PASSPORT 362.104258 P30PH WIN 2005 MontanaStateLibrary 3 0864 1003 4127 3 Health Keeping Providers Informed Volume 2, Issue 1, Winter 2005 PASSPORT Inside This Issue Provider Input Sought at PASSPORT Summits Summits this Spring Planned for Spring I Tobacco Quit Line and Nurse First: WAhNeantuCrlailenFitts Aren't Right 2 As the PASSPORTto Health program held in Helena during the week ofApril lorTeam Care 2 enters its twelfth year ofsuccessfully 25, followed by Havre during the week of Spotlight: Mary Patrick 3 managing the delivery ofhealth care to May 10, Billings during the week ofMay PASSPORT FAQs 3 Montana's Medicaid clients, the Montana 17, and Kalispell the week ofJune 7. A PASSPORTReferral Reminders 4 Department ofPublic Health and Human cross-section ofPASSPORT stakeholders Key Contacts Services (DPHHS) is planning summits to are invited, including: PASSPORT determine ifthe current operation ofthe providers, specialists and other non-PCPs, PASSPORTTo PASSPORTto Health program is the most representatives from billing companies, Health Provider Relations effective way to meet its objectives. hospitals, FQHCs, RHCs, the tribal health community, and client advocates. The Department Forproviderenrollment or disenrollment. chan.ge ofownership or stresses that Implemented in 1993, address, increasing/decreasing client providers should look "Our mission has been, and will the PASSPORTprogram caseload, and claims questions: at the program in a continue to be, maintaining quality has been successful in truly comprehensive and assuring adequate access to saving over $20,000,000 (800) 624-3958 In-State way; therefore, no primary care while controlling health annually. These savings (406) 442-1837 idea is offthe table care costs. With that in mind, we're allow the program to (406)442-4402 Fax for consideration. looking for people within the provide services to PASSPORT Program provider community who are willing people who may not Mail documentation to: Officer Niki to share innovative ideas and have otherwise received Provider Relations PO Box 4936 Scoffield said, "We specific suggestions for them, and also help Helena. MT .^^9604 felt that it was time to ^^^^imp^ro^ve^me^nt with us." maintain provider check in with the reimbursement rates. PASSPORTTo providercommunity about several issues. Health Client Services Our mission has been, and will continue to In addition to meeting its financial be, maintaining quality and assuring objectives, the PASSPORT program has Forenrolling ordisenrolling clients, adequate access to primary care while been well-received by most ofits PCPs questions about yourmonthly caseload controlling health care costs. With that in and clients. report, orclient services: mind, we're looking for people within the (800) 362-8312 providercommunity who are willing to Ifyou have ideas and would like to (406)442-2328 Fax share innovative ideas and specific participate in one ofthe summits, suggestions for improvement with us." contact Program Officer Niki Scoffield Mail documentation to: at (406) 444-4148 or [email protected] PASSPORT Program PASSPORTto Health's objectives include by February 8. PO Box 2.'i4 assuring adequate access to primary care Helena. MT .S9624 and fostering a medical home between Visit Montana Medicaid's website at: providers and clients which promotes www.mtmedicaid.org or watch the Claim Visit our website: www.intineclicaid.org appropriate care and reduces costs. Jumper for more details. One-day facilitated summits are planned for For newsletter mailing list changes, contact [email protected] locations across the state. The first will be PASSPORT To Health Newsletter Tobacco Quit Line and Nurse First: When Clients A Natural Fit Don't Belong in Team Care Community Health Partners, a Hargraves, a social worker/case community health center in manager at Community Health Livingston, is finding that a number of Partners. Team Care is MontanaMedicaid's Medicaid clients who participate in the utilization control program that State's Nurse First Disease Nurse First, the State's care promotes the strict adherence to the Management Program also enroll in management program, provides proper use ofMedicaid services through the MontanaTobacco Quit Line. health management education and positive case management. Team Care advice to Medicaid clients with the Janice Gomersall, M.D., Medical chronic conditions ofasthma, is forclients with a history ofusing Advisor forthe Nurse First programs, diabetes, heart failure, cancer, and services at an amount or frequency that says the programs are a natural fit. chronic pain. Program nurses work is not medically necessary, and who "Nurse First puts the thought into closely with community health require additional assistance when people's heads that quitting is a good centers to identify Medicaid clients accesing care. idea in context with theirdisease who might benefit from enrollment in management. The number one reason the disease management programs. There are three ways clients are people choose to quit smoking is when indentified forTeam Care. someone involved in their medical The Tobacco Quit Line and Nurse well-being talks to them about it. First work well together because the Nurse First serves that purpose," registered nurses who staffthe • Claims data review (i.e. client visits explains Dr. Gomersall, who's also a disease management programs provider more than 25 times per year family practitioner specializing in reinforce the principles ofthe or presents in the ER more than 12 obstetrics at the Lolo Family Practice. Tobacco Quit Line. Because the times annually); nurses identify smoking as a medical The Montana Department ofPublic problem in initial assessments made • DUR Review (Drug Utilization Health and Human Services sponsors for the disease management program, Review Board Pharmacy Claims Review); the Tobacco Quit Line and the Nurse they not only encourage use ofthe • Provider referrals. First Disease Management Program, Tobacco Quit Line, but can follow-up both ofwhich are free to eligible on the issue in subsequent calls. Ifyou are managing the care ofa client Medicaid clients. "My take on this exciting develop- who is not appropriate forthe program, As part ofthe Tobacco Quit Line, ment is that the disease management contact the Medicaid Managed Care callers work with a counselor who program is working with the Bureau at (406) 444-1518 ore-mail helps them pick a quit date, schedules community-based programs to make [email protected] to request a times to call throughout the quitting the patients successful as they disenroUment. The State can also process, and provides nicotine patches improve their health. Stopping provide additional information to help or gum to help reduce nicotine smoking takes a number ofsteps, and you decide ifa client's enrollment is Nurse First is in a perfect position to appropriate. be that first step," Dr. Gomersall said. In order for the Quit Line to provide nicotine replacement therapy to For more information regarding the Acurrent list ofyourTeam Care clients Medicaid clients at no cost, clients Nurse First programs, contact is included with your monthly must first expend their Medicaid Program OfficerTedd Weldon at PASSPORTenrollment list. smoking cessation benefits. (406) 444-1518 [email protected]. For more information about the By working in collaboration, we can "One thing we are noticing in our Montana Tobacco Quit Line, contact ensure Team Care clients get the right community is that patients who utilize Tobacco Use Prevention Supervisor both the Nurse First Programs and the Georgiana (George) Gulden at (406) care in the right place at the right time. Tobacco Quit Line are moving 444-9617 or [email protected]. For more information, visit our website forward in their goals at quitting To contact the Quit Line directly, call or contact Program OfficerTedd Weldon cigarettes. I know that Nurse First is (866) 485-QUIT. at (406) 444-1518 or teweldon®mt.gov. really encouraging and educating patients to stop smoking," said Rie In The Spotlight: provided no-cost breast and prostate Frequently Asked cancer screening to qualified PASSPORT recipients statewide. Montana Medicaid Before moving to Montana with her Questions Welcomes Quality husband, Willard, Mary worked in various healthcare organizations as a Assurance Nurse staffnurse, nurse manager, and Can I use my ProviderEnrollee listas supervisor in both an acute care and an eligibility verification method? Managed Care for long-term care setting for over 20 Programs years. From 1980 to 1991, Mary NMeod;itchaisidliestliwgiabsilniotytvdeersiifgincaetdiotnotboeola. taught medical-surgical, obstetrical, As a PASSPORT provider, you need to and mental health nursing at St. verify a client's eligibility using an Augustine Technical Center in Florida established verification method, such as forover 10 years. She also held the FaxBack, before providing services or position ofProgram Director at Santa making a referral to another provider. Fe Community College in Gainesville, forits Emergency Rememberto verify eligibility at every Medical Services programs prior to visit, even for those clients who appear moving to Montana. on your Provider Enrollee list. Mary graduated from Pilgrim State Why do Ihave individuals on my Hospital School ofNursing in ProviderEnrollee list who are Brentwood, New York in 1968 with a identifiedas "new clients" when I've diploma in nursing. In 1977, she managedtheircare in thepast? earned a Bachelor ofScience degree Mary Patrick, R.N., M.Ed. in Health Care Management from St. The enrollee list identifies those Francis College in Brooklyn, New individuals who are new to PASSPORT Mary Patrick, R.N., M.Ed,joined the York. Mary went on to earn her each month. You may have managed the PASSPORTto Health team last fall as Master ofEducation degree from the client's care before they became one oftwo Quality Assurance University ofFlorida in Jacksonville Medicaid eligible, or they may have lost in 1988. In 2000, Mary completed the Program Officers. She is responsible eligibility for a period oftime. "Managed Healthcare Professional" for quality assurance duties that were home study course from the Health previously performed by acontractor InsuranceAssociation ofAmerica. How can we assistclients in selecting for the department. MedicaidManaged ourclinic as theirPASSPORT Care Bureau ChiefMary Angela "I am excited to be doing quality provider? Cthoaltlilnoscastaiindg, b"oWteh'rqeuaallirtyeaadsysufirnadnicneg aidsesnutriafnyciengagbaoitnhaqnuadliItlyocolkiefnotrcwaarred to Ipfroyvoiudrerc,liheenrte'wsanhtoswaynoeuwcaPnASheSlpP:ORATsk positions here in the Department and areas ofcare that perhaps need clients to call the Montana Medicaid results in even better synergy. Mary is more support or better processes in Help Line at 1-800-362-8312. You may a valuable source ofexpertise and place fordesired positive outcomes," also assist them in filling out the Change we're excited to have heron board." Mary said. She will work with Jackie ofProvider form. Youroffice can obtair Thiel, who continues in her role as several copies ofthe form by calling the Priorto accepting this position, Mary Quality Assurance Manager for Help Line; the form may also be worked at Blue Cross and Blue Shield PASSPORTto Health as well as the available for downloading soon at our ofMontana from 1991 to 2002 in rest ofthe PASSPORTTeam. website: www.mtmedicaid.org several capacities, including Medical Policy Coordinator, Quality Improvement Coordinator, and Mary's latest pastime is learning how Please keep in mind that until the change Preventive Health Coordinator. to play the piano. She enjoys going in providers is complete, you will need for walks with her husband and their to get a referral, or establish a private She also helped coordinate the Care Boykin Spaniel, "Ginger." pay agreement with these clients until Screenings Program through the they appear on yourProvider Enrollee Caring Foundation ofMontana, which list. PASSPORT To Health Newsletter PASSPORT to providercalls the next business day to get that number, it cannot be Referral Reminders taken back. Ifyou are not a client's PCP, you An integral component ofmanaging must get the referral prior to yourclient's healthcare needs is giving providing services. Ifyou do not, referrals when appropriate and and you provide the service, you run necessary. This enables you to better the risk ofthe PCP refusing to give treat yourclient and meet his/her needs. you a referral and your claim will be When giving referrals, remember: denied. The PASSPORTreferral is aclinical referral. It is based on the need ofthe client, and, as with all clinical issues, Ifyou are a client's PASSPORT can only be given by the PASSPORT provider, it is not necessary to put provider (oracovering provider). yourown referral number on the Although office staffcan relay the claim form (Box 17A). Ifyou find referral to anotherprovider, it must be that your claims are denying for lack given by the PCP. ofPASSPORT authorization for your own PASSPORT clients, please Sometimes, the on-call provider gives contact Crystal Nachtsheim in the referral, but does not actually have Provider Relations at l-(800) 624- the referral number. When the referred- 3958. Your PASSPORT number may not be set up correctly in our system. avaHavHQ ** ** HHXNHD SNOIlVDIiand 31VXS Xa^VHOHO VX^380^ CS31d03 8) AaVaan 3XVXS VNVXNOIAI KT0-t7096S XIAI 'VN3iaH K6 xoa Od 69 ON liiAiyad IIM 'VN313H mie^H, aivd 33visod sn "ox ssviDisaid lyosayd iHOdSSVd