SOUTH COUNTRY HEALTH ALLIANCE

PROVIDER NETWORK NEWS Volume 10, Issue 1Winter 2018

Chiropractic and Dental Network Changes, 2

RideConnect Transportation, 3

Member ID Card Changes, 3

MinnesotaCare 19- & 20-Year-Old Enrollees, 4

Formulary Updates, 5

2017 CAHPS Survey Results, 6

2018 SeniorCare Complete Star Rating Performance, 7

SeniorCare Complete Rated 4 out of 5 Stars, 8

2018 AbilityCare Star Rating Performance, 9

Quality and Performance Improvement Project: Reducing Chronic Opioid Use, 10

SNBC Dental Access Improvement Project, 11

Best Practice: Reminders for Documenting and Coding Chronic Kidney Disease, 12

What’s Inside

Subscribe TodayStay up to date on all the latest news and information by signing up to receive the Provider Network Newsletter and other Provider Bulletins right in your email. Click the envelope icon to subscribe!

Provider ResourcesVisit us online at www.mnscha.org. Click the Providers tab to find all the forms, instructions, and other resources and information you need.

2018 Voucher Reward ProgramIncentive Programs Offered to Eligible South Country MembersThrough our Be Rewarded™ program, South Country Health Alliance (SCHA) offers gift card rewards to members who complete important preventive care services on time.

We have updated our wellness rewards for 2018. Here’s what Be Rewarded™ includes this year:NEW! $25 Cervical Cancer Screening Reward: For female

members ages 21 through 64 who complete a cervical cancer screening. This reward is available for one visit per calendar year.

NEW! $25 Dental Visit Reward: For AbilityCare, SharedCare, SingleCare, SeniorCare Complete (MSHO), and MSC+ members who complete at least one preventive dental care visit during the calendar year. This reward is available for one visit per calendar year.

$50 Prenatal Care Reward: Completion of their first prenatal care visit with a health care provider during the first trimester (three months) of pregnancy (or within 42 days of enrollment).

$50 Postpartum Care Reward: Completion of a postpartum care visit with a provider between 21 and 56 days after delivery.

$75 Infant Well-Care Visit Reward: Completion of at least six out of the seven Well-Child checkups before 15 months of age.

$25 Lead Test Reward: Completion of a blood lead test by age 1 and again by age 2.

$25 Child Well-Care Visit Reward: Completion of an annual well-care exam by members ages 3-6 years of age.

$25 Adolescent HPV Immunization Reward: Completion of the series of HPV immunizations by 13 years of age.

$25 Adolescent Well-Care Visit Reward: Completion of an annual well-care exam by members ages 11-17 years.

$25 Young Adult Well-Care Visit Reward: Completion of an annual well-care exam by members ages 18-21 years. Members can receive a $25 bonus reward for choosing to complete Chlamydia screening during their well-care visit.

$25 Mammogram Reward: Completion of a mammogram by women ages 50 and older.**Women under the age of 50 are encouraged to complete screening as

recommended by their health care provider.

South Country Health Alliance will honor previous vouchers with dates of service on or before January 12, 2018.All wellness reward vouchers are available to download and print on our website. Members can also call Member Services to request a voucher or talk to their county’s Public Health department. A complete booklet of our vouchers is also available upon request by calling Member Services or the county Public Health department.

For questions about the Be Rewarded™ program, call Member Services at 1-866-567-7242. For more information, visit www.mnscha.org.

*

2 SCHA Provider Network News

Chiropractic Network ChangeEffective January 1, 2018South Country Health Alliance (SCHA) is now managing the chiropractic benefits and network internally. Clinical Resource Group (CRG) is no longer managing these benefits.

Providers interested in becoming a network provider may contact the SCHA Provider Network team at ProviderInfo@mnscha.org.

Thank you for the important care you provide South Country Health Alliance members. We look forward to continuing our work with you.

Claims submission addresses and provider service phone numbers for 2017 and 2018 claims:

Chiropractic claims for dates of service in 2017 through 12/31/17 can be submitted to:

1-866-281-1997Clinical Resource Group1700 W. Hwy 36, Suite 520Roseville, MN 55113Electronic claim submissionPayer ID # CRGMN

Chiropractic claims for dates of service 1/1/18 and after can be submitted to:

1-800-995-4543Mayo Clinic Health SolutionsP.O. Box 211698Eagan, MN 55121Electronic claim submission PayerID # 41154

Dental Network ChangeEffective January 1, 2018South Country Health Alliance (SCHA) will be partnering with Delta Dental of Minnesota. DentaQuest will no longer administer SCHA’s dental program.

If you are currently a part of the Delta Dental Minnesota network, they can assist with any contractual or creden-tialing requirements. If you are not a current provider in the CivicSmiles net-work, we ask that you join the network to continue to serve SCHA members.

Members can find dentists in Delta Den-tal’s CivicSmiles network on our website at www.mnscha.org (Find a Provider > 2018 Dental Provider Search).

Prior authorization requests made in 2017 and approved by DentaQuest will be honored by Delta Dental through-out 2018. Prior authorization requests made after January 1, 2018, should be sent to SCHA until February 28, 2018.

Claims submission addresses and phone numbers for 2017 and 2018 claims:

Claims for dates of service in 2017 through 12/31/17 can be submitted to:

DentaQuest Attn: Claims 11100 W. Liberty Drive Milwaukee, WI 53224-3626 Electronic claims submission Payer ID # CX014

Claims for dates of service 1/1/18 and after can be submitted to:

Delta Dental of Minnesota – (Hold claims until 3/1/18) P.O. Box 1328 Minneapolis, MN 55440-1328 Electronic claims submission Payer ID # 07000

We are committed to maintaining and building our positive partnerships throughout this transition. Please contact Michele Grose at 507-431-6949 with any feedback or questions.

NEW! EX Program Tobacco Cessation We are excited to announce our new tobacco cessation program called the EX Program. The EX Program is free for South Country Health Alliance members and features online chat with certified coaches, social support from peers and experts in an active online community, and includes a website full of resources and tools designed to help members quit for good. Plus, after chatting with a coach, members can receive nicotine patches, gum, or lozenges shipped directly to their home.

Using the EX Program, members will learn to do the following:

• Prepare for their quit date• Choose medication that suits

them• Outsmart cravings with tips

and techniques• Occupy their hands, mouth,

and mind without cigarettes• Handle stress without

tobacco• Avoid the five mistakes that

lead to relapseIn short, members get expert guidance and empathy, without judgment or pressure.

Members can register for the EX Program at www.BecomeAnEX.org

3Volume 10, Winter 2018 Issue

Provider Updates

RideConnect TransportationRideConnect is South Country Health Alliance’s Non-Emergency Medical Transportation (NEMT) program that provides our members with the safest, most appropriate and cost-effective mode of transportation to get to and from covered non-emergency medical appointments. Rides can be arranged as a one-way or round trip.

RideConnect schedules two types of transportation:

• Unassisted transportation is a curb-to-curb service for members who can safely get in and out of the vehicle with no assistance.

• Assisted transportation is a door-through-door service for members who need assistance getting in and out of a vehicle and into their scheduled appointments.

Members who request assisted trans-portation must obtain a certification through a Level of Need assessment from South Country Health Alliance prior to scheduling their ride. Members who reside in a nursing facility qualify for assisted services without a Level of Need certification.

To be eligible to use RideConnect trans-portation services, members must be actively enrolled in any South Country Health Alliance product (for Minne-sotaCare, only MinnesotaCare Child enrollees may be eligible).

Anyone acting on behalf of a member can call RideConnect to schedule a ride for the member. However, we ask that you provide RideConnect three busi-ness days to schedule a medical-related ride.

If you or a member would like to schedule a ride, please call RideCon-nect Member Services at 1-866-567-7242, or you may fill out the RideCon-nect Ride Request Form (web) on our website (Providers > Forms). RideCon-nect Member Services is available to schedule rides Monday through Friday, 8 a.m. to 4 p.m.

Recent Changes to RideConnect TransportationEffective November 1, 2017South Country Health Alliance members will call the RideCon-nect Member Services call center to schedule rides for their covered health care appointments. They will no longer call transportation providers directly to schedule rides. We still request that rides are scheduled at least three business days prior to a medical-related appointment.

Member ID Card Changes for 2018All South Country Health Alliance members received new ID cards at the beginning of the year.

New ID cards were issued because of our dental network change to Delta Dental’s CivicSmiles network. The cards now show CivicSmiles on the front and dental provider information on the back.

The Mayo Clinic Tobacco Quitline was also removed from the back of the ID cards.

2018 Changes to Member DocumentsTo prevent waste and save cost, plan documents for members will no longer be printed and mailed to members in 2018, but will be available on the South Country Health Alliance website.

New members for Medical Assis-tance and MinnesotaCare prod-ucts will receive a letter directing them to their materials on our website at www.mnscha.org. Medicare Advantage members will receive a similar notice, as well as a printed Member Hand-book or Evidence of Coverage.

All members can still request printed documents by calling the Member Services call center at 1-866-567-7242.

4 SCHA Provider Network News

MinnesotaCare 19- & 20-Year-Old Enrollees Effective January 1, 2018DHS changed the definition of Min-nesotaCare child to only include en-rollees 18 years old and under. Thus, MinnesotaCare 19- and 20-year-old members will now receive the Adult MinnesotaCare benefit set. Minneso-taCare 19- and 20-year-old enrollees will continue to be exempt from cost-sharing.

At this time, DHS continues to identify these enrollees in the Min-nesotaCare Child product (LL01) in MN-ITS. Please verify the age of Min-nesotaCare members in MN-ITS in order to identify those members that are 19- or 20-year-old enrollees.

Below are some examples of benefit changes for MinnesotaCare 19- and 20-year-old enrollees in 2018:

• Orthodontia is not covered foradults. All other dental servicescovered under Minnesota Stat-utes, § 256B.0625, subd. 9, forthe adult benefit set are covered.

• Home care nursing, personalcare assistance services, andcase management services arenot covered. All other home careservices are covered.

• Non-emergency medical trans-portation services are notcovered.

• Behavioral health home servicesare not covered.

Face-to-Face Rule for Durable Medical Equipment, Appliances, and SuppliesEffective January 1, 2018The initiation of medical equipment requires a documented face-to-face encounter that must be related to the primary reason that the member requires medical equipment. This encounter must occur no more than six (6) months prior to the start of services.

The face-to-face encounter may be conducted by one of the following:

• a physician

• a nurse practitioner

• clinical nurse specialist

• a physician assistant

The face-to-face encounter may oc-cur through telemedicine. In addi-tion, the need for medical supplies, equipment, and appliances must be reviewed annually by a physician.

A list of items subject to the face-to-face rule may be found in Chapter 3 of the DME MAC Jurisdiction B Supplier Manual. Refer to the Medicare contractor supplier documentation (PDF), ACA 6407 Specified Items, pages 11-17.

New Provider Requirement for Home Care ServicesThe eligible provider must be con-tracted with South Country Health Alliance and:

• Verify South Country Health Al-liance enrollment/eligibility foreach member each month.

• Maintain qualifying documenta-tion in the member’s file (healthservice record) at the provider’soffice of a face-to-face encounteras specified in Minnesota Statute§ 256B.0653, subd. 7. This in-cludes:

◦ An encounter with a physician,advanced practice nurse, orphysician assistant.

◦ The visit must be related to theprimary reason the memberrequires home health ser-vices and must occur within theninety (90) days before or thethirty (30) days after the start ofhome care services.

◦ The encounter/visit may occurthrough telemedicine.

◦ The provider must submit thequalifying documentation toSouth Country Health Allianceupon request.

• Maintain signed physician’s ordersin each member’s file at the pro-vider’s office.

• Follow additional provider re-quirements outlined under eachcovered service.

This change and additional clarifica-tion is listed in the South Country Health Alliance Provider Manual Chapter 24 titled Home Health Care Services on our website.

5Volume 10, Winter 2018 Issue

Provider Updates

Formulary UpdatesEffective January 1, 2018There are updates to the South Country Health Alliance Medicare Part D formulary and Medicaid formulary. These two formularies are available on our website (search for “formulary”), as well as prior authorization criteria and step therapy criteria.Please find a listing of the changes to the formularies:

Updated for the 2018 Medicare Formulary (Updated ST, PA, or QL criteria) Med Name

• Amitiza• Butorphanol tartrate• Doxepin

• lamivudine• Linzess• methadone

• Noxafil• Trulicity• Victoza 3-Pak

• Zyprexa Relprevv

Removed from the 2018 Medicare Formulary Med Name

• Afeditab CR• Aldactazide• Amnesteem• Apidra• Apidra SoloStar• Aplenzin• Azilect• Benicar• Benicar HCT• Bethkis• buprenorphine• Busulfex• CellCept Intravenous• Cholestyramine Light• Cubicin• Desvenlafaxine• Diflorasone

• Dutasteride-tamsulosin• E.E.S. Granules• Effient• Emend• Endocet• Epzicom• EryPed 200• fluticasone-salmeterol• Focalin XR• Gattex One-Vial• Isibloom• Kaletra• levoleucovorin• Malarone• mesalamine• Moderiba• Moderiba Dose Pack

• naratriptan• Nasonex• Nilandron• Nitrostat• OxyContin• PegIntron• PegIntron Redipen• Pristiq• Protonix• Proventil HFA• Prudoxin• REBETOL• Renagel• Ribasphere• Ribasphere RibaPak• Seroquel XR• Strattera• Syndros

• Tamiflu• Testim• tolazamide• tolbutamide• tolmetin• Toposar• Treximet• Tribenzor• Tymlos• Vagifem• Valcyte• Voltaren• Vytorin• Xatmep• Zetia• Zubsolv• Zyflo CR

2018 Medicaid Formulary Updates• Adding albuterol 0.63 mg/3 ml solution to the formulary• Adding Accu-Chek Guide meter, test strips, and control solution to the

formulary• Removing Accu-Chek Aviva Plus meter (alternative is Guide)• Removing Accu-Chek Nano meter (alternative is Guide)• Removing all Accu-Chek 25-count test strips (alternatives are 50-count or

100-count strips)• Vosevi and Mavyret were added to the state HCV criteria that is effective

1/1/18

If you have any additional questions about drug coverage for one of our members, please call the PerformRx pharmacy Help Desk:

Medicaid Provider Help Desk: 1-866-935-8874Medicare Provider Help Desk: 1-866-935-6681

Updated Prior Authorization GridThe final 2018 Prior Authorization Grid is now available on the South Country Health Alliance website. (www.mnscha.org > Providers > Authorizations)

6 SCHA Provider Network News

FOCUSED ON Performance

2017 DHS CAHPS Survey ResultsConsumer Assessment of Healthcare Providers and Systems (CAHPS) is an annual survey coordinated by DHS and is designed to rate how well health plans are meeting their member needs. The survey is mailed to a random selection of members every year to collect feedback about the services received. Some of our top ratings are listed below.

Rated #1 Among MN Health Plans

PMAP• Shared Decision Making

MinnesotaCare• Getting Needed Care• Getting Care Quickly• Customer Service

MSC+• Getting Needed Care• Customer Service• Rating of All Health Care

SNBC (AbilityCare/SingleCare/SharedCare)• Customer Service

Rated #2 Among MN Health Plans

PMAP• Customer Service• Rating of Personal Doctor• Rating of Health Plan

MinnesotaCare• Customer Service

MSC+• Getting Care Quickly• Rating of Health Plan

SNBC (AbilityCare/SingleCare/Shared Care)• Rating of All Health Care• Rating of Personal Doctor• Rating of Specialist Seen Most Often

EXCEEDED State / National AveragesRated at or Above the State Average

PMAP• Getting Needed Care• Getting Care Quickly• How Well Doctors Communicate• Rating of Specialist Seen Most Often

MinnesotaCare• Rating of Health Plan

Rated Above the National Average in Star Ratings

SeniorCare Complete*• Getting Needed Care• Getting Care Quickly• Customer Service• Rating of Health Plan• Rating of All Health Care

*State averages not available from DHS

7Volume 10, Winter 2018 Issue

4

SOUTH COUNTRY 2018 STAR RATING PERFORMANCESeniorCare Complete (MSHO)The Centers for Medicare and Medicaid Services (CMS) uses Star Ratings to score and rank Medicare Advan-tage health plans according to the quality of services they offer Medicare beneficiaries. CMS rates health plans on a one to five star scale, with 5 stars representing the highest quality. Health plan Star Ratings are posted on the Medicare website at www.medicare.gov to assist beneficiaries in selecting an appropriate Medicare Advan-tage plan. South Country’s top ratings for 2018 are shown below.

Medicare Overall Rating: 4 Star Rating Medicare Part C: 3 Star Rating Medicare Part D: 5 Star Rating

MEASURES WITH A5 STAR RATING

Staying Healthy• Annual Flu Shot• Diabetes Care - Eye Exam• Reducing the Risk of Falls

Managing Chronic Conditions• Care for Older Adults - Pain Screening

Member Experience• Getting Care and Appointments Quickly• Overall Rating of Drug Plan

Drug Safety• Medication Adherence - Blood Pressure• Medication Adherence - Cholesterol

Member Satisfaction and South Country’s Quality Performance• Low Number of Complaints about Drug Plan• Low Number of Complaints about Health Plan• Few Members Choosing to Leave the Plan (Enrollment)• Medicare Audit of Beneficiary Access

MEASURES WITH A4 STAR RATING

Staying Healthy• Improving or Maintaining Mental Health

Managing Chronic Conditions• Care for Older Adults - Pain Screening• Care Management - Health Risk Assessment

South Country’s Customer Service• Call Center - Foreign Language Interpreter & TTY/TDD

Drug Safety• Medication Adherence - Diabetes• Medication Therapy Management

Member Experience• Getting Needed Care without Delay• Getting Needed Prescriptions• Overall Rating of Health Care Quality• Customer Service• Overall Rating of Health Plan

8 SCHA Provider Network News

SeniorCare Complete Rated 4 Stars for 2018National MA-PD Ratings

384 total contracts

3.9% (15) of contracts earned 5 stars

14.8% (57) of contracts earned 4.5 stars

South Country Health Alliance 25.5% (98) of contracts earned 4 stars

55.8% (214) of contracts earned 3.5 stars or fewer

Too Small for Rating

Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.

MSHO 2018 Health Plan Quality and Performance RatingMedicare Advantage Health Plan Ratings are listed on Medicare.gov

The Medicare Program rates all health and prescription drug plans each year, based on a plan’s quality and performance.

The ratings above are for Medicare Advantage plans with prescription drug coverage (MA-PD).

Medicare Star Ratings help you know how good a job our plan is doing.

A five Star Rating is excellentA four Star Rating is above averageA three Star Rating is averageA two Star Rating is below averageA one Star Rating is poor

SeniorCare Complete (HMO SNP) is a health plan that contracts with both Medicare and the Minnesota Medi-cal Assistance (Medicaid) programs to provide benefits of both programs to enrollees. Enrollment in SeniorCare Complete depends on contract renewal.This plan is available to anyone who has both Medical Assistance and Medicare; lives in our service area; and are ages 65 and over.

9Volume 10, Winter 2018 Issue

SOUTH COUNTRY 2018 STAR RATING PERFORMANCEAbilityCare (SNBC)The Centers for Medicare and Medicaid Services (CMS) uses Star Ratings to score and rank Medicare Advantage health plans according to the quality of services they offer Medicare beneficiaries. CMS rates health plans on a one to five star scale, with 5 stars representing the highest quality. Health plan Star Ratings are posted on the Medicare website at www.medicare.gov to assist beneficiaries in selecting an appro-priate Medicare Advantage plan. South Country’s top ratings for 2018 are shown below.

Medicare Overall Rating: Not enough participant data Too Small for Rating

Medicare Part C: Not enough participant data Too Small for Rating

Medicare Part D: 5 Star Rating

MEASURES WITH A 5 STAR RATING

MSHO 2018 Health Plan Quality and Performance Rating

Staying Healthy• Diabetes Care - Eye Exam• Controlling Blood Pressure

Drug Safety• Medication Adherence - Diabetes• Medication Adherence - Blood Pressure• Medication Adherence - Cholesterol

Member Satisfaction and South Country’s Quality Performance• Medicare Audit of Beneficiary Access

MEASURES WITH A 4 STAR RATING

Staying Healthy• Colorectal Cancer Screening• Adult BMI Assessment

Drug Safety• Medication Therapy Management

South Country’s Customer Service• Call Center - Foreign Language Interpreter & TTY/TDD

AbilityCare (HMO SNP) is a health plan that contracts with both Medicare and the Minnesota Medical Assis-tance (Medicaid) programs to provide benefits of both programs to enrollees. Enrollment in AbilityCare de-pends on contract renewal. This plan is available to anyone who has both Medical Assistance and Medicare; lives in our service area; and are ages 18 and older and ages 64 and under.Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.

10 SCHA Provider Network News

Quality and Performance Improvement Project:Reducing Chronic Opioid UseOn December 1, 2017, former Lt. Governor Tina Smith and DHS Com-missioner Emily Piper announced new opioid prescribing guidelines designed to reduce the risk of opioid addiction. The new guidelines focus on appropri-ate opioid prescribing during the acute/subacute pain period and promote evi-dence-based pain management alterna-tives in attempts to prevent long-term (chronic) opioid use. These guidelines were developed in accordance with a legislative directive passed in 2015 intended to 1) reduce progression to-ward new chronic opioid use, 2) reduce variation in opioid prescribing behavior, and 3) provide educational resources for prescribers. The legislation resulted in the creation of an Opioid Prescribing Improvement Program through col-laboration of a DHS Commissioner-ap-pointed Opioid Prescribing Work Group (OPWG) and the Minnesota Depart-ments of Health, Human Services, and Labor and Industry.

The three main principles that provide the foundation for the opioid prescrib-ing guidelines include:

1. Prescribing the lowest effective dose and duration of opioid anal-gesia when an opioid is indicated for acute pain: the first 4 to 7 days after an acute event.

2. Closely monitoring patients during the post-acute pain period (pain occurring up to 45 days following an acute event).

3. Carefully managing patients who remain on opioid medication beyond 45 days, a time frame associated with increased risk of opioid addiction, potential abuse, and diversion.

The OPWG also developed a set of prescribing measures that will be used as part of a 2018-2020 Performance Improvement Project (PIP) and Qual-ity Improvement Project (QIP) by Minnesota Managed Care Organiza-tions (MCOs), including South Country Health Alliance (SCHA). The goal of the project is to reduce the number of public health plan enrollees, ages 12 and older, who become new chronic opiate users. This project will use the New Chronic User (NCU) of Opioid Pain Relievers measure developed by Minnesota DHS to monitor the success of interventions and outcome perfor-mance.

Collaborative MCO interventions are expected to include provider education such as a provider pain management resource toolkit, a series of educational webinars, provider outreach, com-munity outreach messaging, and care coordination strategies for members enrolled in MSHO, MSC+, and SNBC products. SCHA-specific interventions will focus on providing case manage-ment support services for members

receiving opioid prescriptions during the acute and subacute pain period and outreach to providers who prescribe outlier quantities and doses of opioids to SCHA members.

The case management support services provided by SCHA will include assess-ment of member functional status relative to pain and ability to engage in normal activities of daily living, mem-ber education regarding safe and effec-tive pain management, identification of potential risk factors associated with opioid use, education on the availability of non-opioid alternative therapies and treatments, safe storage and disposal of opioid prescriptions, and use of com-munity support systems, including care coordination.

More information will be made available about this three-year project when intervention processes, materials, and other resources are ready for distribution. Providers may contact SCHA Chief Medical Officer Dr. Brad Johnson at bjohnson@mnscha.org with questions, concerns, comments, and feedback.

11Volume 10, Winter 2018 Issue

Provider Updates

SNBC Dental Access Improvement ProjectSouth Country Health Alliance is partnering with other Managed Care Organizations and Minnesota Depart-ment of Human Services (DHS) on a collaborative Special Needs BasicCare (SNBC) Dental Access Project to explore strategies that support community-based dental clinics in caring for more individuals with special health care needs.

The Minnesota health plans offer-ing dental services to enrollees in the Medicaid SNBC program sent a survey to dental clinics in 2017 regarding ac-cess barriers for people with disabilities ages 18-64 years. The purpose of the survey was to learn about community-based general dentistry accommoda-tions to serve patients with special health care needs.

Here is a summary of the results com-piled by DHS:

Community-Based Dental Clinic Survey Results Of the 167 responses received from dental clinics, 43 percent were from seven counties in the Twin Cities metro area, 33 percent were from northern Minnesota, and 24 percent from south-ern Minnesota. Most of the clinics were staffed by one or two dentists and two or three hygienists or dental therapists.

• Approximately half of the clinics reported asking new patients if they required special accommodations that could impact their care.

• Approximately 70 percent reported they communicated with the pa-tient’s primary care or behavioral health provider.

• More than 85 percent of respondents allowed service animals, had dental chairs that could adjust to wheelchair level, and had wheelchair-accessible waiting areas. 11 percent of clin-ics had a bariatric dental chair, and

one-third of respondents indicated they could accommodate patients who require a private waiting area. Approximately two-thirds of the clin-ics indicated that their staff already had training to support patients with physical limitations or mildly chal-lenging behaviors.

• 78 percent of the responding clin-ics indicated interest in education on working with people with special needs. Dental clinic staff voiced con-cerns about a lack of training in work-ing with people with special needs since obtaining their degree. Several comments addressed the need for continuing education courses, job shadowing, or additional training by experts experienced in working with people with disabilities.

• Most respondents indicated they may be able to serve people with certain special needs provided they had an understanding of the person’s complete needs before coming to the dental appointment. Respon-dents discussed the importance of clear and complete communication of a person’s needs when scheduling a dental appointment. In addition, dental staff expressed the need for the person to have staff attend the appointment if there is a need for as-sistance in activities of daily living.

• Many respondents commented on the need for higher reimbursement rates due to the extended length of time needed to give quality care to this population and the need for ex-panded benefits to help this popula-tion maintain good oral health.

Observations • The survey shows that dental clin-

ics are serving patients with special needs and are willing to see more SNBC patients if DHS and the health plans can provide meaningful ways

to overcome some of the barriers to dental care experienced by people with disabilities.

• Survey responses demonstrated a need for more information and train-ing on the management of dental patients with special needs. Dental staff want and would benefit from ac-cess to information and consultations about special needs dentistry. Den-tists want to care for their commu-nity members and need mentoring, care support, and access to tangible information about a person’s unique needs.

• Dental care for people with and without disabilities is important. Prevention and early intervention are the milestones of modern den-tistry. These milestones can be more difficult to accomplish when dental professionals feel unprepared for the unique needs of SNBC recipients. It is the intent of this project to fos-ter collaboration for the purpose of meeting the oral health care needs of SNBC recipients. Currently, less than half of adults (19 to 64 years old) receive at least one dental visit per year. By working through operational accommodations, these statistics can be improved, eventually enabling many SNBC individuals to be seen regularly by dental providers in their own communities.

Click here to see the full report (PDF).

Thank You We at South Country Health Alliance, along with DHS and the SNBC health plans, express our appreciation to all of the Minnesota dental providers that responded to this survey. The team will strive to use your input as we move forward with implementing this Dental Access Project.

12 SCHA Provider Network News

Provider Updates

Best Practice: Reminders for Documenting and Coding Chronic Kidney DiseaseChronic kidney disease (CKD) is classified to category N18 in the ICD-10-CM manual and then further classified based on the level of severity in desig-nated stages 1-5 using the fourth character of the ICD-10-CM code:

• N18.1 – CKD stage l

• N18.2 – CKD stage ll (mild)

• N18.3 – CKD stage lll (moderate)

• N18.4 – CKD stage lV (severe)

• N18.5 – CKD stage V

End Stage Renal DiseaseEnd stage renal disease (ESRD) is coded with N18.6, and the ICD-10-CM manual instructs to use an additional code to show dialysis (Z99.2). Docu-mentation should also state that the member is on dialysis. If the documen-tation states a stage of CKD and ESRD, assign only N18.6 (ESRD).

When documentation does not state the stage of CKD, code N18.9 (CKD, unspecified) is assigned. The following conditions are also coded to N18.9:

• Chronic renal disease

• Chronic renal insufficiency

• Diffuse sclerosing glomerulonephritis NOS

• Chronic renal failure, not otherwise specified (NOS)

• Chronic uremia

When using category N18, ICD-10-CM also instructs to use an additional code to identify kidney transplant status (Z94.0).

Hypertension and CKDIf hypertension and CKD are both present, ICD-10-CM assumes a cause and effect relationship and classifies it as hypertensive CKD. A code from I12 to indicate hypertensive CKD and stage of CKD should be used, as well as a secondary code from N18.

Hypertensive Heart and CKDHypertensive heart and CKD should be assigned a code from combination category I13, when both hypertensive kidney disease and hypertensive heart disease are stated in the diagnosis. A relationship can be assumed between hypertension and CKD whether or not the condition is stated as such in the note. The appropriate code from category I13 is used along with a secondary code from the N18 category indicating the stage of CKD.

For more information on CKD guidelines, please refer to the American Hos-pital Association (AHA) Coding Clinic and ICD-10-CM Official Guidelines for Coding and Reporting FY 2018.

Provider Network News is a quarterly publication of South Country Health

Alliance. For submission information or reprint permission, contact:

SCHA, 2300 Park Drive, Suite 100, Owatonna, MN 55060

Email: ProviderInfo@mnscha.orgWebsite: www.mnscha.org

REPORTING: Fraud, Waste, & AbuseIt is everyone’s responsibility to report

suspected fraud, waste, and abuse.You can report it by sending an email to the SCHA Compliance Department

at compliance@mnscha.org, by calling anonymously through our Report it

hotline at 1-877-778-5463, or by visiting www.reportit.net.

Username: SCHA, Password: Owatonna

Did You Know?The DHS website provides updates to

Personal Care Attendant (PCA) providers specifically for training requirements,

both for individuals and for agency administration staff. Visit the DHS PCA

Provider Training Web page.

©2018 by South Country Health Alliance