Provider Newsletter August 2020

Practice Tactics

Prior Authorizations

UHA’s Prior Authorization (PA) Grid has been updated. We have also included a change log on the last page of the form so you can see when changes were made.

Retro-PAs

UHA follow’s Oregon Health Authority guidelines for timely submission of prior authorizations. These need to be submitted before the service occurs with sufficient time for review. If you did not submit a prior authorization before the time of service, do not submit a PA, instead you will need to submit your claim with supporting documentation. Retro authorizations may be denied for untimely submission if they are not due to member eligibility.

More on Appeals

Have you ever wondered what the appeal process looks like for the members? Or what options they have if they have a complaint that they would like to address? The Provider Handbook (Section 8) and our website have been updated to include additional information on these topics. Members can reach out to UHA Customer Care Monday-Friday for assistance with these processes, but it’s always good to pass along information to the member in cases where they reach out to you for help. Keep an eye out for additional upcoming updates as well! For now, here are a few things to note:

  • Members can file a grievance (complaint) at any time to UHA or OHA orally or in writing.
  • If a member brings a complaint to your attention, and it is something that you can also address, please do. But please remember, UHA, its subcontractors, and provider should not discourage a member from exercising their rights.
  • If you feel that the member’s health is in serious jeopardy and requires expedited actions, there are options.
  • There is now an Appeals and Grievance tab on the UHA website, please feel free to encourage members to find information and additional forms here
  • Claims Reconsiderations and Provider Appeals information found here

If you have additional questions, please feel free to email UHAGrievance@umpquahleath.com

Clinical Corner

Pharmacy in Action: DUR

This quarter’s Drug Utilization Review (DUR) is concentrating on appropriate management of Asthma.

Clinical Guidelines consistently emphasize use of controller medication (inhaled corticosteroids: ICS) in optimal asthma therapy.  The Pharmacy team has identified UHA members with asthma who have received 4+ prescriptions for “rescue” inhaler (short acting beta agonists: SABA) without an Rx for ICS.  Members and providers received letters reminding the guidelines recommendations.  This has led to new therapy prescriptions, and hopefully, improved health for our members and avoidance of hospital services.

New Clinic for Unassigned Atrio Members

Of the nearly 8,000 Atrio Medicare Advantage members in Douglas County, approximately 3,000 have not chosen or visited a PCP in the last 18 months.  This results in a lack of assessment of risk and gaps in quality care.  P3 Health Partners is a physician led organization that partners with Umpqua Health Network to provide clinical management for Atrio members. P3 has established a Nurse Practitioner clinic within the UHA Transitional Care Clinic on the Mercy campus.  The NP will offer an intake examination (Home, Telehealth, or @ Clinic) for unassigned members to complete risk assessment and close quality gaps.  They will then facilitate assignment to a local PCP.

P3 has a web-based platform, Patient 360, which has up to date information on Atrio members who currently see local PCPs.  P3 is training PCPs on how to use this tool to complete annual comprehensive exams.  For more information, contact Michelle Ross: mross@p3hp.org.

On the Lookout

Douglas Public Health Network staff are working to address COVID-19 in Douglas County. Click http://douglaspublichealthnetwork.org/ for information on how to keep up with the latest local news related to coronavirus, and be sure to request their expanded daily report of COVID-19 related news to be sent to your inbox.

CME for Thee

Webinar: Help adolescents get back on track with immunizations: You are the key to HPV cancer prevention. 8/06, 1-2 p.m. Free CME with advanced registration.
Contact: Anona Gund (anona.e.gund@dhsoha.state.or.us)
Oregon has seen reduced adolescent immunization rates across the state during COVID-19 while in-person adolescent well visits were put on hold. Now that adolescent well visits have resumed, this webinar, hosted by the Oregon Pacific Area Health Education Center, will help all immunization providers make an effective recommendation for HPV vaccination and answer parents’ questions. Register in advance for free CME at: https://bit.ly/YATKAug2020

Webinar: Patient Education and Engagement in Diabetes Care. No-cost, CME-accredited webinar for clinicians
Contact: Sarah Wetherson (sarah.e.wetherson@dhsoha.state.or.us)
How can you help educate and engage patients with diabetes to control HbA1c? Learn more through this no-cost CME-accredited webinar for clinicians who serve Oregonians. The Transformation Center-produced webinar features Dr. Andrew Ahmann, director of the Harold Schnitzer Diabetes Health Center and recipient of the 2018 Outstanding Physician Clinician in Diabetes Award from the American Diabetes Association. After this one-hour recorded presentation, participants will be able to:

  • Review CCO diabetes HbA1c poor control metric specifications
  • Explain what controlling diabetes means and why it is important
  • Name barriers to good glucose control
  • Identify the clinic’s role in lifestyle interventions
  • Understand how to promote diabetes education with your patients
  • Name current standards of care for your patients with diabetes

When: Available on demand through June 30, 2022
Webinar registration: https://attendee.gotowebinar.com/register/3442121612601905932
This educational activity is supported by the Oregon Health Authority.
Accreditation: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of OHSU School of Medicine and Oregon Health Authority. The OHSU School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.
Credit: OHSU School of Medicine designates this live activity for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

COVID-19 Information Sessions for Providers. Updated session details.
Contact: oen@ohsu.edu for Project ECHO sessions.
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, Dana Hargunani, M.D., will host regular information sessions for Oregon health care providers.
Informational Sessions for all Health Care Providers. 1st and 3rd Thursdays, noon-1 p.m.
Links for upcoming sessions:

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