utilization review program provider orientation...

Idaho Medicaid: Utilization Review Program Provider Orientation Meetings July 18-21, 2016

2

Our mission is to improve quality and cost effectiveness of healthcare for consumers and providers

Overview

Employee-owned: founded in 1972 with headquarters in West Des Moines, Iowa with offices in Boise, Baltimore, Chicago, Oklahoma City, Denver, Lincoln, and Boston

Clinical Expertise

Technical Expertise

Healthcare Intelligence

Combining extensive clinical and technical expertise

to solve complex healthcare challenges

3

Areas of Practice

•Healthcare solutions for state agencies that result in appropriate utilization, improved clinical outcomes & lower costs

State Health Solutions

•Quality improvement, data analytics & IT solutions for national programs measuring quality & cost-effectiveness

Federal Health Solutions

•Resources for employer & employees to better understand their healthcare options, reduce costs and obtain better outcomes

Commercial Health Solutions

• Innovate data analytics & health IT solutions clients use to measure the value and effectiveness of care

Federal Information Management

Overview

Currently managing Medicaid populations in

Iowa, Oklahoma, Nebraska, Minnesota & Massachusetts

Federally designated Quality Improvement

Network for Iowa, Illinois & Colorado

Developed & implemented the first pay-for-

performance reporting system for CMS

4

Project Team

Mike Speight

Implementation Director

37 years developing programs to improve healthcare for Medicaid and Medicare

mspeight@telligen.com

Scott Tiffany, MA, MEd

Project Director

Day to day responsibility

17 years experience (including Idaho)

stiffany@telligen.com

David Hancock, MBA, MPIA

Vice President State Health Solutions

16 years experience serving Medicaid programs

dhancock@telligen.com

Stephanie Wilson, MBL

Implementation Manager

swilson@telligen.com

5

Scope of Work: Program components

Utilization Review

Case Management

External Quality Review of Managed Care Plan

6

Qualitrac

Web-based health management system built and maintained by our 200+ person information technology department featuring:

Step-by-step instruction through evidence-based guidelines

Automation that streamlines review process

Secure electronic upload of medical records

Allow providers to track progress of submitted requests

Access 24/7

Our System

7

Activities completed to date:

Secured office space in Boise

Staff recruitment underway

Weekly meetings with IDHW staff for operations and IT issues

Regular meetings with Molina to finalize data transfer process

Introductory notice sent to all Idaho Medicaid providers

Met with Hospital Association and Medical Association

Scheduled regional provider orientation meetings July 18-21

Provider training programs planned in August

Implementation Status (Operational start date = 9/1/16)

8

Telligen Provider Portal

9

Website to access portal log-in: IDMedicaid.Telligen.com

10

Provider Queue

11

Patient Information

12

Provider and Facility Search

13

Provider Portal:

Service Request

14

Auto Authorization

Brummer, Willow

15

Clinical Documentation

16

Clinical Documentation Upload

17

Summary and Attestation

18

Finding a case in the queue

19

Case Details

20

Review Details

21

Website: IDMedicaid.Telligen.com

Call Center: (866) 538-9510

Help Desk email address: IDMedicaidsupport@telligen.com

Phone number of Boise office • Local number:

• Toll free:

Fax number: (866) 539-0365

Important Numbers

22

Questions

Implementation Information