HCAP Highlights - myhcap.com

1 HCAP Highlights Spring 2014. Are you ready for a new way of 2014 PCMH designation. PCMH designated. doing business, especially if it The PCMH process encour- Our overall results for being means additional income and aged physician collaboration and part of the PCMH program have improving patient care? An op- efficiencies by establishing been nothing but positive, said portunity now exists to take ad- standing order protocols for Ruggles. The whole process has vantage of the collaboration be- Coumadin and protein checks, given us the opportunity to assess tween Health Care Alliance Pool said Andrew Robbins, BBA. Plus, and implement changes that we (HCAP) and the Consortium of patients voiced their satisfaction believe are giving our patients Independent Physician Associa- when they obtained appoint- better healthcare. One of the tions (CIPA), one of the largest ments quicker and received fol- more positive effects of PCMH is physician organizations in Michi- low-up calls regarding their care.

2 Seeing our patients becoming gan. Gaining PCMH designation involved in their care, and know- Keep in mind that you may takes on many forms. According ing they have a healthcare team already belong to a physician to Cindy Baker RN, BSN, director, to help them stay healthy. Our organization (PO) and have ac- Healthcare Practices, at Marlette journey with PCMH has given us cess to these funds. In that case, Regional Hospital, working to- the opportunity to change our way you are all set and don't need to wards PCMH was a journey. of not just treating patients but do anything! The educational process actually providing a healthcare There are two steps to earning started with Marlette Regional relationship that encourages, additional funds. Joining the CIPA Hospital transforming its practic- assists, and promotes health to network allows practices to main- es by teaching staff members the all our patients.. tain independence, collaborate principles and guidelines of Ed Gamache, president and with local physicians, and partici- PCMH, said Baker.

3 There was CEO of Harbor Beach Community pate in the Blue Cross Blue an overwhelming response of Hospital, also felt the PCMH. Shield of Michigan (BCBSM) Phy- gratitude for spending the time to methodology made a huge differ- sician Group Incentive Program teach everyone and it showed ence. (PGIP). This is where the addi- that we valued each employee The PCMH process helped our tional payment begins. and wanted them to succeed. clinic staff clarify their team roles CIPA physicians work on a These individuals are the ones in providing care and they learned variety of initiatives to transform that will make it a success. how to use the tools provided by healthcare through PGIP. Physi- There's no magic to earning PCMH to outreach to patients, . cians may earn additional finan- this money. You merely require said Gamache. This allowed us cial incentives or rewards for personalized coaching from a their efforts while improving the CIPA consultant to change a few See BENEFITS, Page 3.

4 Quality of patient care. In the practice methods so you may past three years, CIPA has dis- coordinate patients' healthcare, HCAP Network Area tributed more than $10 million in track patients' conditions and incentives to physicians and ensure that they receive the care physician organizations partici- they need. The concept of PCMH. pating in PGIP. includes the Triple Aim to reduce Success Stories costs, improve quality and en- CIPA has helped approximate- hance patient experience. Ac- ly one-third of its physician prac- cording to recent claims data by tices earn not only BCBSM Pa- BCBSM, PCMH-designated physi- If you would like to tient-Centered Medical Home cians are succeeding in more learn more about (PCMH) designation, but also effectively managing patients'. HCAP receive significant additional care to keep them healthy and please contact reimbursement. For example, prevent complications. Lori Fr y at: physicians earn a 10 percent fee Debbie Ruggles, director of (989) 891-8820 uplift on E&M codes as a BCBSM Heath Care Services for McKen- or designated PCMH.

5 Zie Health Systems, is very Hills & Dales General Hospital pleased with her team's partici- nominated three practices for pation in CIPA and becoming P a g e 2. Remember to always As a reminder, Health Alliance Plan ties ushered in by healthcare reform. check member ID cards for (HAP) and ASR Health Benefits, offered HAP and ASR experienced solid the most current information! through the Health Care Alliance Pool membership growth and gained signifi- (HCAP) Network, expanded their long- cant market share in East Central Send ASR Claims To: standing strategic relationship in 2012 Michigan over the past year. ASR/Physician's Care Network to include an affiliation with majority- Together they enrolled more than P. O. Box 6392 interest ownership of ASR assumed by 10,000 new members in the region. On Grand Rapids, MI 49516-6392 HAP. January 1, 2014, ASR began adminis- Emdeon Payor ID 38265. That investment by HAP was great tering Covenant HealthCare's employ- (616) 957-1751 Providers news for the future growth and sustain- ee health plan benefits.

6 (800) 968-2449 Employee ability of both ASR and HAP. Over the past year, several new em- (616) 464-4458 Claims Fax Since the affiliation, they have in- ployer groups enrolled with Alliance creased resources to strengthen their Health and Life Insurance Company, a position in the marketplace in the are- subsidiary of HAP. as of: product development, finance, Some of the larger regional groups Send HAP Claims To: provider network management and include Hospice Advantage, M & R Cor- HAP Preferred/CuraNet sales and marketing. porate Services, Harbor Beach Commu- Box 02399 This enables HAP to better serve nity Hospital and Rowley Brothers. Detroit, MI 48202-2399 customers, grow membership and re- As of January 1, 2014, total HAP. Payor ID 38224 spond to the challenges and opportuni- membership is 679,550 members. (888) 354-5470 CuraNet (800) 422-4641 AHL/HAP. Send GWH Claims To: GWH-CIGNA Open Access Plus 1000 Great West Drive HAP is offering a free training ses- at the Horizons Conference Center, Kennett, MO 63857-3749.

7 Sion on ICD-10-CM coding on June 18. 6200 State Street in Saginaw. Payor ID 80705. Participants will hear the latest infor- The session is from 9 to 4 (866) 494-2111. mation on ICD-10-CM presented by with registration beginning at 8:30. one of HAP's American Health Infor- Continental breakfast and lunch Send HAP Alliance Health & mation Management Association will be provided. Life To: (AHIMA) certified ICD-10-CM trainers. CEU credits are available, pending HAP Alliance Health & Life Many of the changes between ICD-9- American Academy of Professional Box 02459 CM and ICD-10-CM, covering several Coders and AHIMA approval. Detroit, MI 48202-2459 specialty areas, will be discussed. The Participants must register to attend Payor ID 38224 presentation will also refer to some of and space is limited, so please register (888) 999-4347 HAP's policies to illustrate ICD-10-CM early. To register, contact HCAP Net- coding changes. work Manager Lori Fr y at (989) 891- The free training session will be held 8820 or Send Huron Medical Center & Huron Medical Center Network Provider Claims To: Meritain Health P.

8 O. Box 853921 Per the Internal Revenue Service into our system, which ultimately helps Richardson, TX 75085-3921 (IRS), we cannot process a W-9 with a with timely, accurate payments. EDI: Emdeon Payor ID 38232 form date prior to 2011. You can find the most up-to-date (800) 748-0003 Submitting the proper form will en- form on the IRS website at: sure that we are loading the correct demographic and billing information H C A P H i g h l i g h t s P a g e 3. New HAP Cards for 2014. Verifying member eligibility is crucial! HAP members re- ceived new ID cards with new 11-digit ID numbers last fall. There is a potential increase in your HAP patients due to new and existing employer New Cigna Card for 2014. groups offering HAP as well as new membership from the Health Insurance Market- place. According to your contract with HAP, you must verify eligi- bility of your HAP patients at HCAP Self-funded each visit prior to rendering New ASR/HAP Cards for 2014 Employer Groups: services.

9 Failure to obtain ADS US, Inc. verification may result in deni- Arenac Castings, Inc. al of claims payment, and you AWI Holdings dba Auto-Wares cannot balance-bill the mem- Axis Machining, Inc. ber. Beal City Public Schools You can easily verify mem- Benesys (formerly MRCC). ber eligibility via the following Blue Chip Machining methods: Blue Diamond Steel Casting Online at via the New ASR/Physicians Care Cards for 2014 Cigna Member Eligibility Appli- Cigna West Non-Qualified (SE). cation (MEA). Remember Covenant HealthCare to use your NPI or vendor Fanuc Robotics America, Inc. number to log in. Search Greatwide Logistics Services by last name if ID is not Hospice Advantage available. Huron Casting Call the Provider Auto- Huron Casting Corporate Ser- mated Service (PAS) line vices LLC. at (800) 801-1766 Huron Medical Center (24/7). Intl. Assoc. of Machinists Motor Did you know? City Welfare Fund Call the Provider Verifica- . HAP offers a secure app called HAP OnTheGo so you can access health JAC Products tion Line at (313) 664- information tools to help you make the best decisions for yourself and Kelly Services Inc.

10 8995, Monday through your family. M & R Corporate Services Friday, 8 to 4 Mahle Industries Pipefitters Local #639 Ins. Fund Roofers Local 149 Security Benefit Rowleys Wholesale to demonstrate the value we ing PCMH designated might be Medical Advantage Group, CI- Scheurer Hospital provide to our patients through beneficial for you. We will be PA's managing company, to join Sheet Metal Workers Local 80. increased preventive practices sending you more information in CIPA or if you have questions Star Truck Rentals, Inc. and improved management of the weeks to come. about PGIP or becoming a PCMH. Tri-Hospital Emergency Medical chronic diseases. Plus, watch this newsletter More Info on the Way for future articles on specialist Mark may be reached at: There are also over 250 fully Soon, CIPA will be hosting a uplifts to learn more about op- free webinar about the benefits portunities that are available to or at (734) 302-2119 insured groups. Thank you of PGIP and PCMH. You will physicians.