If you have any questions about these new benefits or how they are covered, please call Customer Service at the number shown on the member’s ID card. 

You can use CoverMyMeds to request prior authorization for these medications. CoverMyMeds provides faster determinations, usually within 24 hours.  To get started using CoverMyMeds, go to the CoverMyMeds web site and sign in to your account. You will need to register on your first visit.  

Please note: This prior authorization requirement does not apply to Health Tradition Health Plan or to government plans.

 

To dispute a review and reconsideration decision, providers may file a grievance. All grievances must be submitted in writing on the Grievance Request form. The grievance request will only be accepted after the provider has received a determination from Mayo Clinic Health Solutions to their claim review and reconsideration request. 

Please review Chapter 4 Claims in the Provider Manual for more information and to determine when it is appropriate to submit these forms. Providers assisting members filing an appeal because of an adverse claim or authorization determination (denial or disapproval) should review the member appeal process in Chapter 7 Appeals.

 

Self-Registration

After clicking on the “register” button on the Provider home page, the user will be taken to the Provider Registration screen. The user may then select the option he or she wants to use for registration:

1. Register online as a Super User: The user must be able to provide a tax ID and a valid Mayo Clinic Health Solutions claim number previously processed for their health care facility.
2. If the user cannot provide a claims number, they should choose the Register using the Super User Registration form option. 
3. If the user would like to register as an End User for their facility, we provide a Look up the name of my facility’s Super User tool that will provide the email address of their facility’s Super User. The user may then contact their Super User to request access.

Password Reset

Online password reset functionality will be released on our website in the coming weeks. Here’s how this new tool will work: 

1. To reset your password, click on Forgot your user ID or password? on the sign in page, then follow the instructions provided.  
2. A temporary system generated password will be sent to the email address associated with your Online Services for Providers account. 
3. When you sign in using this temporary password, you will automatically be asked to input a new password.  

Please note, the password requirements have changed:

• When setting up a new password, you will now be required to choose a password containing at least one of each of the following: an upper case letter, a lower case letter, and a number. 
• Each End User is now required to input an email address associated with their account. If you do not currently have an email address associated with your account, you will be asked to provide one the next time you sign in.

If you are an End User and have forgotten your User ID, you can use the Look up the name of my facility’s Super User tool, mentioned in the previous article, to look up your facility Super User’s email address so that you can request assistance. If you are a Super User and have forgotten your User ID, please contact Customer Service for assistance.

 

Critical Business Reminders for UCare Providers

On Dec. 14, 2016, UCare emailed critical business reminders to all accounts in the UCare email database. The document addressed UCare’s: 

• Quality program 
• Pharmacy 
• Medical and Behavioral Health clinical practice guidelines 
• Complex case management referral process 
• Utilization management 
• Member Rights and Responsibilities 
• Complaints, Appeals and Grievance procedures 
• Disease management information 
• Provider Manual 

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2017 UCare authorization and notification grids now available 

The 2017 medical, behavioral health and pharmacy authorization requirements are now available at on the UCare Eligibility and Authorizations page.  Please view the UCare Authorizing Entities FAQ for information on when to contact Mayo Clinic Health Solutions for authorizations. 

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Medicare Outpatient Observation Notice - Required by March 8, 2017

On August 6, 2015, Congress enacted the Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act, which requires all hospitals and critical access hospitals (CAHs) to provide written notification and an oral explanation of such notification to individuals receiving observation services as outpatients for more than 24 hours.

All hospitals and CAHs are required to provide this statutorily required notification no later than March 8, 2017. Click here to view the notice and accompanying instructions.

The Medicare Outpatient Observation Notice was developed to inform all Medicare beneficiaries when they are an outpatient receiving observation services, and are not an inpatient of the hospital or CAH. In accordance with the statute, the notice must include the reasons the individual is an outpatient receiving observation services and the implications of receiving outpatient services, such as required Medicare cost-sharing and post-hospitalization eligibility for Medicare coverage of skilled nursing facility services. Hospitals and CAHs must deliver the notice no later than 36 hours after observation services are initiated or sooner if the individual is transferred, discharged or admitted.

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Promoting HPV Vaccination in Preteens 

The Measurement and Reporting Committee of Minnesota Commu¬nity Measurement recently approved an update in reporting of adolescent immunization status to adopt a new HEDIS “Combo 2” performance measure. The current measure con¬sists of the meningococcal and Tdap immunizations, which Minnesota Community Measurement currently reports publicly as outcome data. Human Papilloma Virus (HPV) immunizations for both boys and girls will be added to the measure in the 2017 report (CY 2016 dates of service), and the data will be publicly published for report year 2018 (CY 2017 dates of service). 

According to data released by the Centers for Disease Con¬trol and Prevention (CDC) in August, the 2015 Minnesota immunization rate for three doses of the vaccine against HPV for females was 44.5% and for males 22.4%. 

The American Cancer Society provides an excellent clinician guide—Steps for Increasing HPV Vaccination in Practice—for motivating parents to get their children vaccinated. This guide provides evidence-based strategies and tools, stating the biggest predictor of successful HPV immunization is an effective recommendation to parents from a health care provider. The guide includes the following strategies: 

• Recommending the HPV vaccine for all boys and girls at 11 or 12 years of age on the same day or in the same way you recommend immunization for Tdap and meningococcal. 
• Providing educational information on the importance of protection from the cancers caused by HPV and the men¬tion that vaccination during the preteen years provides a more robust immune response. 

South Country Health Alliance is in the process of exploring health promotion strategies to encourage increased mem¬ber participation in this important preventive care service. Further updates will be provided to you as SCHA determines the focus of its “Take Charge! Be Rewarded!” programs for 2017.