NMHC Provider Connection
Transcription
NMHC Provider Connection
NMHC Provider Connection A Newsletter for Contracted Providers of New Mexico Health Connections Volume 1, Issue 1 • Fall 2014 Please share this newsletter with all healthcare providers and administrative billing staff in your office. Important reminder: An insurance card is not always proof of member eligibility! We urge you to verify NMHC member eligibility at every visit. This will ensure that your RI´FHRUIDFLOLW\LVSURSHUO\UHLPEXUVHG7KH PRVWHI´FLHQWZD\WRFKHFN10+&PHPEHU HOLJLELOLW\LVYLDRXUSURYLGHUSRUWDO/RJLQRU register at www.mynmhc.org©FOLFNRQ Member & Provider Login :HOOEHKDSS\WRRIIHUSURYLGHUSRUWDOWUDLQLQJWR\RXDQGRU\RXUVWDII-XVWVHQGDQ email to provider.services@mynmhc.org ZLWK\RXUSUDFWLFHQDPHDQGDGGUHVVWD[ LGHQWL´FDWLRQQXPEHUDQGWHOHSKRQHQXPEHU<RXU3URYLGHU6HUYLFHV5HSUHVHQWDWLYH ZLOOFRQWDFW\RXWRVHWXSDWHOHSKRQHWUDLQLQJRUVLWHYLVLW NMHC makes it simpler for members to access behavioral healthcare :HUHFRJQL]HWKHLPSRUWDQFHRIEHKDYLRUDO KHDOWKFDUHLQDSHUVRQVRYHUDOOFDUH7RKHOS RXUPHPEHUVUHFHLYHWKHFDUHWKH\QHHGZH DUHUHGXFLQJEDUULHUVWREHKDYLRUDOKHDOWKFDUHWKDWPD\KDYHH[LVWHGLQWKHSDVW :HKDYHPDGHEHKDYLRUDOKHDOWKFDUHPRUH DIIRUGDEOHWRRXUPHPEHUVWKURXJKDYDULHW\ RILQQRYDWLRQV :HRIIHUPRVWRIRXUPHPEHUVD$0 copay for the first three outpatient behavioral health visitsWRKHOSWKHPJHWRYHU WKDWKXUGOHRIHVWDEOLVKLQJDUHODWLRQVKLS DQGIUDQNO\DFNQRZOHGJLQJWKDWXQIRUtunately, there remains in many of our FRPPXQLWLHVDVWLJPDDWWDFKHGWRVHHNLQJEHKDYLRUDOKHDOWKVHUYLFHV 0HPEHUVZKRGRQRW´OORUUH´OOWKHLU PHGLFDWLRQVDUHPRUHVXVFHSWLEOHWRWKH V\PSWRPVWKDWKDGWKHPVHHNFDUH,Q PDQ\FDVHV10+&UHPRYHVWKHPHPEHUVPHGLFDWLRQFRVWVDVDEDUULHUWR ,' REWDLQLQJWKRVHPHGLFDWLRQV)RUPRVW PHPEHUVWKHUHLVD$0 copay for generic depression and bipolar disorder medications:HYHDOVRHVWDEOLVKHGD SURFHVVWRFRQWDFWKLJKQHHGPHPEHUV ZKHQWKH\DUHODWHWRUH´OOWKHLUPHGLFDWLRQV :HKDYHsimplified our prior authorization (PA) process for behavioral health services2QO\DIHZVHUYLFHVUHTXLUH3$ LQFOXGLQJDSSOLHGEHKDYLRUDODQDO\VLV $%$SDUWLDODQGLQSDWLHQWKRVSLWDOL]DWLRQDQGHOHFWURFRQYXOVLYHWKHUDS\ (&70RVWRWKHURXWSDWLHQWEHKDYLRUDO KHDOWKVHUYLFHVGRQRWUHTXLUH3$ ,I\RXKDYHDQ\TXHVWLRQVDERXWEHKDYLRUDO KHDOWKDW1HZ0H[LFR+HDOWK&RQQHFWLRQV FRQWDFW0DW0F)DGGHQ3V\'6HQLRU 'LUHFWRURI%HKDYLRUDO+HDOWK0DQDJHPHQW at (505) 200-0414 Find what you need at www.mynmhc.org 2XUZHEVLWHFRQWDLQVDOORIWKHLQIRUPDWLRQ \RXQHHGWRZRUNZLWKRXUPHPEHUV©\RXU SDWLHQWV:KHWKHU\RXUHORRNLQJIRURXU IRUPXODU\RUSULRUDXWKRUL]DWLRQSURFHVV ZDQWWRXSGDWH\RXUSUDFWLFHVLQIRUPDWLRQ RUVRPHWKLQJHOVHHQWLUHO\\RXOO´QGLWRQOLQH Provider Handbook :HFUHDWHGWKH3URYLGHU+DQGERRNWRKHOS \RXGHOLYHUVHUYLFHVDQGFDUHWRRXUPHPEHUV7KHHQWLUHKDQGERRNLVSXEOLVKHG RQOLQHGLYLGHGLQWRVHFWLRQV)URPRXUKRPH SDJHJRWRFor ProvidersWKHQVHOHFW Provider Handbook<RX OO´QGLQIRUPDWLRQRQ • +RZWRFRQWDFW10+& – &XVWRPHUVHUYLFH – /DQJXDJHOLQHLQWHUSUHWHUVHUYLFHV – 1XUVHDGYLFHOLQH – 7''77<VHUYLFHV • 2XUTXDOLW\LPSURYHPHQWSURJUDP • &UHGHQWLDOLQJDQGUHFUHGHQWLDOLQJ • 3URYLGHUUROHVDQGUHVSRQVLELOLWLHV • 2XUPHGLFDOPDQDJHPHQWSURFHVVHV LQFOXGLQJXWLOL]DWLRQPDQDJHPHQWDQG SULRUDXWKRUL]DWLRQ • &DVHPDQDJHPHQWGLVHDVHPDQDJHPHQW • &OLQLFDOSUDFWLFHJXLGHOLQHV • &ODLPVVXEPLVVLRQDQGSD\PHQW • 0HPEHUrights and responsibilities • Affirmation statement • 6XEURJDWLRQ • • • )UDXGDQGDEXVH 3URYLGHUJULHYDQFHVDQGDSSHDOV 0HPEHUFRPSODLQWVDQGDSSHDOV ,I\RXKDYHTXHVWLRQVDERXWLQIRUPDWLRQRQ RXUZHEVLWHSOHDVHFRQWDFW\RXU3URYLGHU 5HODWLRQV6SHFLDOLVW6HHSDJH4IRUD3URYLGHU5HODWLRQVVWDIIGLUHFWRU\ Provider forms :HFRQWLQXRXVO\XSGDWHDQGDGGWRWKH IRUPVZHVWRUHRQOLQHIRURXUFRQWUDFWHG SURYLGHUV7KHFXUUHQWOLVWRIIRUPV\RXFDQ DFFHVVRQRXUZHEVLWHLQFOXGH • &ODLPV,QTXLU\)RUP • &ODLP5HDVVHVVPHQW$GMXVWPHQW5HTXHVW • &ODLPV5HIXQG)RUP • &RPSOH[&DVH0DQDJHPHQW • 'UXJ3ULRU$XWKRUL]DWLRQ5HTXHVW)RUP • ()7$XWKRUL]DWLRQ$JUHHPHQW • (PGHRQ(5$3URYLGHU6HWXS)RUP • ,QSDWLHQW1RWL´FDWLRQ)RUP • 10+&4XLFN5HIHUHQFH*XLGH • 3ULRU$XWKRUL]DWLRQ/LVW3URFHVV • 3ULRU$XWKRUL]DWLRQ5HTXHVW)RUP • 3URYLGHU&ODLP5HIXQG)RUP • 3URYLGHU3D\PHQW$SSHDO5HTXHVW • 3URYLGHU6HUYLFHV&RQWDFW/LVW • 3URYLGHU8SGDWH)RUP • 7UDQVLWLRQRI&DUH)RUP NMHC members can call the nurse advice line for medical guidance 10+&PHPEHUV© \RXUSDWLHQWV©FDQ FDOO1XUVH$GYLFH1HZ 0H[LFRDWDQ\WLPHRI WKHGD\RUQLJKWZKHQ WKH\KDYHTXHVWLRQV DQGFDQWJHWLQWRXFK ZLWKWKHLUSURYLGHUV ULJKWDZD\7KHKRWOLQHLVVWDIIHGE\H[SHULHQFHGUHJLVWHUHG QXUVHVZLWKLQ1HZ 0H[LFR7KHQXUVHV FDQKHOS\RXUSDWLHQWVNQRZZKDWQH[WVWHSV WRWDNHLQWKHFDVHRILOOQHVVRULQMXU\ 7KHWROOIUHHQXPEHULV1-877-725-2552 +HDULQJLPSDLUHGPHPEHUVVKRXOGFDOO 1-800-659-8331 or 7110XOWLOLQJXDOVHUYLFHV DUHDYDLODEOH 2 Communications options for our members :HLQIRUPRXUPHPEHUVRIWKHGLIIHUHQW ZD\VWKH\FDQFRPPXQLFDWHZLWKXV • 9LDHPDLOinfo@mynmhc.orgRUYLDDQ RQOLQHVHFXUHPHVVDJLQJSRUWDODW www.mynmhc.org/Contact_Us.aspx • 9LDSKRQHWROOIUHH1-855-7MY-NMHC (769-6642) • 2XU77<VHUYLFHOLQHLV1-800-855-2880 • ,IDPHPEHUVSULPDU\ language is something other than English, we KDYHWUDQVODWLRQDQG LQWHUSUHWDWLRQVHUYLFHV DYDLODEOHYLDRXUWROO IUHHFXVWRPHUVHUYLFHOLQH Formulary updates DQ\QHJDWLYHIRUPXODU\FKDQJHV6RPHWLPHV XSGDWHVWRWKHIRUPXODU\DUHPDGHEHWZHHQ TXDUWHUV:KHQWKLVRFFXUVZHSRVWDQRWH DERXWLQWHULPIRUPXODU\FKDQJHVRQRXU ZHEVLWHwww.mynmhc.org 7KH10+&IRUPXODU\LVFRQVLGHUHGFORVHG ZKLFKPHDQVWKDWVRPHGUXJVKDYHUHTXLUHPHQWVIRURQHRUPRUHRIWKHIROORZLQJ *HQHULFVXEVWLWXWLRQWKHUDSHXWLFLQWHUFKDQJHVWHSWKHUDS\SURWRFROTXDQWLW\OLPLWVRUSULRUDXWKRUL]DWLRQ$OLVWRIGUXJVZLWK 10+&FRQWUDFWVZLWK&DWDPDUDQ&75; TXDQWLW\OLPLWVLVSRVWHGRQWKHZHEVLWHDQG IRUSKDUPDF\EHQH´WVHUYLFHV7KH&75; GUXJVZLWKDTXDQWLW\OLPLWDUHGHVLJQDWHGLQ 1DWLRQDO3KDUPDF\DQG7KHUDSHXWLFV37 WKHIRUPXODU\ZLWKDª4/«$OLVWRIVSHFLDOW\ FRPPLWWHHPHHWVTXDUWHUO\WRUHYLHZDQG GUXJVLVDOVRSRVWHG'UXJVUHTXLULQJDSULRU DSSURYHIRUPXODU\FKDQJHV4XDUWHUO\IRUDXWKRUL]DWLRQDUHGHVLJQDWHGLQWKHIRUPXPXODU\XSGDWHVDUHSURYLGHGWR10+& ODU\ZLWKDª3$«$QH[SODQDWLRQRIKRZWR EDVHGRQWKH37FRPPLWWHHVDFWLRQV:H REWDLQDSULRUDXWKRUL]DWLRQLVLQFOXGHGLQWKH SRVWDQHZIRUPXODU\RQRXUZHEVLWHwww. FRQWHQWRQRXUZHEVLWH3URYLGHUVFDQFDOO mynmhc.orgRQWKH´UVWGD\RIHDFKFDOHQ&75;DW1-855-577-6550 for more informaGDUTXDUWHUIRUERWKPHPEHUVDQGSURYLGHUV WLRQRUWRUHTXHVWDSULRUDXWKRUL]DWLRQ :HQRWLI\LQGLYLGXDOPHPEHUVE\PDLODERXW Want to receive this newsletter electronically? Send us your email $W10+&ZHVWULYHWRXVHRXUUHVRXUFHV • 7KHQDPHVRIWKHDERYHSHUVRQV ZLVHO\DQGZHNQRZ\RXGRWRR,I\RXZRXOG • 7KHQDPHRI\RXUSUDFWLFH OLNHWRUHFHLYHIXWXUHLVVXHVRIWKLVQHZVOHWWHU YLDHPDLOSOHDVHVHQG\RXUFRQWDFWLQIRUPDWe will not share this information with anytion to michelle.mcruiz@mynmhc.org RQHRXWVLGHRIRXURI´FH ,Q\RXUHPDLOSOHDVHSURYLGH • 7KHHPDLODGGUHVVRIWKHRI´FHPDQDJHU ELOOLQJPDQDJHUDQGRURWKHUVSHFL´F VWDIIZKRVKRXOGUHFHLYHWKHQHZVOHWWHU 5HFHLYLQJNMHC Provider Connection not RQO\VDYHVSDSHULWDOVRDOORZV\RXWRTXLFNO\GLVWULEXWHRXUFRPPXQLFDWLRQVWRDQ\ SURYLGHUVRURI´FHVWDIIZKRQHHGLW 3 3UHVRUWHG6WDQGDUG 863RVWDJH 5(78516(59,&(5(48(67(' 3$,' $OEXTXHUTXH10 3HUPLW1R What you'll find in your first issue of NMHC Provider Connection, a newsletter for contracted providers of New Mexico Health Connections: • • • Verify member eligibility at every visit! Three ways NMHC improves access to behavioral healthcare Find the information you need at www.mynmhc.org • • • Resources for your NMHC patients: Nurse advice line, multiple communication options Updates to the NMHC formulary Sign up for e-delivery of this newsletter Welcome to the first issue of the NMHC provider newsletter! :HDUHSOHDVHGWRKDYH\RXLQRXUSURYLGHU QHWZRUN<RXDUHRXUSDUWQHUVLQDFKLHYLQJRXU SULPDU\JRDORILPSURYLQJRXUPHPEHUVKHDOWK :HDUHVHQGLQJ\RXNMHC Provider Connection WRNHHS\RXXSWRGDWHRQRXUPHGLFDOPDQDJHPHQWSURJUDPVDQGVHUYLFHVDQGWRKHOS\RX VHUYHRXUPHPEHUVEHWWHU ,I\RXKDYHDQLGHDIRUDQHZVOHWWHUWRSLFRU IHHGEDFNDERXWWKHQHZVOHWWHUSOHDVHHPDLOWKH HGLWRUmichelle.mcruiz@mynmhc.org NMHC Provider Relations staff directory Name Title Phone Fax 1RUPD5D\ 3URYLGHU5HODWLRQV 6SHFLDOLVW -HDQH)RZNHV 3URYLGHU5HODWLRQV 6SHFLDOLVW $P\5LGGOH &UHGHQWLDOLQJ 6SHFLDOLVW 'DYLG)ORUHV 6HQLRU&UHGHQWLDOLQJ 6SHFLDOLVW 'RQQD0DUWLQH] 0DQDJHU3URYLGHU 6HUYLFHV 3DXOD+RVNLQV 'LUHFWRU3URYLGHU 6HUYLFHV Email QRUPDUD\# P\QPKFRUJ MHDQHIRZNHV# P\QPKFRUJ DP\ULGGOH# P\QPKFRUJ GDYLGµRUHV# P\QPKFRUJ GRQQDPDUWLQH]# P\QPKFRUJ SDXODKRVNLQV# P\QPKFRUJ
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