Title: Indiana Care Select Overview
1Indiana Care Select Overview
Mitchell E. Daniels, Jr., Governor State of
Indiana Indiana Family and Social Services
Administration Anne W. Murphy, Secretary Pat
Casanova, Medicaid Director
2Todays Agenda
- Program Goals Overview
- Member Enrollment Process
- Primary Medical Provider (PMP) Overview
- Certification Code Policy
- Right Choices Program Referral Process
- Care Management Overview
- Member Support Services
- Care Coordination Conferences
- HEDIS
- On-line CM Portals
- Question Answer
3Program Goals
- To more effectively tailor benefits to its
members - To improve the quality of care and health
outcomes of its members - To control the growth of health care costs
- To provide a more holistic approach to members
health needs
4Program Overview
- Care Coordination
- Individualize services for its members
- Assist its members in gaining access to needed
medical, social, educational and other services - Disease Management
- Population-based
- Target specific diseases
- Utilization Management
- Appropriate use of facilities, services
and pharmacy
5Program Overview
- Care Select Care Management Organizations (CMOs)
- ADVANTAGE Health Solutions, Inc.sm
- MDwise, Inc.
- Care Select Members
- Members that are Aged, Blind or Disabled
- Wards of the Court and Foster Children
- Home Community-Based Waiver participants
- Members who receive Adoption Assistance
- M.E.D. Works participants
- Will NOT include members in institutional
settings, spend down, or dual-eligibles
(Medicare/Medicaid)
6Care Select Member Enrollment Process
Member letter sent
Does Member have a PMP?
Member enrolled in PMPs CMO
Member auto-assigned to CMO and PMP
Yes
Yes
No
No
Did member choose a PMP and CMO?
Enrollment Broker (MAXIMUS) begins to call
members to answer questions and help enroll
If Primary Medical Provider (PMP) is in both
plans, member will choose a plan or be
auto-assigned to a plan.
7The Primary Medical Provider (PMP)
- What is a PMP and why is having one so important?
- Linked to each Care Select member as the members
medical home - Connects primary and specialty health care
- Provides referrals to specialists via telephone
or in writing - Works with member and care manager to improve the
health of the member - Who can be a PMP?
- Primary care physicians
- i.e. family practice, general practice,
internist, pediatrician, and OB/GYN - Specialists
8The Primary Medical Provider (PMP)
- How does a PMP enroll?
- PMPs in Care Select may contract with one or both
CMOs. - Why are there two CMOs?
- IHCP wants to give both members and providers a
choice. - How does this affect a members choice between
CMOs? - The member is enrolled in the CMO with which his
or her PMP is contracted. - Members with no prior PMP linkage will receive a
letter and call from the enrollment broker to
assist in choosing a PMP. - Members can change PMPs by contacting their CMO
or Maximus. - Those who do not choose a PMP get auto-assigned
to one.
9Certification Code Policy
- The Care Select PMP is responsible for providing
and/or overseeing a members care during the time
the member is linked to that PMP through the PMP
assignment process. - The PMP agrees to provide the necessary primary
and preventive health services directly to their
assigned members or agrees to refer the member to
another health care provider for those services
undeliverable by the PMP. - Each Care Select PMP is assigned a cert code on a
quarterly basis. This code, in addition to the
PMPs National Provider Identifier (NPI) is
needed to allow a specialist or another
providers claims to be paid when appropriate
10Certification Code Policy
- Policy Description Statement
- While it is always preferable that the assigned
PMP authorize treatment and provide their NPI and
cert code, there may be occasions when this is
not possible. - Appropriate and designated CMO staff will need to
provide this information to another health care
provider in order to allow the Care Select member
access to appropriate and timely care - The following are specific circumstances in which
designated CMO staff may release to another
health care provider a members PMPs cert code
and NPI before or after a service has been
rendered as approved by the State
11Certification Code Policy
- Exceptions
- PMP change is still pending after a previously
auto-assigned member has selected a new PMP - Death of PMP
- PMP moves out of the region without proper
notification to the program - Newly transitioned members into the program (i.e.
wards and foster children) who are in need of
treatment (i.e. EPSDT) within the first sixty
(60) days of enrollment - Auto-assigned member lives in an underserved area
and is unable to select a PMP from that area - Other urgent, emergent, or ongoing issues (i.e.
dialysis or emergent ER admission) where the
member is unable to access necessary services and
the assigned PMP is unwilling or unable to
provide services or the appropriate referral
12Right Choices Referral Processformerly known as
Restricted Card Program
- ADVANTAGE Health Solutions identifies and
monitors individuals in both ADVANTAGE Care
Select and the Traditional or fee-for-service
Medicaid Program - MDwise Care Select identifies and monitors
individuals in the MDwise Care Select Program - This includes members who have shown a pattern of
potential mis - utilization or over - utilization
of services - The RCP is
- Not a loss of benefits
- Not a reduction in benefits
- Not punitive action, but is a legal action
- Note Members are still eligible for all
medically necessary IHCP services. However, those
services must be ordered or authorized in writing
by the members assigned PMP
13Right Choices Referral Process
- The RCP identifies members appropriate for
assignment and subsequent lock-in to - one Primary Care Physician (PCP)
- one pharmacy and
- one hospital
- The RCP Program applies to both members in
Traditional Medicaid and Indiana Care Select - Specialty providers receive written authorization
from the PMP - The CMOs add those specialists to the members
provider list in order for the specialty provider
to be reimbursed
14Right Choices Referral Process
- The PMP manages the members care and determines
whether a member requires evaluation or treatment
by a specialty provider - Referrals are required by the PMP for most
specialty medical providers (except self referral
services) - Referrals should be based on medical necessity
and not solely on the desire of the member to see
a specialist - Emergency services for life threatening or life
altering conditions are available at any
hospital, but non-emergency services require a
referral from the PMP
15Right Choices Referral Process
- Adding Providers to a Right Choices Members Lock
In List - Additional providers may be locked-in, either
short-term or on an ongoing basis, if the PMP
sends a written referral. - Providers may be locked-in for one specified date
of service or for any defined duration of time,
up to one year.
16Right Choices Referral Process
- When a Referral is Not Necessary Self Referral
- Behavioral health (except prescriptions)
- Chiropractic services
- Dental services (except prescriptions)
- Diabetes self-management services
- Family planning services
- HIV/AIDS targeted case management
- Home health care
- Hospice
- Podiatric services (except prescriptions)
- Transportation
- Vision care (except surgery)
- Waiver services
17Right Choices Referral Process
- Referral Guidelines for the PMP
- Referrals must be faxed or mailed
- Referrals may be handwritten on letterhead or a
prescription pad, however, they must include the
following information - IHCP members name
- IHCP members RID
- First and last name and specialty of the
physician to whom the member is being referred - Primary lock-in physicians signature (not that
of a staff member) - Date and duration of referral
18Right Choices Referral Process CMO Right
Choices Contact Information
- ADVANTAGE
- ADVANTAGE Health Solutions Traditional FFS
- Attn Right Choices Program
- P.O. Box 40789
- Indianapolis, IN 46240
- 1-800-784-3981
- Fax 1-800-689-2759
- ADVANTAGE Health Solutions - Care Select
- Attn Right Choices Program
- P.O. Box 40789
- Indianapolis, IN 46240
- 1-800-784-3981
- Fax 1-800-689-2759
- MDwise
- MDwise Care Select
- Attn Care Management
- P.O. Box 44214
- Indianapolis, Indiana 46244-0214
- Phone 1-866-440-2449 or
- 317-829-8189 Option 1
- Fax 1-877-822-7187 or
- 317-822-7517
19Care Management Overview
- PHILOSOPHY
- Member-centered care management focus
- Strong partnerships with community providers to
coordinate behavioral, developmental and medical
services - Utilize assessments and risk stratification tools
to determine needs at the member/provider level - Excel in communication with members, their
families and their caregivers
20Care Management Overview
21Step 1 Assess Member Needs
- Identify high risk members through medical claims
history/risk stratification - Identify and reach out to members family or
facility case manager - Share existing assessments/care plans to avoid
duplicative assessment questions or interventions - Conduct initial interview with member or
caregiver - Assign care management Level 1-4
- Identify the need for more comprehensive medical,
behavioral, psychosocial, and/or functional
assessments - Identify immediate needs and implement immediate
interventions if needed - Members are reassessed and care plans updated as
needed (at least annually)
22Stratification
- Once the assessments are complete, the member is
stratified into one of four need groups - Level one minimum provided to all Care Select
members - Level two all level one services plus more
support/guidance - Level three all level one and two services plus
high level support as determined by risk issues
related to health - Level four all level one, two and three
services plus support related to require most
services and often face crisis situations - Note all Care Select members who are pregnant or
are seriously mentally ill are automatically
placed into Level two and members can be
re-stratified at anytime depending on condition
and need
23Step 2 Design Care Plan
- Involve member, caregivers and providers in
developing the members Care Select Care Plan - Establishing care plan goals that are
evidence-based and outcome-oriented - Taking responsibility for achieving care plan
goals - Integrate goals/interventions across a members
- other care plans
- Primary Care
- Family Teaming
- Medicaid waiver program
- Individualized Education Plan (IEP)
- CMHC/behavioral health treatment plan
- Prioritize goals/interventions recognizing the
members priorities
24Step 3 Coordinate Care
- Share individualized care plan with
- Member/Caregiver
- PMP
- Waiver/CMHC Case Managers
- Involve members, caregivers, Care Managers,
- Care Partners, Care Advocates, Family Case
Managers, and providers in active dialogue about
barriers, goals and progress - Web-based care plans
- Care conferences
- Ongoing dialogue
- Facilitate communication with health care
providers, i.e. physicians, community
organizations, waiver programs, school-based
services, and the Division of Child Services
25Step 3 Coordinate Care (cont.)
- Connect member/caregiver with needed services
- Advocate for member by
- Removing barriers to care
- Providing education about conditions, access to
care, member rights and responsibilities - Facilitate member/caregiver independence through
teaching and reinforcing self-management skills - Utilize the members comprehensive assessment and
care plan to provide context and support for PA
requests
26Step 4 Measure Results
- Member level outcomes
- Achievement of care plan goals
- Annual health needs assessment
- Program level outcomes
- Member and provider satisfaction
- Evidence-based practice
- Improvement in quality of life metrics
- Reduction in inpatient/ER admissions
- Complaints, grievances/appeals
27Member Support Services
- The CMO care management teams are engaged in the
provider community in order to create a well
rounded approach to providing member support,
care plan development and improved treatment
outcomes. The CMOs currently partner with several
providers to achieve these goals - Community Mental Health Centers (CMHCs)
incorporate behavioral health treatment plans
into the members overall plan or care AND assist
the CMHC in accessing physical health services
(i.e. primary care and dental services) for their
Care Select population - Developmentally Disabled (DD) Waiver Providers
incorporate the members plan of care developed
by the Waiver case manager as well as non DD
Waiver provider training materials to educate
PMPs on best practices for working with the DD
population AND assist the DD Waiver provider in
accessing physical health services (i.e. primary
care, dental, and behavioral) for their Care
Select population
28Member Support Services
- Hospitals obtaining notification from hospitals
that they are about to discharge a Care Select
member allows the care manager to work to ensure
the member has access to needed post inpatient
services that reduce the chance of another
inpatient admit - Dental informing our members on the importance
of getting dental care and reminding those, by
mail, if they have not seen the dentist within
the calendar year - Social Services supporting members with social
crisis (i.e. eviction, utilities disconnection)
and connecting pregnant members with pregnancy
related services (i.e. WIC, parenting classes,
etc..)
29Care Coordination Conferences
- The CMOs will coordinate with its Care Select
PMPs to perform care coordination conferences to
review a members plan of care and the progress
with that plan of care. - Care Coordination Conference
- is a covered benefit for Indiana Care Select
Program members assigned PMP - can occur up to twice per member per rolling
calendar year - will be scheduled on a semi annual basis
- can be held in person at the PMPs office or via
phone conference - is a billable service (not applicable to FQHC/RHC
providers)
30Care Coordination Conference
- Care Coordination Conference Purpose
- open communication and coordination between all
healthcare providers - to provide a forum for PMPs to interact directly
with our care management teams - discuss the care plans of your patients and
collaboratively decide how we can effectively
facilitate the management of your patients -
- We realize that our members often require
complex medical care from a variety of sources,
which often extend beyond the confines of your
office. Our goal in care management is to
coordinate the efforts of the healthcare team
with other participating government, social and
community agencies working together on behalf of
the patient. Indiana Care Select Program CMO
Care Management Departments
31Care Coordination Conference
- How to Schedule/Plan for the Care Coordination
Conference - ADVANTAGE Care Select Program
- Will notify each contracted PMP by mail, when it
is time to schedule the conference - Mailing will include How to schedule and
complete your Biannual Case Conference form
where the PMP will - Select date and time
- Review a panel listing of your members
- Identify additional concerns
- Note any additional information
- Fax, Email, or direct mail the panel back to
ADVANTAGE prior to scheduled date of conference - each conference will last no longer than 60
minutes and can be conducted via phone or an on
site visit by request (pending availability)
32Care Coordination Conference
- How to Schedule/Plan for the Care Coordination
Conference - MDwise Care Select Program
- Will notify each MDwise PMP by mail or phone,
when it is time to schedule the conference - Mailing will include a member checklist form and
members care plan where the PMP will (Please
note Providers can sign up for CareConnect and
access each members plan of care there rather
than receiving a mailed care plan) - Review the members care plan
- Identify additional concerns on the checklist
- Note any additional information on the checklist
- Fax, Email, or direct mail the member checklist
form back to MDwise prior to scheduled date of
conference - Each conference will last no longer than 60
minutes and can be conducted via phone or an on
site visit by request (pending availability)
33Care Coordination Conference
- How to Bill for Care Coordination Conferences
- PMPs, or their designated nurse practitioner (NP)
or physician assistant (PA) who works for the PMP
or PMPs employer such as a group or clinic are
eligible to receive reimbursement from Indiana
Health Coverage Programs (IHCP) for their
participation in the care coordination
conferences - Both the CMO and the PMP will be responsible for
checking eligibility on the date of the care
coordination conference - Submit claims for members discussed during the
care coordination conferences to EDS as with all
other covered Care Select services
34Care Coordination Conference
- How to Bill for Care Coordination Conferences
(continued) - No prior authorization is required for care
coordination conferences - Care coordination conferences are carved out of
the Third Party Liability requirements for Care
Select so providers do not need to submit claims
for these services to the members private
insurance company prior to submitting them to EDS
for reimbursement - Submit claims on a CMS 1500 claim form using
the CMS 1500 paper claim format found in
Chapter 8, Section 4 of the IHCP Provider Manual.
Providers may also submit these claims
electronically using their proprietary software
or using EDSs web interChange
35Care Coordination Conference
- How to Bill for Care Coordination Conferences
(continued) - The primary diagnosis providers should use when
billing for care coordination conferences is
either the members last known diagnosis related
to the members disease state or V70.9 - All PMPs, or NPs must be linked to the billing
group - The CMO and provider will identify via the CMOs
bi-annual Care Coordination Conference Checklist,
potential members to be reviewed and discussed
during the conference. If neither the PMP nor the
CMO have issues resulting in a discussion of the
members plan of care, the provider cannot bill
for a care coordination conference for that member
36Care Coordination Conference
- How to Bill for Care Coordination Conferences
(continued) - The Bi-annual Care Conferences Checklist verifies
the PMPs review regarding the plan of care.
Providers are required to keep a copy of the
Bi-annual Care Conferences Checklist for auditing
and documentation purposes - PMPs are limited to billing up to two care
coordination conferences per member per rolling
calendar year - The service code to be used to identify billing
for care coordination conferences for each Care
Select member is 99211 SC Office or other
outpatient visit for the evaluation and
management of an established patient. Note
Please refer to both IHCP Bulletins BT200723
BT200804 for further details
37Care Coordination Conference
- How to Bill for Care Coordination Conferences
(cont.) - If the PMPs NP is in the same group or clinic as
the PMP who performs the care coordination
conference with the members CMO care manager,
the NPs IHCP provider number is appended to
99211 SC. If the NP is not enrolled in the IHCP,
providers must append modifier SA - Services for NPs not linked to the PMPs clinic
or group will be denied because that practitioner
does not participate in the same group or clinic
as the members PMP and it will be assumed that
those practitioners have no practical experience
with that member and are not in a position to
discuss that members plan of care
38Care Coordination Conference
- How to Bill for Care Coordination Conferences
(cont.) - PAs cannot enroll in the IHCP, but can
participate in the care coordination conference
and be reimbursed. The care coordination service
code 99211 SC must be billed along modifier HN or
HO (use the modifier that corresponds to the PAs
education level) - The PMP or the PMPs NP or PA will be reimbursed
by the IHCP at a rate of 40 per member per
conference. PMPs, or their NP/PA who refuse to
participate or do not attend a scheduled care
coordination conference cannot bill the IHCP for
that conference
39Healthcare Effectiveness Data and Information Set
(HEDIS)
- The Healthcare Effectiveness Data and Information
Set (HEDIS) is a widely used set of performance
measures in the managed care industry, developed
and maintained by the National Committee for
Quality Assurance (NCQA). - Set of standardized performance measures based on
evidenced-based best practice - HEDIS was designed to allow consumers to compare
health plan performance to other plans and to
national or regional benchmarks. - The Indiana Care Select CMOs both use HEDIS or
HEDIS-like measures to assess the quality
outcomes for Indiana Care Select members.
40HEDIS Performance Metrics
- Acute Inpatient Mental Illness 7 Day Follow-up
(ages 6) - Planned Activity
- Increasing the Rate of Follow-Up after
Hospitalization for Mental Illness - Scope and Population
- Members 6 years of age and older as of the date
of discharge. - Discharged alive from an acute inpatient setting
with a principal mental health diagnosis. - Eligible population is based on discharges (not
members). - Includes all discharges for members who have more
than one discharge on or between Jan 1 and Dec 31
of measurement year.
41HEDIS Performance Metrics
- Acute Inpatient Mental Illness 7 Day Follow-up
(ages 6) - RATIONALE
- Over 40 of our Indiana Care Select members have
a Behavioral Health Diagnosis. Selecting this
particular HEDIS measure allows us to improve the
health and continuity of care for a large portion
of our population. - Monitoring and positively affecting this HEDIS
measurement allows us the opportunity to
potentially decrease high cost services by
replacing them with community interventions.
42HEDIS Performance Metrics
- Care Select Initiatives to Increase the Rate of
Follow-Up after Hospitalization for Mental
Illness - Our Care Management staff has been trained and
has implemented new daily communication program
between the Prior Authorization department and
the Care Management Department to identify
members who fit criteria. - Coordinating with providers and members to ensure
that follow up care is being provided in a timely
fashion. - Working in collaboration with the Office of
Medicaid Policy and Planning and all of the
Indiana Health Coverage Programs to increase the
performance for this HEDIS metric.
43HEDIS Performance Metrics
- Adolescent Well-Care Visit (ages 12-21)
- Planned Activity
- Increasing the Rate of Adolescent Well-Care
Visits - Scope and Population
- Members 12-21 who had at least one comprehensive
well-care visit with a PMP or OB/GYN practitioner
during the measurement year and have been
continuously enrolled with no more than a 45 day
gap in coverage.
44HEDIS Performance Metrics
- Adolescent Well-Care Visit (ages 12-21)
- Rationale
- The Indiana Care Select Program has received a
large influx of members in this age group due to
assignment of Ward and Foster children. - Establish a medical home-trust, coordination of
care, outreach - Evaluate physical health, emotional health,
growth and development - Allow for early diagnosis and treatment of
chronic conditions, diseases - Identify and provide guidance about risky
behaviors
45HEDIS Performance Metrics
- Care Select Initiatives to Increase Rate of
- Adolescent Well Child Exams
- Member Incentive to schedule and complete their
Well Child exam - Provider Incentive to ensure all assigned members
are receiving their Well Child exam - Initiative to increase transportation access to
ensure all members are able to get their
appointments
46HEDIS Performance Metrics
- Breast Cancer Screening (ages 40-69)
- Planned Activity
- Increase rate of Breast Cancer Screenings
- Scope and Population
- Women ages 40 69 years of age who have had a
mammogram to screen for breast cancer and
continuously enrolled with no more than a 45 day
gap in coverage
47HEDIS Performance Metrics
- Breast Cancer Screening (ages 52-69)
- Rationale
- Early diagnosis of breast cancer allows for less
invasive treatment and is associated with better
outcomes. - Breast Cancer Screenings have shown to reduce
breast cancer mortality rates. - One in 8 women in the US will be diagnosed with
breast cancer in their lifetime. - In an effort to improve the overall health of our
Indiana Care Select members, we will target this
preventative care measure to improve timely
intervention in order to enhance treatment
options.
48HEDIS Performance Metrics
- Care Select Initiatives to Increase rate of
Breast Cancer Screenings - Member Incentive to schedule and complete their
Breast Cancer Screening - Provider Incentive to ensure their assigned
members are completing their Breast Cancer
Screenings - Educational mailings on the importance of womens
preventative health - Just-in-time education and assistance with
appointments (during health screening and
assessment, mailings, inbound calls for other
reasons).
49HEDIS Performance Metrics
- Cervical Cancer Screening (ages 21-64)
- Planned Activity
- Increase rate of Cervical Cancer Screenings
- Scope and Population
- Women ages 21-64 continuously enrolled with no
more than a 45 day gap in coverage who received
one or more Pap tests to screen for cervical
cancer.
50HEDIS Performance Metrics
- Cervical Cancer Screening (ages 21-64)
- Rationale
- Early diagnosis of cervical cancer allows for
highly effective treatment and cure. - Easiest form of female cancer to prevent with
regular screening tests and follow-up - Control Studies have found that the risk of
developing invasive cervical cancer is three to
ten times greater in women who have not been
screened - Screenings can detect early changes in the body
that may lead to cervical cancer
51HEDIS Performance Metrics
- Care Select Initiatives to Increase rate of
Cervical Cancer Screenings - Member Incentive to schedule and complete their
Cervical Cancer Screening - Provider Incentive to ensure their assigned
members are completing their Cervical Cancer
Screenings - Educational mailings on the importance of womens
preventative health - Just-in-time education and assistance with
appointments (during health screening and
assessment, mailings, inbound calls for other
reasons).
52HEDIS Performance Metrics
- Comprehensive Diabetes Care, Hemoglobin A1c
(HBA1c) test (ages 18-75) LDL-C Screening (ages
18-75) - Planned Activity
- Increasing the Rate of HBA1c Testing LDL-C
Screening for Diabetics - Scope and Population
- Members 18-75 with diabetes (type 1 and type 2)
who had an HbA1C test. - Members 18-75 with diabetes (type 1 and type 2)
who had an LDL-C Screening.
53HEDIS Performance Metrics
- Rationale
- Hemaglobin A1C
- Hemoglobin A1C is a measure of blood sugar
control over time - Management of blood sugar levels is key to
preventing short and long term complications from
diabetes - LDL-C
- Management of cholesterol levels is a major
component for preventing cardiovascular
complications from diabetes - LDL-C is bad cholesterol and is usually
measured as part of a panel of lipid tests - Regular testing provides the member and the
members doctor with important information to
guide and measure the effectiveness of treatment
54HEDIS Performance Metrics
- Care Select Initiatives to Increase A1C and LDL-C
Testing for Members with Diabetes - Disease Management (DM) program provides
- Disease and treatment education
- Support for achieving self-management goals
- Reminders for regular testing
- Coordination with PMP, schools
- Member Incentives
- Active participation in their Diabetes DM program
- Completing their A1C and LDL-C tests
- PMP Incentives
- Active participation in their members DM program
- Ensuring their assigned members receive testing
55HEDIS Performance Metrics
- Annual Dental Visit (ages 3-64)
- Planned Activity
- Increase rate of Dental Exams
- Scope and Population
- Members ages 3-64 who have had at least one
dental visit within a calendar year.
56HEDIS Performance Metrics
- Annual Dental Visit (ages 3-64)
- Rationale
- Dental care is one of the most prevalent unmet
health needs in America today. - Dental health is highly correlated with many
other health concerns - Loss of teeth
- Abscesses that shed bacteria in bloodstream
- Ulcers
- Malnutrition
57HEDIS Performance Metrics
- Care Select Initiatives to Increase rate of
Dental Exams - Member Incentive to schedule and complete their
annual dental exams - Initiative to increase transportation access to
ensure all members are able to get to their
appointments - Just-in-time education and assistance with
appointments (during health screening and
assessment, mailings, inbound calls for other
reasons).
58Online CM Provider Portals
- ADVANTAGE Care Select - Flexport
- What is Flexport?
- Flexport is a (PMP) Primary Medical Providers
connection to comprehensive medical utilization
information about ADVANTAGE Care Select members. - It is a secure web-based portal supplying the
designated PMPs access to important and timely
member utilization data. (Examples emergency
room visits, PMP visits, Specialist visits, and
medications filled) - Flexport is an efficient tool to view a members
comprehensive medical profile and provide input,
on the Case Plan, to the Case Manager
59Online CM Provider Portals
- ADVANTAGE Care Select Flexport (cont.)
- Why use Flexport?
- Flexports comprehensive medical utilization
information provides a complete picture of a Care
Select patients health status. This reinforces
the benefit of having a medical home for
ADVANTAGE Care Select members - You and your staff will be able to save time by
- ? Having the care plan in one location
- ? Being able to view services the member is using
- ? Providing feedback for patient care plans
directly and securely
60Online CM Provider Portals
- ADVANTAGE Care Select Flexport (cont.)
- What Type of Information Is In Flexport?
- The Flexport member profile displays your
ADVANTAGE Care Select patients use of services,
prescriptions, and providers including - ? Care Plans for each issue or condition
- ? Number of visits to PMP
- ? Number of visits to Specialists
- ? Primary and secondary diagnoses
- ? Inpatient admissions
- ? Emergency room utilization
- ? Durable medical equipment history
- ? Pharmaceutical history by drug classification
61Online CM Provider Portals
- ADVANTAGE Care Select Flexport (cont.)
- What Flexport Is Not?
- Flexport is not a replacement for Indiana Care
Select panel rosters. Refer to the roster sent to
you twice monthly from EDS - Flexport is not used to determine eligibility.
Please continue to check eligibility of Care
Select patients through Indiana Health Coverage
Programs eligibility resources
62Online CM Provider Portals
- ADVANTAGE Care Select Flexport (cont.)
- Enrollment Steps
- 1. Obtain a Web Portal Agreement
- visit the Provider page at www.advantageplan.com/
advcareselect - OR
- get the Agreement from your ADVANTAGE Care Select
Provider Relations Representative - 2. Complete and sign the Web Portal Agreement.
- 3. Fax or Mail the agreement to
- 317-587-8411 or
- ADVANTAGE Care Select Attn Provider Relations
- 9045 River Road, Suite 200
- Indianapolis, IN 46240
- 4. When the agreement is received you will be
sent a confirmation letter with your user name
and password - User Name and Password cannot be changed. They
are preset by the system
63Online CM Provider Portals
- MDwise Care Select CareConnectNX (CCNX)
- What is CCNX?
- CCNX provides access for MDwise Primary Medical
Providers (PMP) to their assigned members Care
Plan and medical utilization information. It is a
secure web-based portal supplying the designated
PMPs access to important and timely member
utilization data (Examples emergency room
visits, PMP visits, Specialist visits, and
medications filled) - CCNX is an efficient tool to view a members
comprehensive medical profile, provide input on
the Care Plan to the Case Manager either during
the care coordination conference or at any point - You and your staff will be able to save time by
- ? Having the care plan in one location
- ? Being able to view services the member is using
- ? Providing feedback for patient care plans
directly and securely
64Online CM Provider Portals
- MDwise Care Select CareConnectNX (CCNX)
- What Type of Information Is In CCNX?
- The CCNX member profile displays your MDwise
Care Select patients use of services,
prescriptions, and providers including - ? Care plans
- ? Case notes and progress notes
- ? Initial and full assessments
- ? Primary and secondary diagnoses
- ? Inpatient admissions
- ? Emergency room utilization
- ? Pharmaceutical history
- Note PMPs will eventually be able to add
information to the members profile
65Online CM Provider Portals
- MDwise Care Select CareConnectNX (CCNX)
- Enrollment Steps
- 1. Obtain a Web Portal Agreement
- visit the Provider page at www.mdwise.org
- 2. Complete and sign the Web Portal Agreement
- 3. Fax or Mail the agreement to
- 1-877-822-7188 or 317-822-7519
- MDwise Care Select
- Attn Jeff Leathers
- 1099 N. Meridian St., Suite 320
- Indianapolis, Indiana 46204
- When the agreement is received you will be sent a
confirmation e-mail with your user name and
password - CCNX is not an eligibility verification or panel
roster maintenance tool
66Question Answer
- Presentation by ADVANTAGE Health Solutions, Inc.
and MDwise, Inc. Provider Relations Team in
cooperation with each organizations Care
Management Department - Janet Edwards SeniorManager Care Management,
MDwise Care Select - Kristin Atkinson Care Management Manager,
ADVANTAGE Care Select - Kelvin Orr Director of Network Development
ADVANTAGE Care Select - Chris Kern Provider Relations Manager MDwise
Care Select - ADVANTAGE Traditional Medicaid
- P.O. Box 40789
- Indianapolis, IN 46240
- ADVANTAGE Care Select
- P.O. Box 80068
- Indianapolis, IN 46280
- MDwise Care Select
- P.O. Box 44214
- Indianapolis, IN 46244