Provider Newsletter – March 2021

Practice Tactics

Retroactive Prior Authorizations

Services that require prior authorization need to be submitted before the service is provided. If a request is received more than 30 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 are not related to an issue with eligibility, please follow our claims reconsideration and provider appeal process found on the UHA website at https://www.umpquahealth.com/claims/.

Prior Authorization Code Groups

UHA continually looks for ways to improve efficiencies and eliminate provider burden. One means of this service is by creating “Procedure Code Groups” for prior authorization (PA) requests. If a code group is available for your submission, you will only need to enter one (1) of the codes in this group and your max units. For example: If you are asking for a new patient office visit and three (3) follow-up requests, enter the CPT code (99201) and select “E&M Code Group”. Enter the max units of four (4). This means you requested any code from the group (99201-99205, 99210-99215), for 4 total visits. For a step-by-step submission instructional, see  our prior authorization website at https://www.umpquahealth.com/prior_authorizations/.

Member Appeals and Grievances

UHA, participating providers and subcontractors are to comply with UHA’s Grievance and Appeal System requirements. This means notifying the member of their right to a grievance (complaint)  or appeal (denied services) at any point they express dissatisfaction or concern with their care.  UHA, its subcontractors, and its participating providers may not:

  • Discourage a member from using any aspect of the grievance, appeal, or hearing process or take punitive action against a provider who requests an expedited resolution or supports a member’s grievance or appeal;
  • Encourage the withdrawal of a grievance, appeal, or hearing request already filed;
  • Use the filing or resolution of a grievance, appeal, or hearing request as a reason to retaliate against a member or to request member disenrollment;
  • Member grievance and appeals resolution process will protect the anonymity of complaints and protect callers from retaliation.

A member grievance or appeal may be received orally or in writing. With written consent, a provider or an authorized representative can file on the member’s behalf, either to UHA or to the State.  A grievance or appeal can be completed by going to the Customer Care office, in writing by mail or email, calling the standard phone number, or by using the TTY or TTY toll free phone number.  For more specific Grievance, Appeal and Hearing information, visit our website at https://www.umpquahealth.com/appeals-and-grievances/ or review our provider page at https://www.umpquahealth.com/providers/ for provider trainings and policies.

Clinical Corner

Management Guide for Asthma and COPD

UHA Pharmacists (Robin Traver and Tiina Andrews) have taken the latest guidelines for management of asthma (NIHLBI) and COPD (GOLD) and have created one-page management tools that align with current medications on the UHA Formulary.  You can use this for all of your patients to ensure the most effective yet cost effective approach to treating these respiratory conditions.  Of course, proper management supposes correct diagnosis, which relies on spirometry to confirm diagnosis and assess severity of these conditions.  These resources are located here.

Medication Therapy Management (MTM) Reminder

Providers seeking assistance identifying, preventing, and resolving medication-related problems for their patients are encouraged to:

  • Complete 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.

Alternatively, a completed MTM Referral Form may be submitted via email UHPharmacyServices@UmpquaHealth.com, or via fax to (541) 677-5881.

On the Lookout

For the latest information on COVID vaccination in Douglas County, visit Douglas Public Health Network: http://douglaspublichealthnetwork.org/

CME for Thee

PCPCH webinars on new measures through March

The Patient-Centered Primary Care Home (PCPCH) program has been creating pre-recorded webinars followed by live Q&A sessions twice a month for many of the new measures in the PCPCH model. This series will continue through early March. See more details here: https://www.oregon.gov/oha/HPA/dsi-pcpch/Pages/Resources-Technical-Assistance.aspx

Quality improvement training + TA for primary care: diabetes control and dental care for patients with diabetes March 11, noon-4 p.m.

Half-day virtual training plus an additional five hours per clinic team for individually tailored improvement support targeting poor HbA1C and oral health evaluation. TA will be provided by the Oregon Rural Practice-based Network and is sponsored by the OHA Transformation Center.

SBIRT webinar training series February–September

This SBIRT webinar training series is supported by the Oregon Rural Practice-based Research Network’s (ORPRN) ANTECEDENT project. ANTECEDENT focuses on addressing unhealthy alcohol use in Oregon. The project team intends to work with over 80 primary care clinics and provide each clinic with the evidence and tools they need to help patients with moderate to severe alcohol use disorder through the use of screening and brief intervention and medication assisted treatment. See flier for details: https://www.oregon.gov/oha/HPA/dsi-tc/Documents/2021%20Webinar%20Blurb.pdf

Contact: antecedent@ohsu.edu or Alissa.Robbins@dhsoha.state.or.us

REALD lessons learned for Phase 1 organizations

Phase 1 providers (see definition below) are invited to a learning series on lessons learned while operationalizing REALD. If you’d like to present on lessons your organization has learned, please contact Renee Harger (renee.a.harger@dhsoha.state.or.us) Craig Mosbaek (craig.mosbaek@dhsoha.state.or.us).

Phase 1 providers are:

  • Hospitals except for licensed psychiatric hospitals
  • Health care providers within a health system
  • Health care providers working in a federally qualified health centers

CADC-I Certification Opportunity

The Oregon Health Authority (OHA) is pleased to announce an opportunity for individuals living and working in rural and frontier Oregon to obtain the education required by the Mental Health and Addiction Counseling Board of Oregon (MHACBO) to become a Certified Alcohol and Drug Counselor Level I (CADC I).  Questions: call 541-241-8145 / email spiritlifewisdom@hotmail.com

Participants must meet the MHACBO CADC I requirements concerning criminal histories and their recovery status.  Participants must use their certification to work in a rural or frontier community.  As defined by Oregon Office of Rural Health (ORH).  Click on this link for a map that defines rural and frontier Oregon. https://www.ohsu.edu/media/881

Click here to see the announcement and here to view the application form.

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