utilization review program provider orientation...
TRANSCRIPT
Idaho Medicaid: Utilization Review Program Provider Orientation Meetings July 18-21, 2016
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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
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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
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Project Team
Mike Speight
Implementation Director
37 years developing programs to improve healthcare for Medicaid and Medicare
Scott Tiffany, MA, MEd
Project Director
Day to day responsibility
17 years experience (including Idaho)
David Hancock, MBA, MPIA
Vice President State Health Solutions
16 years experience serving Medicaid programs
Stephanie Wilson, MBL
Implementation Manager
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Scope of Work: Program components
Utilization Review
Case Management
External Quality Review of Managed Care Plan
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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
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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)
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Telligen Provider Portal
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Website to access portal log-in: IDMedicaid.Telligen.com
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Provider Queue
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Patient Information
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Provider and Facility Search
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Provider Portal:
Service Request
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Auto Authorization
Brummer, Willow
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Clinical Documentation
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Clinical Documentation Upload
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Summary and Attestation
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Finding a case in the queue
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Case Details
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Review Details
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Website: IDMedicaid.Telligen.com
Call Center: (866) 538-9510
Help Desk email address: [email protected]
Phone number of Boise office • Local number:
• Toll free:
Fax number: (866) 539-0365
Important Numbers
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Questions
Implementation Information