HEDIS Preparation
Call for Claims
and Medical
Records
T
ogether, we fulfill the
requirements of the Health
Effectiveness Data and
Information Set (HEDIS) and,
in turn, reflect the quality of care
providers give to Alliance members.
We look forward to sharing another
successful HEDIS season with you.
Please remember to submit all
claims for 2012. This will increase
your rates for our annual HEDIS
reporting.
This year we will request more
medical records than in prior years
due to new state requirements and
decreased reporting time. Medical
record requests account for services
performed that are not captured
through claims. Thank you in
advance for your cooperation.
I
n September 2012, the Alliance
informed providers of the
impending transition of Healthy
Families (HF) members into the
Medi-Cal program. Few details
were known at that time, as the
Department of Health Care Services
(
DHCS) transition plan had not
yet been submitted to the state
Legislature. The plan was submitted
in October.
Based on information currently
available, we understand the
following:
●●
There are four phases for the
transition. The Alliance is impacted
only by phases 1 and 3.
●●
Current Alliance HF members will
transition to the Alliance Medi-Cal
program effective March 1, 2013.
This includes approximately 5,000
members in Santa Cruz County and
18,000
in Monterey County. This is
the second subphase of the phase 1
transition, with the first subphase
occurring on January 1, 2013.
●●
HF members covered by other
insurerswill transition to theAlliance
Medi-Cal program no sooner than
August 1, 2013 (phase 3). This
includes over 2,000 members
in Santa Cruz County, 8,700
members in Merced County
and a few hundred in Monterey
County as well.
●●
All currently enrolled HF
members will transition to
the Medi-Cal program and
are not at risk of losing
their coverage.
●●
The State sent all
HF enrollees a general
notice about the transition
November 1, 2012. Members
will also receive a 60-day notice
and a 30-day notice prior to
their exact transition date. The
notice will include information on
their benefits and changes to their
health, dental, and vision benefit
delivery system. The Alliance notice
to members will follow the State’s
notice.
●●
The state intends to continue
enrolling children into the HF
program until December 31, 2012.
Any HF enrollee that selects the
Alliance will be an Alliance HF
member through February, and
will transition to Alliance Medi-
Cal on March 1, 2013.
●●
HF members who have questions
about the transition or their coverage
can call the HF program for more
information at
(866) 848-9166
.
Details are still emerging. Staff
will continue to provide updates to
the network as new information is
received. Through our partnership
with our providers, we have a goal
of ensuring that our former HF
members will continue to receive
the same high-quality service from
their existing providers. Should
you have any questions or concerns
about the transition,
please contact your
Provider Services
Representative.
Healthy Families Update
New Additions to the
Alliance Formulary
●●
Ciclopirox 8% solution
●●
Metformin ER
●●
Oxycodone/APAP—
all strengths
DECEMBER 2012
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PROVIDER NEWS