In This Issue

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Nebraska

Provider

Newsletter

August 2020

In This Issue

Quality

How Care Management Can Help You 1�

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� Nebraska Medicaid Expansion 1

Getting Needed Care 2

The Nebraska Tobacco Quitline 3 Provider Satisfaction Survey 3 Operational

Updating Provider Directory Information 4 Electronic Funds Transfer (EFT)

through PaySpan 4

Provider Resources 4

We’re here to help you!

For more information about Care Management, or to refer a member to the program, please call us at 1-866-635-7045.

This no-cost program gives the member access to an RN or LCSW Monday-Friday from 8 a.m. to 8 p.m. Eastern Time.

Quality

How Care Management Can Help You

Care Management helps members with special needs.

It pairs a member with a care manager. The care manager is a registered nurse (RN) or licensed clinical social worker (LCSW) who can help the member with issues such as:

• Complex medical needs

• Solid organ and tissue transplants

• Children with special health care needs

• Lead poisoning

Nebraska Medicaid Expansion

Medicaid eligibility will be expanded to Nebraska residents ages 19-64 whose income is at or below 138 percent of the federal poverty level. This equates to approximately $16,000 per year for an individual.

Applications will begin to be accepted on August 1, 2020 and benefits will begin on October 1, 2020.

For more information refer to the DHHS website:

http://dhhs.ne.gov/Pages/Medicaid-Expansion.aspx

Join the Conversation on Social Media

Join our digital and social communities for up-to-date information on how we’re working with you and others to help our members live better, healthier lives.

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Quality

Getting Needed Care

Access to medical care, including primary care, specialist appointments and appointment access, are key

elements of quality care.

Each yeah, CAHPS surveys patients and asks questions like:

• In the last 6 months, how often was it easy to get appointments with specialists?

• In the last 6 months, how often was it easy to get the care, tests, or treatment you needed through your health plan?

• In the last 6 months, when you needed care right away, how often did you get care as soon as you thought it was needed?�

• In the last 6 months, not counting the time when you needed care right away, how often did you get an appointment for your health care at a doctor’s office or clinic as soon as you through you needed it?

• In the last 6 months, how often did you see the doctor you were scheduled to see within 15 minutes of your appointment time?

To ensure your patients are satisfied with their ease of access:

• See members within access and availability standards

• Schedule appointments in a reasonable window for each request

• Follow up with members after referral to specialists to ensure care is coordinated

• Provide all information for specialists, tests and procedure authorizations and follow up as necessary

• Reduce time in the waiting room to no more than 15 minutes from appointment time

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Care Coordination

These are also helpful tips to provide the needed care to your patients:

Review medications with your patients Offer to schedule specialist and lab appointments while your patients are in the office

Remind your patients about annual flu shots and other immunizations

Make sure your patients know you also are working with specialist on their care. Ensure you receive noted from specialists about the patient’s care and reach out to specialists if you have not gotten consultation

notes. Tell your patient the results of all test and procedures. Share decision making with patients to help them manage care.

And please follow up on all authorizations requested for your patient

Call or contact your patients to remind them when it’s time for preventative care services. These include annual wellness exams, recommended cancer screenings and follow-up care for ongoing conditions such as hypertension and diabetes

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Quality

The Nebraska Tobacco Quitline

As of August 1, 2020, Nebraska Tobacco Quitline is transitioning to a new vendor, National Jewish Health.

The number for clients to reach the 24/7 Quitline, 1-800-QUIT-NOW, will remain the same. Spanish-speaking residents may also call 1-855-DÉJELO-YA (1-855-335-3569).

Services are free & confidential to Nebraska residents, 24/7 access to counseling & support services.

Starting August 1st, please use the new fax referral form found here http://dhhs.ne.gov/Documents/

QuitlineFax.pdf.

Please note the new fax number for referrals starting Aug 1st : 1-800-261-6259.

The Quitline will continue to offer a FREE 2 week supply of Nicotine Replacement Therapy to qualified callers.

Check out their website for more information. QuitNow.ne.gov

Quality

Provider Satisfaction Survey

WellCare of Nebraska is committed to improving provider satisfaction with the health plan. Provider surveys are conducted in the fall to assess provider satisfaction among primary care providers, specialists and behavioral health providers.

In 2019, we rated well in the following:

• Ability to answer questions and resolve problems

• Process of obtaining member information In 2019, we identified opportunity in the following:

• Coordination of care

• Quality of provider trainings and provider onboarding process�

In response to the survey results, in 2020 we have implemented:

• Interdepartmental work group to address provider satisfaction

• Monthly provider training opportunities

• Quarterly provider town hall meetings with market leadership

Surveys for 2020 will be conducted September through November.

Please consider completing the survey. We value your opinion!

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Operational

Updating Provider Directory Information

We rely on our provider network to advise us of demographic changes so we can keep our information current.

To ensure our members and Care Management staff have up-to-date provider information, please give us advance notice of changes you make to your office phone number, office address or panel status (open/closed). Thirty-day advance notice is recommended.

New Phone Number, Office Address or Change in Panel Status:

Please call us at 1-855-599-3811. Thank you for helping us maintain up-to-date directory information for your practice.

Electronic Funds Transfer (EFT) through PaySpan® �

Five reasons to sign up today for EFT:

You control your banking information.

No waiting in line at the bank.

No lost, stolen, or stale-dated checks.

Immediate availability of funds – no bank holds!

No interrupting your busy schedule to deposit a check.

Setup is easy and takes about five minutes to complete. Please visit www.payspanhealth.com/nps or call your Provider Relations representative or PaySpan at 1-877-331-7154, Monday–Friday 8am–8pm EST, with any questions.

We will only deposit into your account, not take payments out.

Provider Resources

1-855-599-3811 www.wellcare.com/Nebraska/Providers Provider News – Provider Portal

Remember to check messages regularly to receive new and updated information. Access the secure portal using the Secure Login area on our homepage. You will see Messages from WellCare on the right. Provider Homepage - www.wellcare.com/en/Nebraska/Providers.

Resources and Tools

You can find guidelines, key forms and other helpful resources from the homepage as well. You may request hard copies of documents by contacting your Provider Relations representative.

Refer to our Quick Reference Guide, for detailed information on many areas such as Claims, Appeals, Pharmacy, etc. These are located at

www.wellcare.com/en/Nebraska/Providers/Medicaid.

Additional Criteria Available

Please remember that all Clinical Guidelines detailing medical necessity criteria for several medical procedures, devices and tests are available on our website at www.wellcare.com/en/Nebraska/Providers/

Clinical-Guidelines.

Provider Relations Team

Kayla Baumberger [email protected] Christine French [email protected] Michelle Hartman [email protected] Dana Hinkle [email protected] Kami Hudson [email protected] Angi Tran [email protected]

PRO_61851E_NE State Approved 11192020

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