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TIMELINESS OF PRENATAL AND POSTPARTUM CAREParamount is dedicated to working with you, our providers, to offer the best prenatal and postpartum care to each one of our members. We follow the American College of Obstetricians and Gynecologists (ACOG) recommendation to provide 14 prenatal visits for a 40-week pregnancy. ACOG also recommends that women with uncomplicated pregnancies be seen every four weeks for the first 28 weeks of pregnancy, every two to three weeks until 36 weeks of pregnancy, and weekly thereafter.

Prenatal visits are a good time to update patient contact information and provide counseling and education to emphasize the importance of postpartum care and family planning.

To ensure follow-up visits, please encourage eligible patients to take advantage of nurse home visits after delivery. Providing access to contraceptives prior to discharge from the hospital or birthing center is beneficial.

A postpartum visit should occur on or between 7 and 84 days after delivery and consist of:

• A pelvic exam

• An evaluation of weight, BP, breasts and abdomen

• Family planning

PARAMOUNT ELITE | ELEMENTS

DOT PATTERN FOR BACKGROUND

NewsNETWORKSPRING/SUMMER 2020

PROVIDED AS A SERVICE TO OUR PROVIDER AND OFFICE MANAGER COMMUNITY

INSIDE This Issue:1 Timeliness of Prenatal and

Postpartum Care

2 Programs for Prenatal and Postpartum Care

3 Well Visits for Preventative Health Care

4 NFL Healthy Rewards Programs

5 Transportation Assistance Program

5 COPD Programs for Members

6 Diabetes Self-Management Education and Support

6 Medication Reconciliation

7 Quality Improvement Program

7 Utilization Management

A PUBLICATION OF PARAMOUNT

PROGRAMS FOR PRENATAL AND POSTPARTUM CARE

2 | Network News | SPRING/SUMMER 2020

PRENATAL TO CRADLEParamount Advantage members can earn up to $150 in reward cards by going to prenatal and postpartum appointments. When they sign up for Prenatal to Cradle, members will be entered once into a drawing for the chance to win diapers. First trimester visits must occur in the office with the OB physician, and all prenatal and postpartum claims must be billed in order for members to earn rewards. To sign up members can go online to paramounthealthcare.com/rewards or call Member Services at 800-432-3589 (TTY: 888-740-5670).

CRADLE TO CRIBParamount Advantage is offering a new program for members. Cradle to Crib is an initiative to improve well visits for infants 0-15 months of age. Infants should have eight well visits before turning 15 months. Parents of infants who receive six of their eight well visits prior to 15 months of age will receive a $100 reward card. All six well visit claims must be billed in order for members to earn rewards. Members can sign up online at paramounthealthcare.com/rewards or by phone at 800-462-3589 (TTY: 888-740-5670). Once members have signed up, Paramount will track infant well visit claims and count them toward the $100 reward.

FREE HOME VISITS FOR BABY AND MOM If a member has a baby, they are eligible for visits to their home by a nurse. Members can call 800-462-3589 (TTY: 888-740-5670) to get this benefit.

POSTPARTUM DEPRESSION SCREENINGS Members feeling sad or overwhelmed for more than two weeks after having a baby may be suffering from postpartum depression. Paramount will mail a survey to the member two weeks or more after receiving notification that she has delivered her baby. Members should fill out the survey and mail the top part back to Paramount. Members should also bring a copy of the survey to their follow-up postpartum appointment. Behavioral health case management will contact providers when a member scores an 11 or greater.



https://www.paramounthealthcare.com/medicaid/additional-services/

https://www.paramounthealthcare.com/medicaid/additional-services/


COMPLETING A WELL VISIT DURING A SICK VISITChildren will often only visit their provider when sick. Caregivers may experience barriers to scheduling a well visit such as being unable to miss work. Completing the well visit during the sick visit may be the only opportunity the provider has to complete a well visit during the year and give any immunizations the child needs. Therefore, all Medicaid Managed Care Plans provide payment for a combination of certain services on the same day including: sick visits, well visits, immunizations, labs (including lead).

HOW TO BILLWhen a patient is seen in the office for a well visit as a new or established patient, providers can bill that diagnostic exam as an E&M-25. Providers should reference the most up-to-date sources of professional coding guidance for valid CPT/HCPCS codes.

IN ORDER TO RECEIVE PAYMENT, FOLLOW THE BILLING GUIDELINES BELOW:

Visit Type ICD-10 codes CPT codes Modifiers

Well Visit Z00.129 (99381-5 or 99391-5)

None

Well + immunizations

Z00.129, Z23 (99381-5 or 99391-5)

25

Well + Sick Z00.121 AND appropriate sick ICD-10 code

(99381-5 or 99391-5) and 9921x

25

Well + Sick + Immunizations

Z00.121, Z23, AND appropriate sick ICD-10 code

(99381-5 or 99391-5) and 9921x

25 for sick and 25 for immunizations

All five Medicaid managed care plans follow the same well visit guidelines. View the document by visiting paramounthealthcare.com/providers. Choose “Tools & Resources”, click “Documents & Forms”, and then find the document titled, “Medicaid Managed Care Plan Well Visit Provider Guidelines.”



BEST PRACTICES FOR IMPROVING WELL VISITS IN YOUR PRACTICE:

• Consider every visit an opportunity for a well visit andan immunization visit.

• Schedule the next well visit during check out.

• Collaborate with your EHR vendor to incorporate popup alerts for preventive services.

• Check payer specific provider portal when a memberpresents to your office without their insurance card.

• Clarify payer procedures for covering well visits everycalendar year, not every 365 days.

EARLY AND PERIODIC SCREENING, DIAGNOSTIC, AND TREATMENT (EPSDT)/MEDICAID’S HEALTHCHEK PROGRAM This program ensures that members under the age of 21 have access to services that are available in accordance with federal EPSDT requirements found at 42 U.S.C. 1396d(r) as amended.

This includes medically necessary services covered by Ohio Medicaid, as well as any medically necessary screening, diagnostic and treatment services available to Medicaid consumers that go beyond the applicable coverage and limitations set forth in Division 5160 of the Ohio Administrative Code (OAC).

Screening components, frequencies, and indications of need for further evaluation are in accordance with the most current American Academy of Pediatrics recommendations for pediatric preventive health care. Prior authorization and coverage determinations are based on medical necessity.

https://www.paramounthealthcare.com/services/providers/




NFL HEALTHY REWARDS PROGRAMS

TRANSPORTATION ASSISTANCE PROGRAM

Paramount Advantage Medicaid has teamed up with Ohio NFL teams to offer Healthy Rewards. Members who schedule their yearly wellness checkup with their family doctor will be in the running to win great prizes from the Cincinnati Bengals or Cleveland Browns, such as home game tickets, sideline experiences and more!

WHO IS ELIGIBLE?Your patient must be a Paramount Advantage member at the time of their wellness visit, and at least 12 months old. If they win, they must still be a Paramount Advantage member to receive their prize.

*They are eligible to sign up with one team, based on the county they live in. Visit paramounthealthcare.com/bengals and paramounthealthcare.com/browns to view each team’s list of eligible counties.

SIGNING UP IS EASY! HERE’S HOW1. Schedule a yearly wellness checkup/routine annual

physical with their PCP.

2. Go to the doctor and complete their wellness checkup.

3. Sign up for one program online at paramounthealthcare.com/bengals or paramounthealthcare.com/browns.*

For More Information: Call: 800-462-3589 (TTY: 888-740-5670) or visit paramounthealthcare.com/browns or paramounthealthcare.com/bengals

To assist you with appointment adherence, Paramount Advantage provides members with transportation options. They can choose to take a cab, bus, or Lyft, and add on extra destinations, like health condition education classes and trips to food banks.

To take advantage of this service, members need to call the TRANSPORTATION SCHEDULING LINE: 866-837-9817 (TTY 800-750-0750), Monday – Friday, 7 a.m. – 7 p.m. Members can also schedule rides by downloading the Access2Care app by searching for “Access2Care” in the App Store or Google Play Store.

Do you have an Advantage Member who needs to be transported in less than two business days’ time? Use the Provider Health Plan Help Desk for assistance. Email [email protected] (no “n”) or call 866-282-4836, Monday – Friday, 8 a.m. – 7 p.m.

Transportation concerns? Please call our Member Services team at 800-462-3589 to record a grievance so we may track and correct these issues.

mailto:[email protected]

https://www.paramounthealthcare.com/medicaid/additional-services/who-dey-healthy-rewards

https://www.paramounthealthcare.com/medicaid/additional-services/dawg-pound-healthy-rewards

https://www.paramounthealthcare.com/medicaid/additional-services/dawg-pound-healthy-rewards

https://www.paramounthealthcare.com/medicaid/additional-services/who-dey-healthy-rewards




COPD PROGRAMS FOR MEMBERSAt Paramount, we follow the GOLD guidelines for COPD care. The 2020 GOLD Guidelines require Spirometry testing to accurately make the diagnosis of COPD, specifically the presence of a post-bronchodilator FEV1/FVC <0.70.

In caring for patients with COPD we recommend the following programs.

PULMONARY CLINICSOutpatient pulmonary clinics work to empower patients and their families to successfully manage their lung disease.

These clinics work to:

• Educate patients about their medications and how they work

• Create individualized, written action plans

• Show patients how to use their inhalers

• Teach proper breathing techniques

• Assess patients for home oxygen needs

PULMONARY REHABILITATION

Pulmonary rehabilitation is suggested for all patients who have relevant symptoms and/or are at high risk for an exacerbation. Physical activity is a strong predictor of

mortality and patients should be encouraged to increase their activity. This can be accomplished by working with a skilled respiratory therapist in a pulmonary rehab program.

TOBACCO CESSATION SERVICES

Tobacco use remains the single largest preventable cause of death and disease in the United States. According to the CDC, cigarette smoking kills more than 480,000 Americans each year. Specialized programs are available for both adults and teens. Services may include:

• Confidential group and individual nicotine addiction counseling

• Assistance in developing a plan to quit tobacco

• Medication education

• Support groups

• Preventative education for children and teens

COPD can be treated and managed better the earlier it is identified. We invite you to partner with us to best help patients with COPD. If you need additional information with ways to assist COPD patients, contact your local respiratory clinic or pulmonary rehabilitation department.




DIABETES SELF-MANAGEMENT EDUCATION AND SUPPORTIn order to align with the American Diabetes Association and the American Association of Diabetes Educators, Paramount is asking that all in-plan providers who manage patients with diabetes refer them to Diabetes Education programs that provide diabetes self-management education and support (DSME/S).

Diabetes education is an interactive, ongoing process involving the person with diabetes (caregiver or family) and a diabetes educator. DSME/S is now being defined as “a collaborative process through which people with or at risk for diabetes gain the knowledge and skills needed to modify behavior and successfully self-manage the disease and its related conditions.” The goal of DSME/S is improved quality of life and self-care behaviors leading to improvements in a wide variety of clinical attributes and decreased healthcare costs.

Diabetes self-management education (DSME) provides the foundation to help people with diabetes navigate daily decisions and activities and has been shown to improve health outcomes. It is the process of facilitating the knowledge, skill, and ability necessary for diabetes self-care. ProMedica’s DSME programs are designed to address the patient’s health literacy needs, physical limitations, emotional concerns, family support, financial status, medical history and other factors that influence each person’s ability to meet the challenges of self-management.

Paramount’s goal is to have 100% of our members with diabetes referred to diabetes education on an annual basis. Please help us do our part in trying to bring this epidemic under control.

MEDICATION RECONCILIATION

Thank you for helping to ensure that medication reconciliation on post-discharge occurs and that documentation is completed in the outpatient medical record.

Medication reconciliation needs to occur at all transitions in care in order to provide the correct medications, prevent harm from adverse drug events, and improve continuity and coordination of medical care.

Continue to make sure:

1. Discharge medications are reconciled with current medications

2. Documentation is signed and dated by a prescribing practitioner, RN, or clinical pharmacist.

3. Documentation clearly states that discharge medications were reconciled with current medications.

4. Medication reconciliation post-discharge is performed within the timeframe on the discharge instructions (the date of discharge through 30 days after discharge per HEDIS® 2020).

5. Visit note references hospital stay for which medications are being reconciled.


SAFEGUARD IN UTILIZATION

Utilization management (UM) decision-making is based only on appropriateness of care and service and the existence of coverage. Paramount does not reward practitioners or other individuals for issuing denials of coverage or care. Paramount does not provide financial incentives for UM decision-makers to encourage decisions that result in underutilization. In fact, Paramount monitors and analyzes monthly reports for patterns of underutilization and takes action to address any identified problems. In addition, Paramount’s staff (UM/case management/behavioral health management coordinators) cannot deny services based on medical necessity. Denials can be made only by board certified, locally participating physicians, or pharmacists, when denials are for pharmacy services.

QUALITY IMPROVEMENT PROGRAMUnder Paramount’s philosophy, quality improvement is the responsibility of every employee and contracted provider. We are committed to using a continuous quality improvement cycle in managing both clinical and administrative services and measure performance indicators across all products. A summary of our quality improvement program and annual quality reports, which highlight quality activities and performance on key indicators, can be found at www.paramounthealthcare.com/about-us/quality. For more information about the Paramount quality improvement program, call 419-887-2537 or email us at [email protected].



http://www.paramounthealthcare.com/about-us/quality




NewsNETWORK

PROVIDED AS A SERVICE TO OUR PROVIDER AND OFFICE MANAGER COMMUNITY

FIRST NAME LAST NAMEADDRESS LINE 1ADDRESS LINE 2CITY, STATE ZIP

NewsNETWORK

Published by: Paramount 1901 Indian Wood Circle Maumee, Ohio 43537

Editor: Shakela Watkins [email protected]

SPRING 2020/SUMMER 2020A PUBLICATION OF PARAMOUNT

© 2020 ProMedica 1.2478.051920.IU
