Practice Tactics

Provider Portal Updates

UHA will no longer be accepting prior authorization (PA) requests or supporting documentation via fax from contracted providers. Please visit our website for access.

CIM, UHA’s provider portal, has updated their PA entry workflow. When selecting “Submit Pre-Auth”, or “Submit Referral”, from the Member Search, you will be lead through various pop-up windows to select the appropriate type of care; Grievance, Pre-Authorization, or Case Management Services. If selecting Pre-Authorization, you will be given the choice of entering a Medical or Pharmacy PA. The benefit of segmenting this workflow will be the improvement of standardization and accuracy as the only applicable options will be available for selection. An example of this pop-up window workflow can be found here.

Update on Retro-Active Requests for PA

For any service that needs prior authorization we require that requests be submitted before the service is provided. Retroactive authorization will be accepted for review in situations where eligibility of the member changed after the service was provided. Additionally, retroactive authorization requests need to be received within 90 days of the date of service. If a request is received more than 90 days from the date of service, documentation needs to be provided indicating why the request was not submitted within the required time frame.

For services requiring prior authorization that are provided without submitting a request before the date of service (and the reason for not submitting a prior authorization request is not related to an issue with eligibility) please follow our claims reconsideration and appeal process found on the UHA website at https://www.umpquahealth.com/claims/.

Update on Provider Claims Appeals

Just a reminder that UHA has a new claims appeal process effective 4/1/2020! What does this mean? Well, A few new requirements, and a streamlined electronic claims appeal process that allows you to bypass the mail and upload appeals directly to the claim! You can find all the details here in section 6.11 Denials and Claim Appeals of the Provider Handbook. A quick overview:

• A Provider Request for Reconsideration and Claim Dispute form will be required for all second level appeals, this can be found here
• You can now upload your appeals electronically through the claim in CIM, click here for a tutorial
• Electronic claim support through E-mail via claim in CIM. Change the auto fill email to UHAClaims@umpquahealth.com and get claims support without having to call!

These changes are effective for claims appeals received after 4/1/2020, regardless of the date of service. Please visit our website at www.umpquahealth.com/claims/  for more information and feel free to reach out with any questions by email at UHAClaims@umpquahealth.com or by phone 541-229-4812, option 2.

Clinical Corner

State Telehealth Guidance from the OHA

The Oregon Health Authority (OHA) has prepared Telehealth Guidance for all health plans, available in this PDF.

For the duration of the COVID-19 outbreak, or until otherwise directed by the directors of the Department of Consumer and Business Services and the Oregon Health Authority, the state expects health plans of all types to provide increased access to health care services through telehealth delivery platforms and to encourage patients to use telehealth delivery options to limit the amount of in-person health care services they seek. This includes commercial health plans regulated by DCBS and Medicaid health plans regulated by OHA.

Specific guidance for OHP/UHA membership can be found here: https://www.oregon.gov/oha/HSD/OHP/Tools/Telehealth%20coverage%20for%20the%20Oregon%20Health%20Plan.pdf

Additional guidance for Behavioral Health clinicians providing care for OHP/UHA members: https://www.oregon.gov/oha/HSD/OHP/Announcements/Expanded%20telehealth%20coverage%20for%20behavioral%20health%20services.pdf

Additional guidance for Oral Health providers providing care for OHP/UHA members: https://www.oregon.gov/oha/HSD/OHP/Announcements/Expanded%20Oregon%20Health%20Plan%20teledentistry%20coverage%20effective%20Jan.%201%2C%202020.pdf

OCR Discretion for Telehealth Communications

During the national public health emergency, the Office for Civil Rights (OCR) will not impose penalties on providers using telehealth in the event of noncompliance with the regulatory requirements under the Health Insurance Portability and Accountability Act (HIPAA). This allows providers to use communication platforms that are not HIPAA compliant, such as Skype or FaceTime. Providers using telehealth that may not normally be compliant should familiarize themselves with the OCR guidance and engage in practices that continue to safeguard patient information.

The State of Oregon is allowing non-HIPAA-compliant platforms.

Medication Therapy Management

Umpqua Health Alliance (UHA) will be implementing a Medication Therapy Management (MTM) program which will offer assistance to members who need help managing their chronic drug therapy.

Overview

MTM is a range of services that optimize drug therapy with the intent of improved therapeutic outcomes for our members. Our UHA Clinical Pharmacy team provide MTM services to help our members get the best benefits from their medications by managing drug therapy and by identifying, preventing and resolving medication-related problems. Our MTM services include:

• Medication synchronization: Coordinating medication refills to reduce trips to the pharmacy to pick up medications.
• Medication reconciliation: Identify and verify the list of current medications being taken is accurate and understood to avoid confusion about which drugs are the correct ones to be taken.
• Dose orchestration: Aligning doses and timing of doses for compatibility and optimum therapy to focus on taking medicines at the right time of day and as few times as possible.
• Medication education: Explaining names and purposes for medications that are being taken, and what side effects or precautions to watch for to ensure understanding of drugs and their effects.
• Economic review of medications: Evaluating current medications to identify appropriate but less expensive alternative treatments for relevant condition(s) and recommending changes to the physician/prescriber.
• Therapeutic review of medications: Evaluating current medications to identify alternative treatments with therapeutic advantages for relevant condition(s) and recommending changes to the physician/prescriber.
• Adherence assistance: Evaluating challenges and factors that affect members taking their medications as prescribed and working with members to develop strategies for improvement.

Our MTM Team

• UHA’s MTM team is staffed by Doctors of Pharmacy (PharmD), and licensed pharmacy technicians with experience in medication therapy management. Our pharmacy team works closely with providers to ensure each member’s medication plan is achieving targeted therapeutic goals.

Accessing Our Services

MTM services will require a referral initiated by either the member or the provider.

• Member self-referral: Members can contact the UHA Clinical Pharmacy Department to enroll in the MTM program and request a medication review with a pharmacist. They may fill out the form themselves, or when requesting a self-referral we can help initiate the referral over the phone.
• Provider referral: Providers, case managers or other members of the care team can refer members as needed. Members may be referred to because they have a high risk of developing medication-related problems, and already identified medication-related problem, medication adherence issues, or other medication-related challenges or needs. The form may be filled out by the provider, or when requesting a referral by phone we can help initiate the referral.

To refer a member to the MTM Program, submit the completed MTM referral form via fax to (541) 677-5881, or email to UHPharmacyServices@UmpquaHealth.com. Alternatively, you can submit a referral using the Community Integration Manager (CIM) platform by choosing the Medication Therapy Management referral type and selecting the specific services requested under the diagnosis section.

On the Lookout

Douglas Public Health Network (DPHN) officials are working tirelessly to battle the spread of COVID-19 in Douglas County. They are offering regular updates on the situation locally, including testing updates, information on local and state cases and more. To find these regular updates, you can visit the DPHN website and navigate to the COVID-19 page in the top menu.

CME for Thee

OHA HEALTH CARE PROVIDER INFORMATIONAL CALLS: COVID-19

Thank you for your leadership and partnership in helping to slow the spread and address the health impacts of COVID-19 in Oregon. With this rapidly changing situation, we want to get information out to healthcare providers across the state as quickly and clearly as possible. To provide a consistent venue for COVID-19 information sharing, OHA’s Chief Medical Officer Dr. Dana Hargunani will host regular information sessions for Oregon healthcare providers at least two times a week.

Informational Sessions this week:

1. OHA COVID-19 Webinar for All Providers: Tuesday, March 31 from 12-1 pm:

Register for the webinar here.

You can submit questions for OHA when you register for the webinar.

Here is an archive video of the OHA’s Tuesday, March 24 provider teleconference.

2. “Oregon COVID-19 Response for Clinicians ” Project ECHO

Also, this week, the “Oregon COVID-19 Response for Clinicians ” Project ECHO, a weekly virtual interactive session, will begin on Thursday, 4/2, 12-1:15 pm. This is hosted by the Oregon ECHO Network at OHSU and will be staffed by Dr. Hargunani and Dr. Jennifer Vines, Multnomah County Health Officer and other invited content experts. They will provide the latest updates, share COVID-19 clinical cases and answer questions. For more information, click here or connect directly on Thursday here.

Ongoing throughout the COVID-19 Response: We continue to host twice weekly information sessions for health care providers on Tuesdays (OHA Webinar) and Thursdays (Project Echo) from 12-1 pm and will reassess for further needs as we go. Further details forthcoming.