For more information

Call our Provider Service Centerat 877-842-3210

Visit www.UHCCommunityPlan.com

Articles ofImportance to Read:

Clinical Resources• Blood Level Screenings . . . . . . . . . . . 1• Quality Improvement Program . . . . . 2

Take Action• EPSDT Screens Must Include theFollowing . . . . . . . . . . . . . . . . . . . . . . 2

Take Note• Aging and Alcohol Abuse . . . . . . . . . 3• Bright Futures™ — Our NewStandard for Well-Child Care . . . . . . 4

• Childhood Nutrition and WeightManagement Services Reminder . . . . 5

• Cultural Needs . . . . . . . . . . . . . . . . . . 6• Erie County Diabetes Associationand Community Health Net . . . . . . . 6

• Improving Member Complianceand Access to Care. . . . . . . . . . . . . . . 7

• One Face, One Name. . . . . . . . . . . . . 7

Pharmacy• Pharmacy Updates . . . . . . . . . . . . . . . 8• UnitedHealthcare Community PlanPreferred Drug List Updates . . . . . . . 8

Important information from UnitedHealthcare for physicians and other health careprofessionals and facilities serving UnitedHealthcare Medicaid members

Clinical Resources

Blood Level Screenings

According to the Centers for DiseaseControl and Prevention (CDC), childrenaged one to five years enrolled in Medicaidare at increased risk for having elevatedblood lead levels (BLLs). The NationalHealth and Nutrition Examination Survey(NHANES), Medicaid enrollees accountedfor 83 percent of U.S. children aged one tofive years who had Blood Lead Levels greater or equal to 20 µg/dL.Despite long standing requirements for blood lead screening in theMedicaid program, an estimated 81 percent of young childrenenrolled in Medicaid had not been screened with a blood lead testand therefore do not receive appropriate treatment.UnitedHealthcare Community Plan wants you to know:

• ALLMedicaid eligible children are considered at risk for leadtoxicity and MUST receive blood lead level screening tests for leadpoisoning

• It is recommended that Primary Care Physicians (regardless ofresponses to the lead screening questions) ensure that childrenreceive a blood lead level screening test beginning at nine monthsand again before their second birthday

• Risk questions should be asked at every visit thereafter

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• Our plan has contracted with both KirbyMemorial Health Center and MEDTOXLaboratories, to provide our contractedPrimary Care Physicians with supplies in orderto conduct convenient in-office blood leadlevel screenings, via finger sticks, as well as themailing supplies to return the samples back toeither Kirby Memorial Health Center orMEDTOX for testing and processing. PrimaryCare Providers can register for these servicesby directly contacting Kirby Memorial HealthCenter at 888-841-6699 or MEDTOX at800-FOR-LEAD. Contact your PhysicianAdvocate or Hospital and Facility Advocate toarrange for Kirby Memorial Health Center orMEDTOX in-service in your office.

Quality Improvement Program

UnitedHealthcare Community Plan’s QualityImprovement Program works to give ourmembers better care and services.

Each year UnitedHealthcare Community Planreports how well they are providing health careservices. Many of the things we report on aremajor public health issues. In 2010 we improvedthe number of screenings our members had forcervical cancer and appropriate treatment ofchildren with upper respiratory infections. For2011 we are trying to improve childhoodimmunization rates, well baby visits, breast andcervical cancer screenings, prenatal andpostpartum visits, and asthma and diabetictreatment.

We also conduct member surveys so we can seehow well we are meeting our member’s needs.Our 2010 surveys showed that most of ourmembers rate the health care that they receiveabove national averages. We are listening to ourmembers and in 2011 are working to improveour customer service center.

If you would like to know more about ourQuality Improvement Program and our progresstowards meeting goals please call 800-600-9007.

Take Action

EPSDT Screens Must Include theFollowing

• Screening services, including a comprehensivehealth and developmental history, an unclothedphysical, assessment of mental development,nutritional assessment, and all appropriateimmunizations according to age and healthhistory

• Laboratory tests, including hemoglobin andhematocrit, urinalysis, iron levels, TB skintesting, sickle cell anemia screening and bloodlead level testing

• Health education including anticipatoryguidance

• Dental screenings are a component of theEarly Periodic Screening, Diagnosis, andTreatment (EPSDT) screening and a coveredbenefit. Referral to dentist home is requiredannually for all children aged 3 years and olderas part of a complete EPSDT screen)

• Autism Screening

• Developmental Screening

• Mental health services, including counseling.Referral to behavioral health or medicalproviders to correct or ameliorate any problemsdiscovered upon the screen, including thosenot covered on the Medical Assistance fee for-service program

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Take Note

Aging and Alcohol Abuse

Anyone at any age can have a drinking problem.The fact is that families, friends, and health careprofessionals often overlook their concerns aboutolder people's drinking. Sometimes trouble withalcohol in older people is mistaken for otherconditions that may occur as people age. Butalcohol use deserves special attention and shouldbe assessed during general medical examinations.Because the aging process affects how the bodyhandles alcohol, the same amount of alcohol canhave a greater effect as a person grows older.Over time, someone whose drinking habitshaven't changed may find she or he has aproblem. Patient education about aging andalcohol is important. Below are a few key pointsthat you can share with your patients whenindicated.

Facts about Alcohol and Aging• Some research has shown that as people age

they become more sensitive to alcohol's effects.In other words, the same amount of alcoholcan have a greater effect on an older personthan on someone who is younger.

• Some medical conditions, such as high bloodpressure, ulcers, and diabetes, can worsen withalcohol use.

• Many medicines—prescription, over-the-counter, or herbalremedies—can be dangerousor even deadly when mixedwith alcohol. This is a specialworry for older peoplebecause the average personover age 65 takes at least twomedicines a day and mayhave more than oneprescribing physician.

Patients taking any medications should beencouraged to talk with you or theirpharmacist about any risk associated withdrinking alcohol. The following examples mayhelp illustrate that risks include over-the-counter medication:

– Aspirin can cause bleeding in the stomachand intestines; the risk of bleeding is higherif you take aspirin while drinking alcohol.

– Cold and allergy medicines (antihistamines)often make people sleepy; when combinedwith alcohol this drowsiness can be worse.

– Alcohol used with large doses of the painmedicine acetaminophen can raise the risk ofliver damage.

– Some medicines, such as cough syrups andlaxatives, have high alcohol content.

Effects of AlcoholEven drinking a small amount of alcohol canimpair judgment, coordination, and reactiontime. It can increase the risk of work andhousehold accidents, including falls and hipfractures. It also adds to the risk of car accidents.

Heavy drinking over time also can cause certaincancers, liver cirrhosis, immune system disorders,and brain damage. Alcohol can make somemedical concerns hard for doctors to find and

treat. For example, alcohol causeschanges in the heart and bloodvessels. These changes can dullpain that might be a warningsign of a heart attack. Drinkingalso can make older peopleforgetful and confused. Thesesymptoms could be mistaken forsigns of Alzheimer's disease. Forpeople with diabetes, drinkingaffects blood sugar levels.

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People who abuse alcohol also may be puttingthemselves at risk for serious conflicts withfamily, friends, and coworkers. The more heavilythey drink, the greater the chance for trouble athome, at work, with friends, and even withstrangers.

How to Know if Someone Has a DrinkingProblemDrinking problems may have an early or lateonset. Some people have been heavy drinkers formany years. Over time the same amount ofliquor has stronger effects. Other people developa drinking problem later in life. Sometimes thisis due to major life changes like shifts inemployment, failing health, or the death offriends or loved ones. Often these life changescan bring loneliness, boredom, anxiety, anddepression. In fact, depression in older adultsoften goes along with alcohol misuse. At first, adrink seems to bring relief from stressfulsituations. Later on, drinking can start tocause trouble.

Not everyone who drinks regularly has adrinking problem, and not all problem drinkersdrink every day.

Getting HelpStudies show that older problem drinkers are asable to benefit from treatment as are youngeralcohol abusers. There are many types of supportand treatments available. Some, such as 12-stephelp programs, have been around a long time.Others include detoxification; taking prescriptionmedicines to help prevent a return to drinkingonce the person has stopped; and individual orgroup counseling. Newer programs teach peoplewith drinking problems to learn which situationsor feelings trigger the urge to drink as well asways to cope without alcohol. Because thesupport of family members is important, manyprograms also counsel married couples andfamily members as part of the treatment process.

Programs may also link individuals withimportant community resources.

Scientists continue to study alcohol's effects onpeople and to look for newways to treat alcoholism.This research will increasethe chance for recoveryand improve the lives ofproblem drinkers.

For More Information:National Institute onAlcohol Abuse andAlcoholism (NIAAA)www.niaaa.nih.gov

Project Corkwww.projectcork.orgSource: National Institute on Aging(NIA). Public domain (accessedAugust, 2008; adapted for providers,October, 2011).

Bright Futures™ — Our New Standardfor Well-Child Care

We are excited to announce the adoption of theBright Futures™ and American Academy ofPediatrics (AAP) recommendations forpreventive pediatric health care as our standardfor well-child care. Bright Futures is an initiativethat addresses the health needs of children froma holistic perspective while taking the family andcommunity into account when determininghealth promotion and disease preventionassessment and education. Bright Futures waslaunched in 1990 under the leadership of theMaternal Child Health Bureau.

Bright Futures provides a national approach tomanaging the needs of the pediatric populationby providing a framework and comprehensiveset of guidelines for well-child care from birth toage 21.

The National Instituteon Alcohol Abuse andAlcoholism, part of theNational Institutes ofHealth, recommendsthat people over age65 who choose todrink have no morethan one drink a day.Drinking at this levelusually is notassociated withhealth risks.

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The guidelines are designed to represent a singlestandard of care and a common language basedon promotion of good health and diseaseprevention. Some of the benefits of BrightFutures include:

• Holistic model of care including health andwellness, developmental, and psychosocialassessment and intervention strategies

• Systems approach to care incorporating themember, family and community

• Focus on Quality that offers guidance fordefining what constitutes a well-child visit asevidenced by the National Committee forQuality Assurance (NCQA) HealthcareEffectiveness Data an Information Set(HEDIS) specifications reference to AAP andBright Futures

• Standard of Care for preventive health that issupported by the pediatric medical directors ofUnitedHealthcare Community Plan

We believe that preventive pediatric health carethat follows the recommendations of BrightFutures and AAP will lead to increasedopportunity for supervision and coordination ofthe patient’s care needs, and ultimately to betterhealth

We know that a strong relationship between apatient and personal physician will nurture asuccessful health outcome. We believe thatintegrating the Bright Futures and the AAPrecommendations for preventive pediatric healthcare into practice will enhance those healthoutcomes.

If you would like additional information aboutthe Bright Futures/AAP recommendations,please visit brightfutures.aap.org/index.html.

Childhood Nutrition and WeightManagement Services Reminder

“Physician action begins in the examination room.Measuring patient BMI at every well-child visitis essential, along with evidence-based preventionassessment, and treatment strategies...however,physician action must extend beyond theexamination room.”

-- RobertWood Johnson Foundation ChiefExecutive, Risa Lavizzo-Moure,MD

UnitedHealthcare Community Plan iscommitted to reducing the incidence ofchildhood obesity in our population.BMI screenings and plotting ofBMI percentiles are an integralpart of a complete EPSDT/wellchild visit. Assessment, nutritionalcounseling and advocacy for physicalactivity should be an integral part of anticipatoryguidance.

In Pennsylvania additional services for counselingand weight management are available forproviders.These Childhood Nutrition and WeightManagement Services are being underutilized inPennsylvania. We want to remind our providersthat in addition to Early and Periodic Screening,Diagnosis and Treatment (EPSDT) screeningservices discussion of nutrition and determinationof the child’s Body Mass Index (BMI), additionalcounseling and weight management services areavailable.

BillingTipsWhen billing for the initial assessment and re-assessment, providers should include on theirclaim form the appropriate five-digit diagnosiscode 278.00 through 278.02 in conjunction withthe accompanying V-code from the table below:

V85.54 (obesity) BMI > 95th percentile andabove

V85.53 (obesity) BMI 85th < 95th percentile

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V85.52 (obesity) BMI 5th < 85th percentile

• Providers may bill for a physical exam orcomplete EPSDT screen and an initialassessment or re-assessment rendered to achild on the same day.

• Providers may bill for an office visit or clinicvisit and a Childhood Nutrition and WeightManagement Service rendered to a child onthe same day if the child is not being seensolely for a Childhood Nutrition and WeightManagement Service.

• Providers may bill for an initial assessment orre-assessment and individual, group, or familyweight management counseling rendered to achild on the same day.

• An initial assessment is at least 30 minutes induration, per assessment. Initial assessmentsare limited to three assessments per child per365 consecutive day period.

• A re-assessment is at least 30 minutes induration, per re-assessment. Re¬assessmentsare limited to four re-assessments per child per365 consecutive day period.

• Weight management counseling services areinitially limited to a combined total of 2415-minute units of service or clinic visits, forindividual, group, and family weightmanagement counseling per child per 365consecutive day period.

For additional information please contact yourlocal Physician Advocate. You can also referencePA Bulletin 99-07-19.

Cultural Needs

UnitedHealthcare Community Plan believes thatits members have a right to receive care that isculturally competent and respects their culturaland ethnic background and origins. Uponenrollment, information regarding primarylanguage is obtained. Members are assisted in

choosing a Primary Care Physician that willmeet their cultural needs. UnitedHealthcareCommunity Plan provides access to a LanguageLine for translation of communication betweenUnitedHealthcare Community Plan staff andnon-English speaking members. The languageline use is tracked by the Customer ServiceCenter and reported regularly to the health plan.Each health plan then assesses its practitioneravailability to insure that the cultural, ethnic,racial, and linguistic needs of its members arebeing met.

The Provider Directory is available on the web atUHCCommunityPlan.com, and lists thelanguages spoken in the provider’s office.

Erie County DiabetesAssociation and CommunityHealth Net

This is a grant funded program that isavailable to your Adult Diabetic Patients!

The Diabetes Group Visit Series is a programled by a team of health care professionalsincluding a nurse, pharmacist and social workerwho will help your patients learn skills tomanage their diabetes for life. The group formatis very interactive and will allow you to connectwith others who have diabetes and understandyour struggles.

How Long are the Services andWhen are theClasses Offered?The Diabetes Group Visits Program is offeredyear round with a new series starting every sixweeks. Each series consists of five- two and ahalf hour classes that meet weekly on Thursdaysand follow up sessions for support.

To Register: Call/Email: Justine Culmer, BA,RN, Diabetic Nurse Educator-Erie CountyDiabetes Association

Call: 814-454-0715 or email:jculmer@diabeteserie.org

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http://www.diabetes.org/diabetes-basics/

To find recognized American DiabetesAssociation (ADA) classes for DiabetesManagement education access DiabetesPRO. All

you have to do is plug in a zipcode and it gives you a list ofthe programs and the locationsin your area.

DiabetesPRO Professional Resources Online:http://professional.diabetes.org/erp_zip_search.aspx.

Improving Member Compliance andAccess to Care

Free Phone Access may be available for yourPatientsAssurance Wireless is a Lifeline Assistanceprogram provided by Virgin Mobile andsupported by the federal Universal Service Fund.If your patient qualifies for Lifeline Assistance,your patients may be eligible to receive a freeAssurance Wireless cell phone and 250 freemonthly minutes.

You can refer your patients to their website at:www.assurancewireless.com/Public/MorePrograms.aspx

Or your patients may call 888-898-4888.

One Face, One Name

UnitedHealth Group’s health benefit businesses– Commercial, Medicare and Medicaid – arealigning to support a single brand that peoplecan turn to for health care benefits at all stagesof life. Through this brand transition,UnitedHealthcare, UnitedHealthcareCommunity Plan, UnitedHealthcare MedicareSolutions and UnitedHealthcare Military &Veterans Services are now sharing theUnitedHealthcare brand name.

The branding transition began in late 2010 andwill continue into 2012. For additionalinformation about a specific line of business,please click on one of the following links:

UnitedHealthcare Medicare Solutions

UnitedHealthcare Community Plan (selectspecific state plan)

UnitedHealthcare Commercial Businesses

UnitedHealthcare/Oxford

UnitedHealthcareWEST, formerly known asPacifiCare

Recent ActivityMedicare: Medicare SolutionsIn September you received a notification letteralong with a set of Frequently Asked Questions(FAQ's) that helped explain how the brandtransition will work. To find additionalinformation available today on the ProviderPortal, including a presentation on therebranding transition and a comprehensive set ofFAQ's,Click Here.

Your UnitedHealthcare Medicare Advantagepatients began being notified of the plan nameand brand changes in August. Messaging willcontinue through the end of this year. Becauseany of these touch points could lead a patient toask their provider about these health plan brandchanges, here is a summary of all of these touchpoints and the general time frame:

September• TV and Radio brand change advertising in

some markets

• Letter to Evercare and SecureHorizonsmembers

• Annual Notice of Change (ANOC) to allMedicare Advantage members

• Insert in ANOC mailing for AARPMedicareComplete members

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• Customer Service hold messages for allMedicare Advantage members (continuingthrough 2011)

October• Member Newsletter article for

SecureHorizons and AARPMedicareComplete members

• Insert in Provider Directory mailing to allMedicare Advantage members

• Message on health plan website

November• Brand change Reminder Mailer to Evercare

Dual Eligible members

December• Member ID Card mailing to all Medicare

Advantage members - December

We will continue to keep you updated as wemove through this process with a remindernotification letter. You may also be contacted byyour physician or hospital advocate to presentthe information directly to you.

Medicaid: Community PlanThe brand transition for Arizona and Michiganwill be complete on January 1, 2012. This is thesecond step of the transition as logos on the IDcards will now display “Community Plan” next tothe UnitedHealthcare logo instead of “ArizonaPhysicians IPA” in Arizona and “Great LakesHealth Plan” in Michigan as they are shown onthe current ID cards. Note that the only changeyou will see is the logos on the ID cards.

In addition we are soon transitioning fromEvercare Long Term Care to UnitedHealthcareCommunity Plan in six states: AZ, FL, HI,MA, NM and TX. Providers in these states arereceiving communications regarding the detailsof this transition. For additional details on thebranding change, please see the grid belowdescribing the details of the transition includingthe date of transition, product name change andlogo change.

Pharmacy

Pharmacy Updates

Just a reminder: Pharmacy Updates areavailable at AmeriChoice.com. Thepharmacy hotline is 800-922-1557.

UnitedHealthcare Community PlanPreferred Drug List Updates

The UnitedHealthcare Community PlanPreferred Drug Lists (PDL) are available oneach plan's website atUHCCommunityPlan.com. For the most up-to-date information please visit our site, which alsoincludes recent Pharmacy and TherapeuticsCommittee decisions related to PDL additions,PDL deletions and PDL modifications.

Complete PDL information is also accessiblethrough the Epocrates Formulary tool atwww.epocrates.com

Provider Service Center: 877-842-3210

Practice Matters is a periodic publication for physicians and other health care professionals and facilitiesin the UnitedHealthcare network.

M47507PA 11/11

300 Oxford DriveMonroeville, PA 15146