For more information

Call our Provider Service Centerat 877-842-3210

Visit UnitedHealthcareOnline.com

In This Issue:

• Vaccines . . . . . . . . . . . . . . . . . . . . . . . . 1

• Physician Satisfaction SurveyUnderway . . . . . . . . . . . . . . . . . . . . . . . 2

• Inaugural National MedicareEducation Week –September 15 - 22, 2012 . . . . . . . . . . . 3

• Measures to Monitor TreatmentAdequacy for Patients withDepression . . . . . . . . . . . . . . . . . . . . . . 3

• Prompt Responses to AppealsInquiries Ensure Continuity of Care . . 5

• New Clinical GuidelinesUnitedHealthcare Community Plan . 5

• National Institute for Mental HealthResources: Focus on Medications . . . . 6

• When Forces Collide: TraumaticBrain Injury Masquerading asADHD in Adolescents . . . . . . . . . . . . 7

• Blue Button Gives Members Accessto Their Personal Health Records . . . 10

• UnitedHealthcare CommunityPlan Provider Portal Online-Authorizations and NotificationProcess . . . . . . . . . . . . . . . . . . . . . . . . 10

• Getting Started with EDIis simple . . . . . . . . . . . . . . . . . . . . . . . 11

• Quality Improvement . . . . . . . . . . . . 12

Important information from UnitedHealthcare for physicians and other health careprofessionals and facilities serving UnitedHealthcare Medicaid members

Vaccines

Network primary care providers are required to provide all Plancovered U.S. Center for Disease Control and Prevention (CDC)recommended vaccines to members. If your patient is a FloridaHealthy Kids member, vaccines will be through private stock, andare reimbursed according to the federal Title XXI fee schedule. Ifyour patient is a Medicaid M*Plus member, vaccines must beacquired through the Vaccine for Children (VFC) Program.Members should not be referred to a health department or otherprovider for their immunizations, except in the very rarecircumstance of extreme vaccine shortage.

The VFC Program is intended to help raise childhoodimmunization levels in the United States, especially among infantsand children. This federally funded program provides vaccines freeof charge to participating providers. The vaccines may then be madeavailable to children up to age 19 who are enrolled in the Medicaidprogram. It is not available to Florida Healthy Kids or Medikidsmembers.

Borrowing Vaccines from private stock for VFC-eligible patients orfrom VFC stock for other patients is allowed in rare unplannedsituations. Borrowing would occur only when there is a lack ofvaccine due to unexpected circumstances, such as a delayed vaccineshipment, vaccine spoiled in-transit to provider, or new staffmembers who calculated ordering time incorrectly. A borrowingform can be found atcdc.gov/vaccines/programs/vfc/downloads/borrowforms-508.doc

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Below are the 2012 immunization schedules forchildren and adults. UnitedHealthcarerecommends participation in the FloridaSHOTS program. Florida SHOTS (StateHealth Online Tracking System) is a free,statewide, centralized online immunizationregistry that helps health-care providers andschools keep track of immunization records.Florida SHOTS allows registered, authorizedsystem users to access confidentialimmunization information via a secure electronicsystem to check immunization status, updateinformation in the system, and register newchildren. An authorized user who needs to find achild’s immunization history can search thesystem. This important immunization registryhelps to eliminate duplicate vaccinationadministration, allows for easy school vaccinationform printing, and ensures a long-term securerecord of immunizations. Physicians and otherproviders are strongly encouraged to participate.

Physician Satisfaction SurveyUnderway

The annual Physician Satisfaction Survey processhas begun, and you should have received yourfirst fax notification. There will be two morenotifications to participate before the surveycloses in October.

This is youropportunity to letUnitedHealthcareCommunity Planknow how we canimprove ourworkingrelationship andservice to you andhow we can worktogether to better meet the needs of you andyour practice. We look forward to yourparticipation in the survey process.

Thank you for your continued participation withUnitedHealthcare Community Plan.

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Inaugural National MedicareEducation Week – September 15 -22, 2012Medicare, our nation’s largest health insuranceprogram, serves 49 million Americans (accordingto the Centers for Medicare & MedicaidServices). Due to its scale, it can be a complexand confusing system to navigate.

Inaugural Medicare EducationWeekNational Medicare Education Week, which runsSept. 15 – Sept. 22, is dedicated to helping BabyBoomers, and Medicare members, their familiesand caregivers learn more about our nation’slargest health insurance program, serving 49million Americans.*

Taking the time to learn about Medicare duringNational Medicare Education Week will helpyour patients better prepare to make informed,confident health care decisions during theMedicare Open Enrollment Period which runsOct. 15 - Dec. 7, 2012.

A variety of informational resources are availableto you including:

• NMEW.com.

• MedicareMadeClear.com.

• Medicare Made Clear Facebook page.

• National Medicare Education Week app ortab, on the Medicare Made Clear Facebookpage.

• Attend a National Medicare Education Weekevent in your community.

• Watch a National Medicare Education Weekevent on the Medicare Made Clear Facebookpage. Visit the page in early October to see therecording.

• Call 877-630-8721 to request aUnitedHealthcare Medicare MadeClear guide.

• Visit Medicare.gov or call 1-800-MEDICARE (TTY users 877-486-2048),available 24 hours a day, seven days a week, formore information.

• Visit your local State Health InsuranceAssistance Program (SHIP) office.

* Source: Centers for Medicare & Medicaid Service.

Measures to Monitor TreatmentAdequacy for Patients with Depression

UnitedHealthcare Community Plan and ourbehavioral health vendor, United BehavioralHealth are providing you information we hopeyou will find helpful in caring for your patients.

Depression is the most common behavioralhealth condition affecting adults and it is alsothe most treatable. One national health careaccrediting organization, the NationalCommittee for Quality Assurance (NCQA) hasestablished a set of measures to monitortreatment adequacy for patients with depressionwho are prescribed antidepressant medication.The measures recognize the crucial role thatprimary care physicians play in the diagnosis andtreatment of depression.

Compliance for depression is monitored by:

• The percentage of newly diagnosed and treatedmembers who remained on an antidepressantmedication for at least 84 days (12 weeks).

• The percentage of newly diagnosed and treatedmembers who remained on an antidepressantmedication for at least 180 days (6 months).

Referrals by prescribing clinicians to therapistsor counselors early in the treatment episodeincreases compliance with three follow-upcontacts in 12 weeks and medication

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compliance. Recent research has shown thatusing therapy in addition to medicationsproduces the best clinical outcomes.1

One of the major problems in treatingdepression is related to patients not complyingwith treatment recommendations made by theirprescribing clinician. One way to increase

patient compliance is with educationat the beginning of the treatmentepisode. Patients should receiveinformation related to the followingkey areas:

• How antidepressants work.

• The benefits of antidepressanttreatment and the expectation ofremission of symptoms.

• How long the medications should be used.

• Coping with side effects of the medication.

In addition, United Behavioral Health haspsychiatrists available to answer questions youmay have regarding psychiatric medication andtreatment. This service is available from 9 a.m. to4 p.m. Eastern Time, Monday through Friday.Call our dedicated toll free number 800-720-4128for a consultation.

If you would like to receive educational materialson Depression and other behavioral healthconditions, please contact United BehavioralHealth at 800-720-4128 or ATLQI@uhc.com.UnitedHealthcare Community Plan and UnitedBehavioral Health are committed to supportingprimary care physicians in identifying, treatingand referring patients with behavioral healthdisorders.Craig W. Gage, MD, Florida Health Plan Medical DirectorUnitedHealthcare Community Plan

Michael Soto, MD, Regional Medical DirectorUnited Behavioral Health

1 Arnow, BA. Effectiveness of psychotherapy andcombination treatment for chronic depression. J ClinPsychol 2003 Aug; 59(8): 893-905

Inaugural National MedicareEducation WeekSep. 15 – 22, 2012

National Medicare Education Week, which runsSept. 15 – Sept. 22, is dedicated to helping BabyBoomers, and Medicare members, their familiesand caregivers learn more about our nation’slargest health insurance program, serving 49million Americans.*

Taking the time to learn about Medicare duringNational Medicare Education Week will helpyour patients better prepare to make informed,confident health care decisions during theMedicare Open Enrollment Period which runsOct. 15 - Dec. 7, 2012.

A variety of informational resources are availableto you including:

• NMEW.com.

• MedicareMadeClear.com.

• Medicare Made Clear Facebook page.

• National Medicare Education Week app ortab, on the Medicare Made Clear Facebookpage.

• Attend a National Medicare Education Weekevent in your community.

• Watch a National Medicare Education Weekevent on the Medicare Made Clear Facebookpage. Visit the page in early October to see therecording.

• Call 877-630-8721 to request aUnitedHealthcare Medicare Made Clearguide.

• Visit Medicare.gov or call 1-800-MEDICARE (TTY users 877-486-2048),available 24 hours a day, seven days a week, formore information.

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• Visit your local State Health InsuranceAssistance Program (SHIP) office.

* Source: Centers for Medicare & Medicaid Service.

Prompt Responses to Medicare Part DPrescription Appeals Inquiries EnsureContinuity of Care

When you or your patient, files an appeal withUnitedHealthcare, we will contact your office viafax or phone to request certain key informationneeded as part of the appeal process.

By federal law, UnitedHealthcare must render anappeal decision within 72 hours for an expeditedrequest and seven calendar days for a standardrequest.

Your assistance in responding to these requestspromptly helps ensure continuity of themember’s treatment plan.

NEW CLINICAL GUIDELINES

Notification - Effective Oct. 1, 2012 the use ofAntiemetic Medication through a continuoussubcutaneous pump in the treatment of nauseaand vomiting in pregnancy will no longer becovered under UnitedHealthcare CommunityPlan.

Synopsis of report by: Gordon B. Kuttner, MD,MBA, FACOG, FACS, National Sr. MedicalDirector, Optum Health-Healthy First Steps TMUnitedHealthcare Community Plan

Nausea and vomiting during pregnancy, nothyperemesis gravidarum, is a common conditionthat affects 70–85 percent of pregnant women.Fifty percent of pregnant women have bothnausea and vomiting, 25 percent have nauseaonly, and 25 percent are unaffected. (Gadsby,1993; Vellacott, 1988). The mechanism orphysiologic pathway causing the nausea andvomiting is unknown and may be multifactorial.Onset of these symptoms typically is in the

fourth to sixth week of gestation, with a peakoccurrence in the eighth to twelfth week andresolution by week 20.

Hyperemesis gravidarumappears to represent theextreme end of thespectrum of nausea andvomiting duringpregnancy. The incidenceof hyperemesisgravidarum occursinapproximately 0.5–2percent of pregnancies.There is no singleaccepted definition ofhyperemesis gravidarum; it is a clinical diagnosisof exclusion based on a typical presentation inthe absence of other diseases that could explainthe findings. The most commonly cited criteriainclude persistent vomiting not related to othercauses, a measure of acute starvation (usuallylarge ketonuria), and some discrete measure ofweight loss, most often at least 5 percent of pre-pregnancy weight.

For a subset of pregnant women, the nausea andvomiting becomes severe, unremitting anddebilitating. Hyperemesis gravidarum is extremenausea and vomiting during pregnancy. Whendiet modification and non-pharmacologicmethods fail to reduce or eliminate thesymptoms, various medications includingantiemetic medications may be tried.Unfortunately, no single therapy works in allwomen, and occasionally, multiple differentmedications must be tried before finding the onethat is most effective. There is no FDA-approvedantiemetic medication for the treatment ofnausea and vomiting of pregnancy.

Over the last 20 years, the concept ofsubcutaneous continuous administration ofantiemetic drugs has been heavily marketed to

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the obstetric community virtually without anynon-industry-supported medical evidence orscience to support its use as equal or superior toless expense options. Most of these reports havebeen observational using a single company’sunverified database. Since the prevalence ofnausea and vomiting in pregnancy is so high, it isreasonable to expect well-designed, randomized,controlled trials between various medications androutes of administration with sufficient samplesize to demonstrate a clinically meaningfuldifference in cost and outcome effectiveness withseveral of the more common medicationscommonly used for this condition.

Dr. Niebyl authored a review article in the NewEngland Journal of Medicine published onOctober 14, 2010, reviewing the topic of nauseaand vomiting in pregnancy. Niebyl compiled alist (Table 1. Pharmacologic Treatment ofNausea and vomiting in Pregnancy) detailing thevarious agents, doses and routes ofadministration, side effects, FDA category, andcomments.) The agents include vitamins, ginger,antihistamines, dopamine antagonists, 5hydroxytryptamine-3 receptor antagonist andglucocorticords. The recommendations in thisreview are concordant with guidelines publishedby the American College of Obstetricians andGynecologists and by the Society ofObstetricians and Gynecologists of Canada forthe management of nausea and vomiting inpregnancy.

American College of Obstetricians andGynecologistsAccording to ACOG’s step-wise approach tomanaging nausea and vomiting of pregnancy,ondansetron may be tried in refractory cases as alast resort. When indicated, ACOG guidelinesrecommend 8 mg of ondansetron over 15minutes every 12 hours I.V. ACOG makes nomention of continuous subcutaneous

administration. (ACOG 2004 and reaffirmed2009)

Canadian Society of Gynecologists andObstetriciansThe recommendation by the Canadian Societyof Gynecologists and Obstetricians (2002) is thatdue to the scant safety data and limitedeffectiveness data, that 5-HT3 antagonistsshould not be advocated for first-line use untilagents with established safety and effectivenesshave been tried and failed.

At this time the evidence-based literature on thetopic of cost-effective, outcome-based treatmentsfor nausea and vomiting in pregnancy revealsthat the use of Zofran (ondansetron) and Reglan(metoclopramide) administered via a continuoussubcutaneous pump for the treatment of nauseaand vomiting in pregnancy is unproven.

To read the entire review please go toUnitedHealthcareOnline.com>clinicianresources>women’s health>notifications.

National Institute for Mental HealthResources: Focus on Medications

The National Institute for Mental Health(NIMH) web site contains resources designedfor practitioners and consumers that you mayfind helpful in your practice.

For example, their Health Topics publicationsinclude a guide called "Mental HealthMedications." This resource contains consumerinformation covering medications used to treatmental disorders, their side effects and directionsfor taking these medications. It also includesU.S. Food and Drug Administration (FDA)warnings. The guide is available online andincludes links that support review of topics ofinterest and may also be saved or printed as aPortable Document File “pdf.”This publicationcovers:

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• Medications used to treat Schizophrenia,Depression, Bipolar Disorder, AnxietyDisorders, and ADHD.

• Special needs of children/adolescents, olderadults, and pregnant women.

• Suggested questions to ask the prescriber aboutthe medications being prescribed.

• An alphabetical list of medications containingthe trade and generic names and the FDAapproved age for dispensing.

You can find this and many other resourcesthrough the home page of NIMH.

When Forces Collide: Traumatic BrainInjury Masquerading as ADHD inAdolescentsBy Robert A. Friedman, M.D., Associate Medical Director,Outpatient Services and Darin J. Arsenault, MFT, Ph.D., CareAdvocate, ALERT Program

A fourteen-year-old male adolescent namedJimmy is referred to you by his school

counselor after experiencingdifficulty in his classes. His parentsattend the first session to providehistory and report their concerns.The school reports that Jimmy isnot completing his assignments inclass or finishing his homework.When he does complete hishomework, he forgets to bring itinto class or hand it in when due.He seems distracted and is havingtrouble concentrating. At home, heforgets to do his chores andmisplaces objects such as his

house keys and cell phone. You suspect thathe may have a diagnosis of Attention DeficitHyperactivity Disorder (ADHD), but oncompleting a thorough clinical assessmentwith Jimmy and his parents, you find nohistory of these symptoms throughout his

early childhood years. Prior to this year hewas an “A” student and considered a positiveleader amongst his peers. He is also veryactive in team sports and is well liked by hiscoaches and teammates. In addition, there isno family history of ADHD. He has alwaysbeen a cooperative member of his household.Upon further exploration, you learn that thisyoung man has been playing quarterback on atackle football community league, with hopesof playing in high school and college. Hisfather proudly reports that he is talented, andthough he has been tackled many times, buthe gets up, brushes it off, and keeps playing.His mother recalls that this past fall, Jimmysometimes appeared a little dazed andconfused after being tackled, but was able tokeep playing. A recent visit to his pediatricianwas cordial, and his physical exam and labtests were all normal. What do you do?

Traumatic Brain Injury (TBI) in children andadolescents has recently emerged as a majorpublic health problem in the United States.According to a poster presentation at the EighthWorld Congress on Brain Injury (Fall, 2010), inthe US, there are 1.4 million TBI related visits toemergency rooms each year, with 52,000 casesresulting in death. The majority of these visitsare accounted for by children and older adults,who are at a higher risk for sustaining headinjuries, mostly as the result of falls and motorvehicle accidents, as well as being struck bypeople or objects, such as during sporting events.Public awareness about TBIs in increasing andhas begun to influence legislation. In California,for example, the legislature signed into lawAssembly Bill 25 in October 2011. This lawrequires that any student-athlete who appears tohave received a head injury or concussion duringa game or practice is restricted from returning tothe activity for the remainder of the day, andmust be evaluated by a licensed health careprofessional trained in the assessment and

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treatment of concussions and head injuries(Bohan, Feb. 2, 2012).

Symptom andCondition RecognitionIt is not necessary to experience a loss ofconsciousness to experience a concussion. Thesymptoms can be as subtle as a headache, nausea,dizziness or brief disorientation, resulting fromtemporary metabolic chemical changes in thebrain due to a temporary decrease in blood flowto the brain. These symptoms generally resolveand return to normal within one to two weeks.However, if one continues to experience repeatedhead trauma or concussions, it could result in anacute second impact syndrome with swelling inthe brain. Although rare it can result in death. Asecond possible risk is development of a chronictraumatic encephalopathy which sometimesoccurs in adult athletes, resulting in memory loss,attention problems, and changes in mood andbehavior (McKee, Cantu, Nowinski, Hedly-Whyte, Gavett, Budson, Santini, Lee, Kubilus, &Stern, (2009). We see this perhaps mostpointedly with the suicides of National FootballLeague players Dave Duerson and Andre Waters(Schwarz, Feb. 20, 2011)

We are more likely to hear about the mostserious consequences of sports injuries but theirsubtle consequences warrant our attention. Infact, the most common cognitive deficitsfollowing a TBI manifest as attentionalimpairments. Symptoms include slowedprocessing of information, inability to sustainattention, memory deficits, and other aspects ofexecutive functioning (Landre, Poppe, Davis,Schamus, & Hobbs, 2006). Moderate to severeclosed head injuries, accounting for 20 percent ofdocumented TBIs, interfere with school andwork performance and compromise the ability tolearn and complete tasks successfully. Lesscommonly, TBIs can result in personalitychanges, including such features as apathy, mood

and behavioral lability, high impulsivity, paranoia,aggression, and psychosis. These changes maynot manifest for several months after the injury.Increases in the rates of oppositional defiantbehaviors and obsessive-compulsive symptomshave also been observed (Max, Robertson, &Lansing, 2001).

TBI and ADHDThe relation between the impact of TBI onADHD (and ADHD on TBI) is still unclear.Keenan et al (2008) note that the relationshipbetween TBIs and ADHD may be morecomplicated than is initially apparent. As onemight expect, children with ADHD may bemore at risk to sustain head injuries and TBI, asa result of their inattentiveness and impulsivity.Nevertheless, a UK study of 62,082 childrenfound that the rate of ADHD was double inchildren who suffered from a head injurycompared to those who did not sustain an injury.Whether children with ADHD are more at riskfor head injuries, or head injuries can causesymptoms similar to that seen in childrendiagnosed with ADHD, clinicians need to beaware of the correlation, in order to makeappropriate treatment recommendation andinterventions.

InterventionsIn the case of the fictional vignette above, severalclinical recommendations can be levied. First,one consideration is to limit contact sports toprevent further head injury. This might bedifficult, especially if the family is supportive ofJimmy’s desire to play team sports. Ensuring thatJimmy has appropriate protective equipment mayhelp slightly to minimize injuries.Psychoeducation with the family about the risksassociated with acute as well as recurrent traumato the brain, secondary to full contact sports,might be helpful. Second, monitor Jimmy forresolution of the symptoms. A discussion with

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the school and family members could aim atidentification of particular symptoms Jimmy hasbeen struggling with. Third, further brain testingcould be done. A functional MRI, thoughexpensive, could determine which brain sectorsare affected. Neuropsychological testing couldalso help to pinpoint current cognitive strengthsand weaknesses for Jimmy and track changesover time. Fourth, consider treatmentinterventions that are typically used for ADHD,including medication, academic support, andmodification of tasks aimed at improvingattention, concentration, and memory. Whyte,Caccaro, Grieb-Neff, Risser, Polansky, andCoslett (2004) showed in a randomized trial that(Ritalin) methylphenidate is helpful inameliorating some attention deficits such asinformation processing speed and sustainedattention after TBI. Consultation with thepediatrician or child psychiatrist might bevaluable in tailoring medication treatment tosymptoms that may decrease over time. Inaddition, consultation with the school aboutmodifying academic expectations, and employingsimple educational accommodations in order toimprove or compensate for Jimmy’s attentionproblems, may be helpful. For example, givingJimmy short breaks between tasks requiringsustained concentration may help him regroupcognitive resources in order to focus on the nexttask. Breaking up longer tasks into shorter, moreconcrete steps may help Jimmy complete tasksmore readily. At home, putting his house key andcell phone in a particular area, such as on acredenza area near the front door upon entry, oron his nightstand may help him cue morereadily. As always, good clinical practice entailsthorough assessment, education for Jimmy andhis parents, teachers, counselors, coaches, andcollaboration with his pediatrician. Thedevelopment and implementation of appropriatetreatment interventions that are effective intargeting the symptoms that interfere with

Jimmy’s ability to succeed in school, at home,and with peers, are essential for Jimmy and hisfamily. A treatment team approach will offerJimmy the best chance of minimizing the impactof his impairments, help him cope with hisinjuries more successfully, and maximize hisfunctioning now and in the future.

ReferencesBohan, S. (February 2, 2012). California’s concussion lawputs teams on the spot. Contra Costa Times.http://www.contracostatimes.com/news/ci_19873101

Faul, M., Xu, L., Wald, M.M., & Coronado, V.G. (2010,March 12). Traumatic Brain Injury in the United States:Emergency Department Visits, Hospitalizations and Deaths2002–2006. Atlanta (GA): Centers for Disease Control andPrevention, National Center for Injury Prevention andControl.

Keenan, H.T., Hall, G.C., & Marshall, S.W. (2008). Earlyhead injury and attention deficit hyperactivity disorder:Retrospective cohort study. BMJ, 337, a1984.doi:10.1136/bmj.a1984.

Landre, N., Poppe, C.J., Davis, N., Schmaus, B., & Hobbs,S.E. (2006). Cognitive functioning and postconcussivesymptoms in trauma patients with and without mild TBI.Archives of Clinical Neuropsychology, 21, 255-273.

Max, J.E., Robertson, B.A.M, & Lansing, A.E. (2001).Personality Change Due to Traumatic Brain Injury inChildren and Adolescents. The Journal of Neuropsychiatryand Clinical Neurosciences, 13, 161–170.

McKee, A.C., Cantu, R.C., Nowinski, C.J., Hedly-Whyte,E.T., Gavett, B.E., Budson, A.E., Santini, V.E., Lee, H-S,Kubilus, C.A., & Stern, R. A. (2009). Chronic traumaticencephalopathy in athletes: Progressive tauopathy followingrepetitive head injury. J Neuropathol Exp Neurol, 68, 709-735.

Schwarz, A. (February 20, 2011). N.F.L. Players shaken byDuerson’s suicide message. New York Times, D1.http://www.nytimes.com/2011/02/21/sports/football/21duerson.html?_r=2&ref=health

Whyte, J., Hart, T., Vaccaro, M., Grieb-Neff, P., Risser, A.,Polansky, M., Coslett, H.B. (2004). Effects ofmethylphenidate on attention deficits after traumatic braininjury: A multidimensional, randomized, controlled trial.Am J Phys Med Rehabil, 83, 401–420.

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Blue Button®

Enhances CareGives MembersAccess to theirPersonal Health Records

UnitedHealthcare is now partnering with theU.S Department of Veterans Affairs to offer BlueButton access to personal health information forour members . Members will be able to viewand print their personal health records usingBlue Button Download My Data®.UnitedHealthcare joined this national initiativeto empower members with access to theirhealthcare information (PHR) and enable themto share this PHR information with their healthcare providers, caregivers, or people they trust.

Blue Button features include:• Allows patients to share their Personal Health

Record (PHR) in PDF or text format withtheir health care provider, their provider’sclinical staff and caregivers.

• Gives health care providers a clearer picture oftheir patient’s overall health status throughaccess to more comprehensive healthinformation.

• Gives health care providers improvedinformation that may impact medicationprescribing and dosages.

• May reduce risks associated with missinginformation needed to make importantmedical decisions.

• Reduces or eliminates the need for clinicalstaff to search for immunization records orother medical information related to careprovided by another physician.

• Provides patients with 24/7 access to theirhealth care information.

• Is an interim measure to achieving partialcompliance with Stage 2 of Meaningful Use.

Please encourage your patients to use the BlueButton on the Health and Wellness tab atmyUHC.com. Having a patient’s PHRinformation readily available to staff can helpreduce clinic time and costs. Remember to askyour patients to bring their current Blue ButtonPersonal Health Records with them to theiroffice visits.

Providers will not automatically see the BlueButton on UnitedHealthcareOnline.com butpatients may grant you access.['Blue Button,' the Blue Button logo and the slogan'Download My Data' are Service Marks of the U.S.Department of Veterans Affairs (VA), an agency of theUnited States Government and are used by permission ofthe VA.]

UnitedHealthcare Community PlanProvider Portal Online-Authorizationsand Notification Process

As a Health Professional your time is important!We would like to remind you of a time-savingmethod of checking prior notification status andreporting notifications to UnitedHealthcare PriorNotification Department. Register today for theUnitedHealthcare Community Plan ProviderPortals. Use of our Provider Portals to reportMedical Prior Notifications and check the statusof your notifications will save time and the use ofyour valuable staff resources.

How to access the secure provider portals:• UHCCommunityplan.com/health-

professionals.com (select your state)

• Select Claims and Member Information tab

• Locate the member product

• Select the Access to the secure providerwebsite icon

• If you are a registered provider, proceed tologin and enter your on-line prior notificationsand check the status of your prior notifications.

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• If you are not a registered provider, pleaseproceed to the registration link. Once yousecure your username and password, proceed tologin and submit your on-line priornotifications.

On UnitedHealtcareOnline.comLocate the Notifications/Prior Authorizationstab and enter your notifications.

On UHCCommunityplan.com• Locate the Patient Tab-Notification Link

• Select the Notification Submission link. Thisaction will open the appropriate notificationsubmission data entry page.

• In some cases, you will have access to theseparate Radiology Notification link

Assistance:• Quickly access on-line submission notification

screens

• Access the on-line PDF quick reference on-line submission and notification status guides.

• Problems with data entry-access the on-linecontact us link. A representative will be able tohelp you with data entry related issues!

Did you know by converting 10,000 paperclaims, remittance advice, and reimbursementsto electronic transmittal (EDI, EFT, and ERA)we could:

• Save 3729 pounds of paper

• Eliminate 148,389 pounds of greenhouseemissions (Equivalent to 1726 new trees grownfor 10 years or 20,451 square feet of forestconserved).

• Average Practice can save thousands of dollarsper year by converting to electronictransmission.

Source: payitgreen.org

Getting Started with EDI is simple

To submit claims electronically have your officesoftware vendor or clearinghouse make aconnection to UnitedHealthcare’s ClearinghouseOptumInsight.

OptumInsight.com800-341-6141Inisght@Optum.com

UnitedHealthcareCommunity Plan Payer ID:87726Submit claims directly toUnitedHealthcareCommunity PlanYou can access our Secure Provider Portal byvisiting the Claims and Member section of yourstate’s home page onUHCCommunityPlan.com there is no cost forthis service.

There are a number of additional freeelectronic claim submission solutions forProviders such as Office Ally.Please visit the EDI Section of your state’s homepage located on UHCCommunityPlan.com forfurther information.

COB (Secondary) EDI Claims Submissionsare preferred electronically.• Please review the 837 Companion Guides

located on UnitedHealthcareOnline.com foradditional information and setup.

• Do not send paper claim backup for claimsthat have already been submitted electronically.

Electronic Claim SubmissionTips• Include your tax identification number (TIN)

along with your NPI number.

• Member ID numbers are required.

• The Payer ID number indicates whereclearinghouses should direct their claims.

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www.OptumInsight.com

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QUALITY IMPROVEMENT

Quality Improvement ProgramThe Quality Improvement Program at UnitedHealthcare consists of components such as:

• Quality Improvement and Performance Measures and studies

• Clinical practice guidelines

• Health promotion activities

• Service measures and monitoring

• Ongoing monitoring of key indicators (e.g., over and underutilization, continuity of care)

• Health plan performance information analysis and auditing (e.g., HEDIS)

• Care Coordination

• Educating members and physicians

• Risk management

• Compliance with external regulatory agencies

The State of Florida Agency for Healthcare Administration (“Agency”) requires the below HEDIS andAgency-defined measures for all Medicaid health plans. The UnitedHealthcare Community Plan ofFlorida (M*Plus/Medicaid) results for the 2011 measurement year (HEDIS 2012) are included below.

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Performance / Outcome Measure Results Reported to AHCA on July 1, 2012:2012 Results (Measurement Period: Jan. 1, 2011 – Dec. 31, 2011)

IndicatorMeasurement

TypeMedicaidReform

MedicaidNon-Reform

Adolescent Immunizations (Combo 1) IMA HEDIS 42.78% 51.82%

Adolescent Well Care AWC HEDIS 50.61% 48.91%

Adults Access to Preventive/Ambulatory AAP HEDIS 82.08% 72.25%

Annual Dental Visits ADV HEDIS 43.30% No Benefit

Antidepressant Medication Management AMM HEDIS

Initiation N/R 46.98%

Continuation N/R 33.33%

BMI Assessment ABA HEDIS 38.93% 49.64%

Breast Cancer Screening BCS HEDIS 48.11% 50.52%

Call Abandonment CAB HEDIS 2.60% 2.60%

Call Answer Timeliness CAT HEDIS 82.54% 82.54%

Important information for health care professionals and facilities

I Fall 2012 13 Provider Service Center: 877-842-3210

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Performance / Outcome Measure Results Reported to AHCA on July 1, 2012:2012 Results (Measurement Period: Jan. 1, 2011 – Dec. 31, 2011)

IndicatorMeasurement

TypeMedicaidReform

MedicaidNon-Reform

Cervical Cancer Screening CCS HEDIS 53.90% 55.61%

Childhood Immunization CIS HEDIS

Combo 2 88.10% 73.72%

Combo 3 86.90% 66.42%

Children and Adolescents’ Access to Primary Care CAP HEDIS

12 – 24 Months 98.46% 96.26%

25 months – 6 years 90.29% 88.71%

7 – 11 years 85.17% 85.84%

12 – 19 years 85.30% 82.70%

Chlamydia Screening for Women CHL HEDIS 58.50% 62.09%

Comprehensive Diabetes Care CDC HEDIS

Hemoglobin A1c (HbA1c) testing 84.70% 79.32%

HbA1c Poor Control 43.14% 52.31%

HbA1c Control (<8%) 49.02% 38.93%

Eye Exam (retinal) Performed 43.14% 46.96%

LDL-C Screening 81.70% 79.32%

LDL-C Control (<100mg/dL) 32.03% 26.52%

Medical Attention for Nephropathy 77.12% 78.35%

Controlling High Blood Pressure CBP HEDIS 56.30% 50.61%

Follow-up Care for Children Prescribed ADHDMedication

ADD HEDIS

Initiation 40.24% 39.51%

Continuation N/R 47.93%

Lead Screening in Children LSC HEDIS 60.12% 51.58%

Pharyngitis – Appropriate Testing Related toAntibiotic Dispensing

CWP HEDIS 64.87% 58.79%

Important information for health care professionals and facilities

I Fall 2012 14 Provider Service Center: 877-842-3210

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Performance / Outcome Measure Results Reported to AHCA on July 1, 2012:2012 Results (Measurement Period: Jan. 1, 2011 – Dec. 31, 2011)

IndicatorMeasurement

TypeMedicaidReform

MedicaidNon-Reform

Prenatal & Postpartum Care PPC HEDIS

Timeliness of Prenatal Care 80.65% 73.72%

Postpartum Care 58.06% 52.31%

Use of Appropriate Medications for Peoplew/Asthma

ASM HEDIS 76.92% 80.19%

Well Child First 15 Months (Six or more visits) WC15 HEDIS 41.05% 41.61%

Well Child Third, Fourth, Five, Six Years WC34 HEDIS 72.24% 70.58%

Agency Defined Measures:

Follow-up After Hospitalization for Mental Illness FHM Agency-Defined

7 Days 32.06% 37.73%

30 days 51.02% 53.56%

Mental Health Readmission RER Agency-Defined 19.38% 21.99%

Lipid Profile Annually LPA Agency-Defined 79.53% 78.35%

Use of Angiotensin-Converting Enzyme Inhibitors(ACE) /Angiotensin Receptor Blockers (ARB

ACE Agency-Defined 72.00% 68.71%

Prenatal Care Frequency PCF Agency-Defined 66.13% 55.23%

Frequency of HIV Disease Monitoring Lab Tests Agency-Defined

CD4 (2 tests) N/R 38.61%

VL (2 tests) N/R 36.55%

Highly Active Anti-Retroviral Treatment HAART Agency-Defined N/R 57.48%

HIV-Related Medical Visits (2 visits) HIVV Agency-Defined N/R 60.69%

Transportation Timeliness TRT Agency-Defined 89.85% No Benefit

Transportation Availability TRA Agency-Defined 100% No Benefit

N/R = Not Reported (Sample size too small)

Important information for health care professionals and facilities

I Fall 2012 15 Provider Service Center: 877-842-3210

Child Health Check-Up (CHCUP)* Reported to AHCA Feb. 15, 20122012 Results (Measurement Period: October 1, 2010 – September 30, 2011)

GoalMedicaid

(Reform & Non-Reform Combined)

Screening Ratio 80% 76%

Participation Ratio 80% 63%

Screening Ratio (Florida) 60% 77%

* Also known as EPSDT

The goals reflect contractual and regulatory requirements for routine child health check-up screeningas defined by the State of Florida periodicity table. The periodicity table describes the number ofexpected screening visits by age range, as listed below.

Age Rage (in years) Less than 1 1-2 3-5 6-9 10-14 15-18 19-20

Number of Expected Visits 6 4 3 2 5 4 2

Please call Provider Services at 877-842-3210 for helpful Child Health Check-Up tools andinformation.

You can also request a detailed description of our Quality Improvement Program and information onour progress in meeting our goals.

Provider Service Center: 877-842-3210

Practice Matters is a quarterly publication for physicians and other health care professionals and facilitiesin the UnitedHealthcare network.

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