Member information is available 24/7 when you sign in to your Online Service Center account or through the automated voice response system when you call Customer Service. If you need to speak with a Customer Service representative, please call back on the next business day.

Members not currently using test strips made by one of these manufacturers recently received a letter encouraging them to transition to the preferred products. 

• The letter also included vouchers for new blood glucose meters for those members who would need to transition to a new meter along with new test strips. 
• These members will be able to continue using their current non-preferred test strips at their current formulary tier until the end of 2016. After that, the non-preferred test strips will be considered non-formulary and will not be covered. 

Members receiving new prescriptions for test strips are required to use the Ascensia or Roche products in order to receive coverage. 

Members using insulin pumps that require specific types of test strips, as well as members with visual or cognitive conditions that require specific meters or strips may be granted exceptions to this formulary status change. The prescriber should request prior authorization for any exceptions. 

If you have any questions about the test strips or meters available to members from Ascensia or Roche, please contact the manufacturers at:

• Ascensia Diabetes Care:  ContourNextFreeMeter.com  1-800-401-8440
• Roche Diabetes Care: accu-chek.com  1-800-858-8072

If you have any questions about the formulary change, please contact Customer Service at the number listed on the member’s ID card.

Use CoverMyMeds to Request Prior Authorization

Prescribers can now use CoverMyMeds, an electronic prior authorization tool, to request prior authorization for these medications. CoverMyMeds is an easy-to-use tool that provides faster determinations – usually with 24 hours. In addition this tool offers:

• Authorization for all plans and any medication
• Reduced phone calls and faxes, with no need to wait on hold
• 24/7 prior authorization submission from any computer
• Secure HIPAA-compliant submissions
• Live chat support

To get started using CoverMyMeds, go to www.covermymeds.com and sign in to your account. You will need to register on your first visit.  Then follow these steps:

1. Start a prior authorization request, making sure to fill in the “BIN/PCN/RxGroup or Plan or PBM” box with the corresponding information shown on the member’s ID card. Or, fill in the name of the administrator (e.g., Mayo Clinic Health Solutions) if you do not have a copy of the ID card.
2. Fill in all the required medical details. When finished, submit the request. 
3. Your determination will be delivered online via your account on the CoverMyMeds web site.

The Minnesota PMP is run by the Minnesota Board of Pharmacy and collects information on all prescriptions filled for schedule II-V controlled substances, including gabapentin or butalbital. This registry can help prescribers and pharmacists identify patients who may be “doctor-shopping” or misusing controlled substances. In addition, this tool is useful in helping to combat opioid substance abuse while still managing pain in patients who truly need it. For more information about the Prescription Monitoring Program, the registration requirement and account creation, please visit the program’s web site.

For more information about signing up for EFT, please refer to the Electronic Funds Transfer section of the Provider Manual. Or, refer to the instructions on the back of the EFT form.

Change in Vaccination Coverage for 2016-2017 Flu Season

The Centers for Disease Control and Prevention (CDC) has announced it does not support the use of the live attenuated influenza vaccine (LAIV), also known as the “nasal spray” flu vaccine, during the 2016-2017 flu season. This vaccine would be submitted with the CPT code 90672 or 90660. 

South Country Health Alliance (SCHA) will be following this guideline.  Effective immediately, SCHA will not be covering the flu mist for the 2016-2017 flu season for SCHA members. 

Annual flu vaccination is strongly recommended.  In place of the LAIV vaccine, please educate SCHA members about two other options available:  inactivated influenza vaccine (IIV) and recombinant influenza vaccine (RIV).

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Durable Medical Equipment and Medical Supplier Payment Method

On July 1, 2016, South Country Health Alliance (SCHA) began reimbursing providers for Medicare-covered Durable Medical Equipment (DME) based on the current published DME rural and non-rural rates. 

Now that Medicare has established rural rates, DME and medical supplier payment to providers will be based on their zip code, which will determine a rural vs. non-rural rate. In cases where no rural rate has been determined, claims will continue to pay at the non-rural rate until all rural rates have been established.

For more information, please review the announcement released by the Centers for Medicare & Medicaid Services about corrections made to the July 2016 fee schedule amounts. 

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Reminder: South Country Health Alliance Provider 2% Medicare Sequestration

In 2013, the Centers for Medicare & Medicaid Services (CMS) implemented a 2% reduction (sequestration) in payments made to providers for services rendered to Medicare beneficiaries. At the same time, CMS also reduced the capitation amount paid to South Country Health Alliance (SCHA) and other Medicare Advantage health plans contracting with CMS by 2%. South Country Health Alliance, however, chose not to implement this reduction with their contracted provider network.

It was anticipated that the sequestration would sunset in 2016; however, instead, it has been continued indefinitely. Effective August 1, 2016, SCHA implemented the 2% sequestration and applied the reduction to SCHA's Medicare fee schedule, applicable to all Medicare eligible, covered services. Questions may be directed to SCHA Provider Services at 1-800-995-4543.

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Child and Teen Checkups Screening with an Evaluation and Management Service 

If a significant, separately identifiable Evaluation and Management (E&M) service is provided at the time of the Child and Teen Checkup (C&TC) screening, that E&M code must be billed with the modifier 25. Documentation in the health record must support key components of billed E&M services. 

Please follow Current Procedural Terminology (CPT) instructions for appropriate coding. The National Correct Coding Initiative (NCCI) rules state that a vaccine administration and E&M code cannot be billed on the same day, by the same provider, unless a “significant, separately identifiable service by the same physician was provided on the same day.”

Please visit the Minnesota Department of Human Services web site for more information on C&TC requirements. 

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What Does the UCare Behavioral Health Authorization Program Transition Mean for You?

As of October 31, 2016, UCare will no longer use Beacon Health Strategies LLC (Beacon) to perform utilization review of behavioral health prior authorization requests. UCare has decided to bring behavioral health utilization management functions in-house beginning in mid-October, 2016.

What Does This Mean For UCare Providers?

• For the most part, this change will be seamless for providers and for UCare members. 
• There will be no change to the behavioral health/chemical dependency provider network.
• Providers will continue to submit claims directly to UCare for payment. 
• Providers may continue to call the UCare Provider Assistance Center at 612-676-3300 or 1-888-531-1493 (follow the prompts). 
• Any changes to the prior authorization fax number will be communicated prior to the mid-October transition date, and the prior authorization forms will be updated accordingly.

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Complex Case Management Referral Process

UCare offers a Complex Case Management program designed to provide support and assistance to members who have had a major health event or require extensive use of resource, or who need assistance with coordinating their care. UCare identifies members for enrollment in the program using predictive modeling tools. In addition, UCare welcomes individual member referrals from providers.  Other referral sources may include: Disease Management Program, Discharge Planner, and member or caregiver.

Complex Case Management referrals are screened for program eligibility and assigned to complex case managers as received. UCare accepts all referrals for screening for the Complex Case Management program. Participation in this program is voluntary and free for eligible UCare for Seniors and UCare Choices (Exchange) members. 

To refer a member to the Complex Case Management program, please complete the referral form available on the UCare web site. Referrals and related documentation should be faxed to 612-884-2284. For more information, or if you have any questions about this program, please call 612-676-6538.

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