NEWS—October 2015

Molina Healthcare Secures New Transportation

Vendor

On December 1, 2015 Molina Healthcare (Molina) will transition

its transportation vendor from LogistiCare to Secure Transporta-

tion, for all regions in Illinois.

Secure also will provide transportation for Molina’s additional ser-

vice area of Cook County, effective Jan. 1.

Secure Transportation has been in business since 1980, original-

ly serving Members in Southern California, with Non-Emergency

Medical Transportation.

Routine medical transportation is a benefit for Molina Members. It

is designed to help get Members to their Provider visits, including:

Medical or dental appointments

Pharmacy locations to pick up medication

Ongoing care, such as physical therapy

Scheduling Transportation Members in need of transportation may call Secure Transporta-

tion at least three days in advance, but no more than 30 days

before the appointment, to make a reservation.

Please have the following information when making a reservation:

Member ID

Name and address of Provider

Appointment date and time

Pick-up time and location

Find a Provider

For a complete list of Providers in the

Molina Healthcare network, visit

www.MolinaHealthcare.com and click on

the “I’m a Professional” option. Search

under the “Find a Provider” section.

You may also follow this link for access:

https://

providersearch.molinahealthcare.com/

Provider/ProviderSearch?

RedirectFrom=MolinaStaticWeb

HCC Pearls

Molina’s HCC Pearls program focuses

on the coding and documentation rules

(Hierarchical Condition Category —

HCC) applied by the Centers for Medi-

care and Medicaid Services (CMS).

HCC Pearls are concise tips for effective-

ly and easily identifying, coding, and doc-

umenting the health status of your pa-

tients.

Included in this month’s packet are:

Long-Term Use of Insulin

Diabetes with Vascular Manifesta-

tions

Diabetes with Eye Manifestations

Additional HCC Pearls can be found at

http://www.molinahealthcare.com/

providers/il/duals/comm/Pages/hcc-

pearls.aspx

ILPS1510.1

2

Molina Healthcare Supports the Patient– Centered Medical Home Model

Molina Healthcare of Illinois is working to support the transformation of primary care to the Pa-

tient-Centered Medical Home (PCMH) model. PCMH is a concept of care that began in the mid-

1960s and originally referred to a primary care environment that would provide care coordina-

tion to children with special health care needs. Recognizing that healthcare has become in-

creasingly complex for everyone, ten years ago, several primary care societies developed set

joint principles, outlining a model of care that is comprehensive, continuous, coordinated, cultur-

ally-competent, safe, accessible and effective. Since then, multiple studies have documented

that the model provides better outcomes at lower costs, as well as improving consumer satis-

faction.

Achieving the goals of the PCMH model takes considerable investment. Molina supports the

PCMH in three ways.

1. Molina provides educational support to Primary Care Providers (PCPs) to develop new sys-

tems of care and obtain PCMH certification.

2. The Molina Quality team provides tools such as reports that show which Members have

missed needed services, which enhance the ability of PCPs to manage the healthcare of

their entire patient population—a critical feature of the medical home.

3. Molina supplements care coordination services provided at PCP offices with a team of nurs-

es, pharmacists, and community health workers. The Molina care coordination team arrang-

es appointments with various specialists, visits patients in their homes to educate them on

self-management, and provides additional services such as medical therapy management

to help patients understand and adhere to their medication regimens.

PCMH is the foundation to high-quality healthcare and Molina is working to ensure that every

Molina Member has a “home sweet medical-home.”

For more information on the PCMH model, visit the Patient-Centered Primary Care Collabora-

tive at www.pcpcc.net.

Member Care Plans Now Available Via the Molina Healthcare Web Portal

Providers are now able to access Molina Healthcare’s High Risk MMP Care Plans by visiting the Moli-

na Website. Care plans may only be accessed when Members agree to share this information with

their Providers. Please follow the steps listed below to access care plans. Contact Provider Services

at (855) 866-5462 from 8 a.m. to 5p.m. (CST), Monday through Friday if you have any questions.

Visit www.MolinaHealthcare.com and select the “Health Care Professional” option.

Click on the “Sign In” icon and enter your User ID and Password.

Select “Member Eligibility” at the top of the screen.

Enter the Member ID or Member First Name, Last Name, and Date of Birth then click “Search for

Member” to proceed.

Click on the “Member Health Record” tab to locate the care plan available within this tab.

Providers may request high risk member care plans for other Molina Healthcare programs via

their Provider Services Representative.

3

Durable Medical Equipment (DME) - Guidelines for Claims Submission

and Billing

Billing Guide:

DME Providers must bill on a 837P/CMS 1500

Providers must be registered with the Illinois Medicaid Assistance Program (MAP). The

following is a link to register with MAP:

a. www.IMPACT.Illinois.gov

Categories of service for which a Provider may be enrolled for:

a. Category 41, Medical Equipment/Prosthetic Devices

b. Category 48, Medical Supplies

The Handbook for Providers of Medical Equipment and Supplies, Chapter M-200 Policy and

Procedures for Medical Equipment and Supplies, in section M-204, identifies non-covered

services

HFS publishes maximum quantity limits, provided at this link: http://www2.illinois.gov/hfs/

SiteCollectionDocuments/DMEFeeSchedule.pdf

Specific DME requests require prior authorization, per the Molina Provider Handbook and

guidelines.

a. Verify code specific DME by contacting Molina Prior Authorization

Department at (855) 866-5462 or via fax at (866) 617-4971

b. Review Molina’s codification list located on the Molina Website:

Upcoming Provider Education Webinars

Illinois Department of Healthcare and Family Services (HFS) requires all contracted health plans to pro-

vide Covered Services in a culturally competent manner by ensuring the cultural competence of the

Provider Network. Molina makes it easy for Providers to meet the requirement by offering trainings via

webinar. Molina will host the following monthly webinars from October through December: Cultural

Competency and Compliance Training and a special orientation for long-term care facilities.

The online presentations are open to all Molina Providers and Providers not contracted with Molina,

office staff, and clinical staff. To register, Providers should select Communications, and then Webi-

nars and Events, on www.MolinaHealthcare.com. Details for the sessions are as follows:

Cultural Competency and Compliance Training

Tuesday, October 13, 2015 at 10 a.m. CST

Tuesday, November 17, 2015 at 10 a.m. CST

Tuesday, December 15, 2015 at 10 a.m. CST

Long-Term Care Provider Orientation

Tuesday, October 13, 2015 at 1 p.m. CST

Tuesday, November 17, 2015 at 1 p.m. CST

Tuesday, December 15, 2015 at 1 p.m. CST

4

Questions?

For additional information, please con-

tact your Provider Services Repre-

sentative

or call (855) 866-5462.

Provider Services Representative

Territories

A Provider Services Representative

Territories Map, which includes contact

information for each representative

and the counties they cover, is includ-

ed in this month’s packet.

Contract Manager Territories

To locate the Molina Contract Manager

assigned to your county, please refer-

ence the Contract Manager Territories

Map document included in this packet.

Medical Records

Molina Healthcare conducts regular medical record reviews for all Molina- contracted Providers. The process involves a review of the following components:

Medical record confidentiality and release of medical records including behavioral health care records

Medical record content and documentation standards, includ-ing preventive healthcare

Storage maintenance and disposal

Process for archiving medical records and implementing im-provement activities

Providers have a contractual arrangement to provide both Molina

and Members access to the Members’ health information including,

but not limited to, medical records and billing records, in accord-

ance with applicable law, applicable government programs, and

Molina’s policies and procedures. Molina uses these medical rec-

ords, to be available upon request, for purposes of quality improve-

ment and utilization management.

More information can be found within the Molina Provider Manual

under the Contractual Obligations Section. Medical Records, Sec-

tion 9.2 of the manual also provides more information.

4

Annual Comprehensive Exam

Molina conducts a yearly Risk Adjustment Program for our Medi-care-Medicaid Plan (MMP) Members using an Annual Comprehen-sive Exam (ACE) process. This process allows Molina to correctly identify the current health status of Members. During the first quarter 2016, Molina will deliver packets containing ACE forms and instructions for each identified Molina Member as-signed to your practice. You may use your own progress note or Electronic Medical Records (EMR) to document the comprehen-sive examination. A sample copy of your EMR must be sent to the RAMP@MolinaHealthcare.com for prior approval. Further information will be available in future Provider communica-tions. Please reach out to your Provider Service Representative or your Quality Improvement Specialist or call (855) 866-5462 if you have any questions.

Molina Healthcare Coding Tips Diabetes with Vascular Manifestations

Have Questions? Contact: Ramp@MolinaHealthcare.com

The information presented herein is for informational purposes only. It is not intended, nor is it to be used, to define a standard of care or otherwise substitute for

informed medical evaluation, diagnosis and treatment which can be performed by a qualified medical professional. Molina Healthcare Inc. does not warrant or

represent that the information contained herein is accurate or free from defects.

EMR Documentation Examples:

A/P:

72 year old male with DM w/ vascular

manifestations, controlled

ICD9 Code: 250.80

ICD-10 Code: E11.51

Assessment: well controlled

Plan: Continue ASA, ACE Inhibitor and statin

daily

72 year old male with Peripheral Angiopathy in

other Disease

ICD-9 Code: 443.81

ICD-10 Code: E11.51

Assessment: well controlled

Plan: Continue current therapy

Paper Charting Documentation

A/P:

64 year old female with Diabetic Vascular

Disease, uncontrolled and atherosclerosis of left

leg

ICD-9 Code: 250.82, 440.20

ICD-10 Code: E11.59, E11.65, I70.202

Assessment: Progressive disease based on clinical

findings

Plan: Recommend tighter glucose control, smoking

cessation and compliance with medications to

reduce risk of further CVD disease

Welcome to the Molina Healthcare Coding Institute

Molina Healthcare is committed to supporting

your clinical practice. Please take a moment to

review this HCC Pearl.

Molina Healthcare is committed to supporting your

clinical practice. Please take a moment to review

this HCC Pearl on DM with vascular manifestations.

The role of glycemic control on microvascular

disease in type 2 diabetes was documented in the

United Kingdom Prospective Diabetes Study

(UKPDS). Many studies suggest a correlation

between higher rates of cardiovascular disease

(CVD) and chronic hyperglycemia, thus it is our

responsibility to screen, prevent and treat these

complications in our patients. The clinical evidence

supports initiating intensive therapy to target

Hgba1c goals as early as possible in the course of

Diabetes. Aggressive cardiac risk reduction

(smoking cessation, aspirin, blood pressure control,

reduction in serum lipids, preferably using a statin,

diet, exercise, and, in high-risk patients, an

angiotensin-converting enzyme inhibitor) should be

the goal for Type 2 Diabetics.

Molina Healthcare Coding Tips When Do I Use the Code For Long-Term Use of Insulin?

Have Questions? Contact: Ramp@MolinaHealthcare.com

The information presented herein is for informational purposes only. It is not intended, nor is it to be used, to define a standard of care or otherwise substitute for

informed medical evaluation, diagnosis and treatment which can be performed by a qualified medical professional. Molina Healthcare Inc. does not warrant or

represent that the information contained herein is accurate or free from defects.

Documentation Examples:

Managing Existing Long-Term Insulin

65 year old man with diabetes using

insulin daily

Assessment: Poorly controlled HgbA1c of

9.4

Plan: Extensive counseling provided, answered

patient questions and increase dose of Lantus

by 2 units

ICD-9 Code : V58.67

ICD-10 Code : Z79.4

Starting Long-Term Insulin

58 year old woman newly diagnosed with

diabetes starting insulin after labs revealed

DM

Assessment: Uncontrolled fasting blood

glucose (FBG) of 480 with Hgba1c of 11.1

suggestive of need for insulin therapy

Plan: Extensive education provided.

Refer to Certified Diabetic Educator.

Start Glucophage XR 500 mg daily.

Start 2 units of Regular insulin with each meal.

Follow up in 5 days.

ICD-9 Code: V58.67

ICD-10 Code: Z79.4

Welcome to the Molina Healthcare Coding Institute

Molina Healthcare is committed to supporting

your clinical practice. Please take a moment to

review this HCC Pearl.

The use of Insulin in the diabetic population is quite

prevalent, and we hope that all providers are

aware of the various means to help patient’s

achieve HgbA1c goals and control this challenging

and usually progressive disorder. There are

numerous forms of insulin being used in the

healthcare community, it is important that we

consider that managing patients who use insulin

requires significant training for clinicians, patients

and their families to ensure patient safety is not

compromised. CMS recognizes that when

introducing, managing or adjusting insulin believed

to be needed for the chronic management of

Diabetes additional time and care must be

attributed to this patient. Documentation of this

code helps illustrate the increased complexity

of patients who require this treatment.

Molina Healthcare Coding Tips Diabetes with Eye Manifestations

Have Questions? Contact: Ramp@MolinaHealthcare.com

The information presented herein is for informational purposes only. It is not intended, nor is it to be used, to define a standard of care or otherwise substitute for

informed medical evaluation, diagnosis and treatment which can be performed by a qualified medical professional. Molina Healthcare Inc. does not warrant or

represent that the information contained herein is accurate or free from defects.

Documentation Examples: A/P:

52 year old Asian male with Diabetic Macular

Edema, uncontrolled

ICD-9 250.52, 362.01, 362.07

ICD-10: E11.311, E11.65

Assessment: worsening vision loss

Plan: recommend tighter glycemic control, refer to Ophthalmologist

62 year old Black male with Diabetic

Proliferative Retinopathy

ICD-9: 250.50, 362.02

ICD-10: E11.359

Assessment: noncompliant with recommendations

Plan: recommend close follow up with CDE and

Eye care specialist

A/P:

61 year old Russian female with Type 1 Diabetic Retinopathy, controlled

ICD-9 250.51, 362.01

ICD-10: E10.319

Assessment: Stable

Plan: Will monitor

58 year old White female with Diabetic Cataract

ICD-9: 250.50 366.41

ICD-10: E11.36

Assessment: Snelling testing without change

Plan: Continue care with Ophthalmology and repeat labs as discussed

Welcome to the Molina Healthcare Coding Institute

Molina Healthcare is committed to supporting

your clinical practice. Please take a moment to

review this HCC Pearl.

Diabetic patients are at high risk of developing eye

manifestations. The ADA recommends annual

screening for all diabetics with a dilated retinal

examination. The practice of identifying and

treating eye disorders is in order to prevent non-

congenital blindness. Diabetes is the most common

cause of non-congenital vision lost in the United

States.

It is also quite important to remember that

cataracts in the setting of Diabetes are commonly

seen. It is important to document accurately this

condition which is a very common eye

manifestation known as a Diabetic cataract.

ICD-10 Note: DM with the following statuses

should be coded by type, with hyperglycemia:

Poorly controlled, out of control, uncontrolled

Easier-to-Read Explanation of Payment Statements

As part of Molina Healthcare of Illinois’ (Molina) ongoing efforts to incorporate feedback and continuously improve the service we offer Providers, Molina is making its Explanation of Payment (EOP) statements easier to read. What Providers can expect? Effective September 9, 2015, amounts previously listed under the Coordination of Benefits (COB) field for the Program: MMP Medicare will now be listed under the co-pay, co-insurance and deductible fields. The change aims to improve the clarity of the information presented and applies to both the electronic and paper versions of Molina Healthcare’s Medicare Medicaid Plan (MMP) EOPs.

A special reminder:

MMP Members are not liable for Medicare Part A and B cost sharing, including deductibles,

coinsurance and copayments.

Questions? Please call Provider Services at 855-866-5462, Monday through Friday between 8:00 a.m. and 5:00 p.m. Thank you for your continued service to Molina Healthcare Members.

Sample Explanation of Payment Statement - Electronic Remittance Advice (835)

September 9, 2015

PS1509.04

Provider Memorandum

Sample MMP Explanation of Payment Statement (Paper Remittance Advice) with co-insurance and deductible

Sample MMP Explanation of Payment Statement (Paper Remittance Advice) with co-payment

ample MMP Explanation of Payment Statement (Paper Remittance Advice) with co-payment

Sample MMP Explanation of Payment Statement (Paper Remittance Advice) with co-payment

Provider Services Representative Territories

Service

AreaCoun

ties

NonServ

iceArea

Counties

Provider Service Representatives

Jared Fritz - Manager, Provider Servicesjared.fritz@molinahealthcare.com(217) 260-7674• Manages and oversees Provider Service Representatives• Ensures State-escalated Provider complaints are timelyaddressed and resolved

Jonathan Jacksonjonathan.jackson@molinahealthcare.com(312) 520-6184

Candace Peters - Excl. Memorialcandace.peters@molinahealthcare.com(217) 820-2504

Erin Wilsonerin.wilson@molinahealthcare.com(815) 520-9172

Ethan Muenchethan.muench@molinahealthcare.com(224) 257-1957

Michelle Atkins - BJC, WashU, Missourimichelle.atkins@molinahealthcare.com(618) 381-4134

Christina Dorsettchristina.dorsett@molinahealthcare.com(217) 372-7718

Marietta Miner - Tenet, SSM, SluCaremarietta.miner@molinahealthcare.com(618) 381-1385

Nancy Roots - Memorialnancy.roots@molinahealthcare.com(309) 241-3764

ADAMS

ALEXANDER

BOND

WINNEBAGO

BROWN

BUREAU

CALHOUN

CARROLL

CASS

CHAMPAIGN

CHRISTIAN

CLARK

CLAYCLINTON

COLES

COOK

CRAWFORD

CUMBERLAND

DE KALB

DE WITT

DOUGLAS

DUPAGE

EDGAR

EDWARDS

EFFINGHAM

FAYETTE

FORD

FRANKLIN

FULTON

GALLATIN

GREENE

GRUNDY

HAMILTON

HANCOCK

HARDIN

HENDERSON

HENRY

IROQUOIS

JACKSON

JASPER

JEFFERSON

JERSEY

LAKE

JOHNSON

KANE

KANKAKEE

KENDALL

KNOX

JO DAVIESS

LA SALLE

LAWRENCE

LEE

LIVINGSTON

LOGAN

MCDONOUGH

STEPHENSON

MCLEAN

MACON

MACOUPIN

MADISON

MARION

MARSHALL

MASON

MASSAC

MENARD

MERCER

MONROE

MONTGOMERY

MORGAN MOULTRIE

OGLE

PEORIA

PERRY

PIATT

PIKE

POPE

PULASKI

PUTNAM

RANDOLPH

RICHLAND

ROCK ISLAND

ST. CLAIR

SALINE

SANGAMON

SCHUYLER

SCOTT

SHELBY

STARK

MCHENRY

TAZEWELL

UNION

VERMILION

WABASH

WARREN

WASHINGTONWAYNE

WHITE

WHITESIDE

WILL

WILLIAMSON

BOONE

WOODFORD

Evanston

Maywood

Orland Park

Chicago

Contract Manager Territories

ADAMS

ALEXANDER

BOND

WINNEBAGO

BROWN

BUREAU

CALHOUN

CARROLL

CASS

CHAMPAIGN

CHRISTIAN

CLARK

CLAY

CLINTON

COLES

COOK

CRAWFORD

CUMBERLAND

DE KALB

DE WITT

DOUGLAS

DU

PAGE

EDGAR

EDWARDS

EFFINGHAM

FAYETTE

FORD

FRANKLIN

FULTON

GALLATIN

GREENE

GRUNDY

HAMILTON

HANCOCK

HARDIN

HENDERSON

HENRY

IROQUOIS

JACKSON

JASPER

JEFFERSON

JERSEY

LAKE

JOHNSON

KANE

KANKAKEE

KENDALL

KNOX

JO DAVIESS

LA SALLE

LAWRENCE

LEE

LIVINGSTON

LOGAN

MCDONOUGH

STEPHENSON

MCLEAN

MACON

MACOUPIN

MADISON

MARION

MARSHALL

MASON

MASSAC

MENARD

MERCER

MONROE

MONTGOMERY

MORGAN MOULTRIE

OGLE

PEORIA

PERRY

PIATT

PIKE

POPE

PULASKI

PUTNAM

RANDOLPH

RICHLAND

ROCK ISLAND

ST. CLAIR

SALINE

SANGAMON

SCHUYLER

SCOTT

SHELBY

STARK

MCHENRY

TAZEWELL

UNION

VERMILION

WABASH

WARREN

WASHINGTON

WAYNE

WHITE

WHITESIDE

WILL

WILLIAMSON

BOONE

WOODFORD

Evanston

Maywood

Orland Park

Chicago

Kim Gallaher - Manager, Provider Contracts

kimberly.gallaher@molinahealthcare.com

(331) 229-9034

• Manages and oversees all provider contracting

• Creates and implements Provider contracting strategies

• Responsible for single case agreement negotiation

• Handles out-of-state and national provider requests

Service Area Counties

Non Service Area Counties

Contract Managers

Sharon Moloney

sharon.moloney@molinahealthcare.com

(309) 255-6914

Diane Michael - BJC, WashU, SIHF, SSM, SIU

diane.michael@molinahealthcare.com

(217) 561-0708

Sharetta Thomas - St. Louis Area & Southern Illinois

(excl. BJC, WashU, SIHF, SSM, SIU)

sharetta.thomas@molinahealthcare.com

(618) 304-5747

Sara Degrofft

sara.degrofft@molinahealthcare.com

(217) 493-7945

Michael Manade

michael.manade@molinahealthcare.com

(630) 200-8504

Heather Wantland-Welch

heather.wantland -welch@molinahealthcare.com

Caitlin Callahan

caitlin.callahan@molinahealthcare.com