you need information on how to access MMIS, our Customer Service team can help you. Authorization Guidelines Redesigned CareOregon’s Authorization Guidelines have been redesigned:
The new “Frequently Asked Questions” (FAQ’s) section answers common questions. Medicaid Management Information System (MMIS) changes effective Dec. 9 Oregon DHS/DMAP’s new information system (MMIS) is online. Providers have two options for verifying member eligibility:
The new member ID card lists name, ID number and date the card was issued. Possession of the ID card does not guarantee eligibility. If a member is not found in QNXT View, contact DHS Provider Services, 1-800-336-6016, or e-mail dmap.providerservices@state.or.us to verify eligibility. For more information, visit http://www.oregon.gov/DHS/healthplan/notices_providers/main.shtml Care Opportunities! Our goal at CareOregon, like yours, is the best health outcomes for all members. To help improve these outcomes, we're encouraging members to schedule regular health exams and screenings. For the rest of 2008 we will focus on three screening areas:
Your CareOregon patients received these letters in October:
If you have any questions or concerns about screening, please contact your Network Relations Associate. The CareSupport Program provides multidisciplinary, person-centered case management services to CareOregon members who: (1) are at risk for or experiencing a functional health decline because of lack of appropriate supports or self management, (2) are using the health care system ineffectively or inappropriately, or (3) are experiencing a significant health-related transition in their life, such as hospital discharge to home with advanced disease. CareSupport staff work to optimize the productive interaction between the patient and provider, working closely with both the patient in becoming informed and activated and the medical team in being prepared and proactive in the medical home. Please review additional information about the CareSupport Program and how we can work with you to improve the health of your patients. CareOregon wants to hear from you: Provider satisfaction improvement project Physicians, facilities and other providers are vital partners in achieving CareOregon’s mission to ensure access to high-quality health care for Oregon’s vulnerable populations. To make sure that providers’ experience with CareOregon is the best it can be, we’ve launched a process improvement team, the Barrier Breakers. The Barrier Breakers will address several areas to increase provider satisfaction, said Rebecca Fortuine, the team’s co-leader. Care Support and System Innovation Program The CareOregon Care Support and System Innovation (CSSI) Program was created in response to the Institute of Medicine's (IOM) "call to action to improve the American health care delivery system " (Crossing the Quality Chasm: A New Health System for the 21st Century). The CSSI Program focuses on the six aims for improvement outlined in the IOM report by supporting organizations' efforts to develop and implement improvement strategies that transform health care into a safe, effective, patient-centered, timely, efficient and equitable system. The goals of the CSSI Program are to:
Downloadable materials: The application deadline for 2009 is past. For information about the CSSI Program, please contact Diana, CSSI program manager at wolfordd@careoregon.org or (503) 416-4100. CareNews CareNews delivers relevant, thought-provoking, engaging and entertaining information about new provider programs and initiatives. Celebrate the accomplishments of health professionals who are making a difference, every single day. Learn about how clinic and hospital staff are implementing innovative ways of delivering care. View the latest edition of CareNews. Medicare Advantage CareOregon Advantage provides Medicare and Part D prescription drug benefits to qualified members. You can enroll in CareOregon Advantage if you are eligible for both Medicare and Medicaid coverage and live within a nine-county service area: Clackamas, Clatsop, Columbia, Jackson, Josephine, Marion, Multnomah, Polk and Washington.
Visit our Medicare web site: www.careoregonadvantage.org for more information about this plan.
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