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Maryland | Spring 2015

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Practice Matters: MD - Spring 2015 Provider Services Center: 888-362-3368

Important information for health care professionals and facilities

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In This Issue...• A Reminder About Dental Visits During Pregnancy

• The Consumer Assessment Survey Results Are In

• How To Access Health Education and Member Outreach

• Healthy Kids Preventive Health Schedule

• Adult Medicaid Survey Results

• Helping Members with Hypertension Stay Healthy

• Initiatives Encourage Members To Get Preventive Care

• Get Updated Clinical Practice Guidelines

• Reviews Help Ensure Patients Receive Proper Care

• Member Rights and Responsibilities

• Enhanced HIPAA Claim Edits

• Optum Cloud Dashboard Enhancements to Notifications/Prior Authorizations

We hope you enjoy the spring edition of Practice Matters. In this issue, you can read about the results of the Consumer Assessment of Health Providers and Systems (CAHPS) survey, health education and member outreach efforts, updated clinical practice guidelines, and much more. Happy spring!

Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33681

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Most of the services described are covered if your patient has dental insurance. Generally, preventive services such as exams and X-rays are covered in full, and major services are partially covered.

The Consumer Assessment Survey Results Are InOne of the ways we assess UnitedHealthcare Community Plan members’ satisfaction is by evaluating results from the annual Consumer Assessment of Health Providers and Systems (CAHPS) survey. The survey, administered by the State of Maryland, gathers information from members about their experiences with health care. Our goal is to meet or exceed the National Committee for Quality Assurance (NCQA) Quality Compass Medicaid benchmarks, a national database that provides health plans with comprehensive information on the quality of the nation’s managed care plans.

A Reminder About Dental Visits During PregnancyWomen have a higher risk of developing gum disease during pregnancy and that can seriously affect the health of the baby, even leading to premature labor and low birth weight. It’s important that OB/GYNs remind patients to see the dentist before, during and after pregnancy.

A dentist should be involved throughout the pregnancy. Before a pregnancy, a dentist can help ensure that teeth and gums are in good condition to prevent oral health problems.

Dental and periodontal treatment should be avoided as much as possible during certain times in the baby’s development, specifically the first trimester and the final six weeks before delivery. Routine care is OK during the second semester, but patients should try to wait to have major dental work until after the baby is born.

The dentist should be aware of all medications and vitamins the patient is taking, as they can affect how certain conditions are treated. Although X-rays are much safer today than in the past, they should not be done for pregnant patients, except in an emergency, in which case the dentist can take special precautions to keep mother and baby safe.

Pregnancy can cause hormonal changes that make the patient more susceptible to gum disease and can lead to bleeding of the gums, a condition known as “pregnancy gingivitis.” Any form of gum disease can affect the baby, so if the patient notices any bleeding, swelling or tenderness of the gums, she should let her dentist know immediately. Soon after the baby is born, she should have another cleaning and oral health exam to have her periodontal health evaluated, particularly if she had any issues with her gums during pregnancy.

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The General Population Benchmarks are:

How Well Doctors Communicate 94%

Getting Care Quickly 88%

Customer Service 86%

Getting Needed Care 85%

Coordination of Care 83%

Health Promotion and Education* 76%

Shared Decision Making ** 51%

Personal Doctor 87.6%

Specialist Seen Most Often 85%

* Health Promotion and Education composite revised in 2013. Question wording and response choices altered. Trending impacted.

** Shared Decision-Making composite revised in 2013. Added one question and significantly altered the existing questions and response choices. Trending impacted.

The Children with Chronic Conditions (CCC) Population Benchmarks are:

How Well Doctors Communicate 94%

Getting Care Quickly 92%

Customer Service 85%

Getting Needed Care 83%

Coordination of Care 80%

Health Promotion and Education* 82%

Shared Decision Making ** 58%

Personal Doctor 87%

Specialist Seen Most Often 85%

* Health Promotion and Education composite revised in 2013. Question wording and response choices altered. Trending impacted.

** Shared Decision-Making composite revised in 2013. Added one question and significantly altered the existing questions and response choices. Trending impacted.

Survey MethodologyThe Maryland Department of Health and Mental Hygiene (DHMH) selected WB&A Market Research, a NCQA-certified survey vendor, to conduct its CAHPS 5.0H Child Medicaid Survey with CCC Measurement Set. WB&A administered the survey to parents and guardians of Medicaid members ages 17 and younger between February and May 2014.

Of the 3,240 surveys mailed to UnitedHealthcare Community Plan child members, 1,197 valid surveys were completed: 782 by mail and 415 by phone.

There are four overall ratings questions asked in the survey based on a scale of 0 to 10, with 0 representing “worst possible” and 10 representing “best possible”: Rating of Personal Doctor; Specialist Seen Most Often; Health Care; and Health Plan. The summary rate for these questions represents the percentage of ratings that were an 8, 9 or 10. In addition to the standard CAHPS composite measures, five additional composite measures are calculated for the CCC population.

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2014 CAHPS Child Medicaid Survey Results – General Population

Composite Measure GOAL 2014 2013 2012 Change from 2013–2014

How Well Doctors Communicate 93% 94% 94% 93% 0%

Getting Care Quickly 89.5% 87.6% 91% 86% -3.4%

Customer Service 87.9% 86% 85% 80% +1%

Getting Needed Care 85% 85% 81% 78% +4%

Coordination of Care 81% 82.6% 81% 77% +1.6%

Health Promotion and Education* 71.7% 76.2% 72% N/A +4.2%

Shared Decision Making ** 54.7% 51% 51% N/A 0%

Health Care Overall 85% 88.9% 85.6% 85% +3.3%

Health Plan Overall 84% 85.5% 82.6% 83% +2.9%

Personal Doctor 87.6% 89.1% 86% 86% +3.1%

Specialist 85% 84% 87% 80% -3%

Composite Measure2014

(Summary Rate – Always/Usually, Yes or A lot/Yes)

2013(Summary Rate – Always/Usually, Yes or A lot/Yes)


How Well Doctors Communicate 94% 94% 93%

Getting Care Quickly 88% 91% 86%

Customer Service 86% 85% 80%

Getting Needed Care 85% 81% 78%

Coordination of Care 83% 81% 77%

Health Promotion and Education* 76% 72% N/A

Shared Decision Making ** 51% 51% N/A

* Health Promotion and Education composite revised in 2013. Question wording and response choices altered. Trending impacted.** Shared Decision-Making composite revised in 2013. Added one question and significantly altered the existing questions and response choices. Trending impacted.




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2014 CAHPS Child Medicaid with CCC Survey Results

Composite Measure2014

(Summary Rate – Always/Usually, Yes or A lot/Yes)



How Well Doctors Communicate 94% 92% 93%

Getting Care Quickly 92% 92% 91%

Customer Service 85% 88% 85%

Getting Needed Care 83% 83% 82%

Coordination of Care 80% 80% 77%

Health Promotion and Education* 82% 75% N/A

Shared Decision-Making** 58% 58% N/A

Family Centered Care: Personal Doctor Know Child*** 91% 88% 88%

Family Centered Care: Getting Needed Information*** 89% 90% 91%

Access to Prescription Medicine 88% 89% 92%

Coordination of Care for Children with Chronic Conditions 75% 77% 75%

Access to Specialized Services 72% 77% 77%

*Health Promotion and Education composite revised in 2013. Question wording and response choices altered. Trending impacted.**Shared Decision-Making composite revised in 2013. Added one question and significantly altered the existing questions and response choices. Trending impacted.***Five additional composite measures are calculated with regard to the CCC population.

Overall Ratings2014

(Summary Rate of rankings that were 8, 9 or 10)

2013 (Summary Rate of rankings

that were 8, 9 or 10)

2012 (Summary Rate of rankings

that were 8, 9 or 10)Personal Doctor 87% 86% 83%

Specialist 86% 86% 87%

Health Care 84% 83% 83%

Health Plan 82% 78% 79%

If you have any questions or would like more information about the survey, please contact Lorena de Leon, Manager Clinical Quality, at [email protected].



Community Plan



How To Access Health Education and Member OutreachEvery participating care provider has access to health education programs, educational materials and customized outreach support from UnitedHealthcare Community Plan. Our Health Educator serves as a resource for providers and members in need of assistance locating or coordinating health education materials and services. The Outreach Supervisor coordinates a wide variety of efforts to help get members into care.

Providers may contact our Health Education and Outreach departments at 855-817-5624 to help members access health care services or education. You also may submit a health education request form through the Provider Portal.

UnitedHealthcare will make reasonable efforts to accommodate member and provider requests for health education. The health education program is intended to improve or preserve the continuing health and quality of life for individuals with routine or special health care needs.

We work closely with our providers to get members the care they need. We offer in-office and remote-appointment scheduling assistance as well as home visiting services for pregnant and postpartum members or those with disabilities.

You can learn more about the health education and outreach programs available to you and our members from the following resources:

• Provider Web Portal• Health Education/Healthcare Effectiveness Data

and Information Set (HEDIS) Outreach staff (855-817-5624)

• UnitedHealthcare Community Plan community events statewide


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Healthy Kids Preventive Health ScheduleThe goal of the Maryland Healthy Kids/ Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program is to provide access to quality health care services for Medicaid recipients from birth to age 21. All providers serving these members must maintain certification through the Healthy Kids EPSDT program.

The program provides evidence-based guidelines to help ensure the quality of services provided to these members. The guidelines allow for the early identification and treatment of health problems. The Healthy Kids EPSDT standards were developed by the Maryland Department of Health and Mental Hygiene and closely correlate to the American Academy of Pediatrics periodicity schedule. For more information, please see the Maryland Healthy Kids Preventive Health Schedule (chart above).

Maryland Healthy Kids Preventive Health ScheduleComponents Infancy (months) Early Childhood (months) Late Childhood (yrs) Adolescence (yrs)Health History and Development Birth 3-5d 1 2 4 6 9 12 15 18 24 30 36 48 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19/20Medical and family history/update X X X à à à à X à à X X X X X X X X X X X X X X X X X X XPeri-natal history X X X à à à à à à à

Psycho-social/environmental assessment/update X X X à à à à X à à X X X X X X X X X X X X X X X X X X XDevelopmental Surveillance (Subjective) X X X X X X X X X X X X X X X X X X X X X X X X X X X XDevelopmental Screening (Standard Tools)1 X à à X X à à à à

Autism Screening X X à

Mental health/behavioral assessment X X X X X X X X X X X X X X X X XSubstance abuse assessment X X X X X X X XPhysical ExamSystems Exam X X X X X X X X X X X X X X X X X X X X X X X X X X X X XVision/hearing assessments2 O2 S S S S S S S S S S S S S/O S/O S/O S S S S S S/O S S S/O S S S/O SOral/dentition assessment X X X X X X X X X X X X X X X X X X X X X X X X X X X X XNutrition assessment X X X X X X X X X X X X X X X X X X X X X X X X X X X X X

Measurements and graphing:

Height and Weight X X X X X X X X X X X X X X X X X X X X X X X X X X X X XHead Circumference X X X X X X X X X X XBMI X X X X X X X X X X X X X X X X X X X

Blood Pressure3 X X X X X X X X X X X X X X X X XRisk Assessments by QuestionnaireLead assessments by questionnaire X X X X X X X X X XTuberculosis* X X X X à X à à X X X X X X X X X X X X X X X X X X XHeart disease/cholesterol* X X X X X X X X X X X X X X X X X X XSexually transmitted infections (STI)* X X X X X X X XLaboratory TestsHereditary/metabolic hemoglobinopathy X X à

Blood lead Test X à à X à à à à

Anemia Hgb/Hct X à à X à à à à

ImmunizationsHistory of immunizations X X X X X X X X X X X X X X X X X X X X X X X X X X X X XVaccines given per schedule X à à X X X à X X X à à à à à à à à à à X X à à à à à à à

Health EducationAge-appropiate education/guidance X X X X X X X X X X X X X X X X X X X X X X X X X X X X XCounsel/referral for identified problems X X X X X X X X X X X X X X X X X X X X X X X X X X X X XDental education/referral X X X X X X X X X X X X X X X X X X X X X XScheduled return visit X X X X X X X X X X X X X X X X X X X X X X X X X X X X X

Key: XàSO*

RequiredRequired if not previously doneSubjective by history/observationObjective by standardized testingCounseling/testing required when positive

The Schedule reflects minimum standards required for all Maryland Medicaid recipients from birth to 21 years of age. The Maryland Healthy Kids Program requires yearly preventive care visits between ages 2 years through 20 years.¹ Refer to AAP 2006 Policy Statement referenced in the Healthy Kids Program Manual.-Screening required using standardized tools.² Newborn Hearing Screen follow-up required for abnormal results. 3 Blood Pressure measurement in infants and children with specific risk conditions should be performed at visits before age 3 years.


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CAHPS Adult Medicaid Survey ResultsOne of the ways we assess member satisfaction is by evaluating results from the annual Consumer Assessment of Health Providers and Systems (CAHPS) survey, which is a National Committee for Quality Assurance survey that gathers information from members about their experiences with health care.

Our goal is to meet or exceed the benchmarks from the NCQA 2014 Quality Compass Medicaid benchmark, a national database that provides health plans with comprehensive information on the quality of the nation’s managed care plans.

Survey MethodologyThe Maryland Department of Health and Mental Hygiene (DHMH) selected WB&A Market Research, a NCQA-certified survey vendor, to conduct its CAHPS 5.0H Adult and Child Medicaid Survey. Among UnitedHealthcare Community Plan adult members, 555 valid surveys were completed: 332 by mail and 217 by phone. The response rate for 2014 was 32 percent.

Adult CAHPS Results (2012–2014)

Composite Measure GOAL 2014 2013 2012 Change from 2013-2014

Getting Needed Care 80.5% 83.9% 81.2% 68% +2.7

Getting Care Quickly 81% 82.1% 81.9% 80% +0.2

How Well Doctors Communicate 89.5% 91.7% 90.2% 85% +1.5

Customer Service 86.5% 84.6% 78.8% 76% +5.8

Coordination of Care 79.2% 85.9% 82.5% 70% +3.4

Shared Decision-Making* 51.2% 53.9% 58% N/A N/A

Health Promotion and Education ** 71.6% 76.6% 70% N/A +6.6

Health Plan Overall 74.7% 72.9% 67.7% 68% +5.2

Personal Doctor 78.8% 80.6% 78% 70% +2.6

Specialist Seen Most Often 80.4% 78% 81% 83% -3

*Shared Decision-Making composite revised in 2013. Added one question and significantly altered the existing questions and response choices. Trending impacted.**Health Promotion and Education composite revised in 2013. Question wording and response choices altered. Trending impacted.

If you have any questions or would like more information about the survey, please contact Lorena de Leon, Manager Clinical Quality, at [email protected].


Community Plan



Helping Members with Hypertension Stay HealthyUnitedHealthcare Community Plan is committed to improving the health of our members and making resources available to our participating care providers. As part of that, we offer a

number of services aimed at helping members to better control their blood pressure.

Members receive health education outreach, including bilingual mailers and targeted call campaigns, to assist them in achieving their blood pressure goals. Each of our member communications emphasizes the importance of building a relationship with the member’s primary care provider.

In addition to targeted member outreach, a variety of educational resources are available to our members and providers. They include quarterly member and provider newsletters, member and provider websites, and a staff health educator. Clinical practice guidelines on the detection, evaluation and treatment of hypertension are available to all providers on the provider website.

We also offer a case management program to optimize the health and well-being of members with chronic conditions or complex care needs. It provides health education, preventive care, as well as telephone and face-to-face case management and care transition management. A member can receive any or all of the program components. Members with hypertension may receive case management services dependent on the severity and complexity of their condition and utilization of health care services.

Initiatives Encourage Members To Get Preventive CareUnited Healthcare’s Quality Management and Performance Department strives to motivate and encourage members to receive the preventive and diagnostic services they need to stay healthy.

We have implemented several initiatives, such as on-site appointment scheduling, postcard reminders, newsletters, automated messaging, case management, live outreach and other customer services. Our Outreach Unit is available to partner with you to help close the gap in the needed services.

A Quality Clinical Administrative Coordinator can be sent to your practice to contact members and schedule appointments for those identified as having gaps in preventive services. Once an appointment is scheduled, the coordinator will mail a reminder postcard to the member with the date, time and contact information. A reminder call will be made to the member two business days before the appointment.

Members who cannot be reached by phone will be mailed postcards notifying them that we tried to contact them and advise them to call the practice to schedule their appointment. If the postcard is returned as undeliverable, the member’s information will be forwarded to the member’s local Health Department for help in locating the member.

We also collaborate with PCP and OB/GYN practices in our co-brand initiative. This consists of provider recordings being used for automated calls and mailing co-branded letters to members.

If you would like to participate in any or all of these initiatives, please contact our Clinical Outreach Supervisor for Quality and Performance, Hilda Macauley, at 410-379-3460 or e-mail her at [email protected].

http://www.uhccommunityplan.com/health-professionals/md/clinical-practice-guidelines.html


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Get Updated Clinical Practice GuidelinesUnitedHealthcare promotes the use of nationally recognized evidence-based clinical guidelines to support practitioners in making decisions about health care. Guidelines include Diabetic Care, Perinatal Care (we have recently added an additional guideline), Depression and Attention Deficit Hyperactivity Disorder.

To view a complete list of the most current guidelines adopted by UnitedHealthcare, go online to UHCCommunityPlan.com > For Health Care Professionals > Maryland > Clinical Practice Guidelines.

Reviews Help Ensure Patients Get Proper CareWe perform concurrent reviews on inpatient stays in acute, rehabilitation and skilled nursing facilities, as well as prior authorization reviews of selected services. A list of services requiring prior authorization is available in the Provider Manual.

A physician reviews all cases in which the care does not appear to meet guidelines. Decisions regarding coverage are based on benefit coverage as well as appropriateness of care and service.

The treating physician has the right to request a peer-to-peer review with the reviewing physician and ask for a copy of the review criteria. The denial letter contains information on how to request materials and contact the reviewer. Members and physicians also have the right to appeal denial decisions. Appeals are reviewed by a physician who was not involved in the initial denial decision and is of the same or similar specialty as the requesting physician.

Member Rights and ResponsibilitiesThe UnitedHealthcare Community Plan Member Rights and Responsibilities can be found in the Provider Manual, located at UHCCommunityPlan.com > For Health Care Professionals > Maryland > Provider Administrative Manual. Member Rights and Responsibilities are distributed to new members upon enrollment and then annually.

Enhanced HIPAA Claim EditsEffective March 25, 2015, UnitedHealthcare applied additional Workgroup for Electronic Data Interchange (WEDI) Strategic National Implementation Process (SNIP) Health Insurance Portability and Accountability Act (HIPAA) edits to professional (837p) and institutional (837i) claims submitted electronically to most UnitedHealthcare and affiliate payer IDs.* These are new edits that were not applied with the revisions released in 2014. For more information on current and previous edit releases, go to Enhanced Claim Edits.

Because the edits will be applied on a pre-adjudication basis, an increase in claim rejections may occur. But you will be able to identify and correct rejected information prior to our adjudicating and processing claims. The advantage will be fewer denied claims and less interruption to your revenue stream.

The primary impact will come from edits that will validate code sets, such as diagnosis, procedure and modifier codes, at a pre-adjudication level. The new list of edits has been distributed to clearinghouses and software vendors.

It is important to check all claim submission reports regularly. Claims may be rejected by your clearinghouse or UnitedHealthcare Community Plan, so you may receive multiple reports per submission.


https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools and Resources/UHC_Affiliate_PayerID.pdf

https://www.unitedhealthcareonline.com/b2c/CmaAction.do?channelId=4c6372287bcb2410VgnVCM2000002a4ab10a____

https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools and Resources/EDI Education for Electronic Transations/Claim_Edit_List_Mar_2015_release.pdf


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Rejections that may occur from the enhanced edits will appear at a clearinghouse level. For assistance regarding these edits or to resolve rejections, first contact your Electronic Data Interchange (EDI) vendor or clearinghouse.

For assistance from UnitedHealthcare Community Plan, please contact EDI Support at EDI Transaction Support form, send an email to [email protected] or call 800-210-8315.

* Exceptions are: Harvard Pilgrim (04271), Medica HealthCare Plans (78857), Preferred Care Partners (65088), The Alliance (88461) and TRICARE West (99726).

Optum Cloud Dashboard Enhancements to Notifications/ Prior AuthorizationsOptum Cloud Dashboard’s Eligibility & Benefits Center now can be used to determine if Notification/Prior Authorization is required. Submit the Notification/Prior Authorization request form via single sign-on to UnitedHealthcareOnline.com and upload supporting documentation (if prompted to do so). These functions are available for UnitedHealthcare Commercial, UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan members. They are also available for UnitedHealthcare One members, but benefit information is not yet part of the Dashboard functions for these members.

Determining if Notification/ Prior Authorization is RequiredWhen checking eligibility and benefits for a patient on Optum Cloud Dashboard, a field called “Able to Submit Prior Authorization/Notification Request” will be displayed on the results screen. If the field contains “Yes,” the “My Actions” dropdown will include a link to “Submit Prior Auth Request.” You can link to the page and fill in the required fields to see if a Notification/Prior Authorization is required for the planned procedure.

If it is required, an “Initiate Now” button will be available to begin the submission and take you to the “Case Information” screen on UnitedHealthcareOnline.com (pre-populated with the data entered into Optum Cloud Dashboard) to complete the Notification/Prior Authorization request.

Adding Attachments and Clinical NotesAfter a Notification/Prior Authorization request has been submitted, you may be prompted to supply additional information by fax or attachment. If prompted to upload an attachment, you can add as many as needed, one at a time. The system will accept bmp, doc, docx, gif, jpg, jpeg, pdf, png, tiff, and tx files up to 3.5 MB in size. Once a file is uploaded, it cannot be removed. Whether or not an attachment is uploaded, you can type in the “Clinical Notes” section.

For information on required clinical documentation, go to UnitedHealthcareOnline.com > Tools & Resources > Policies, Protocols and Guides > Protocols > Medical Records Requirement for Pre-Service.



https://www.unitedhealthcareonline.com/b2c/CmaAction.do?txnType=ProblemReport&forwardToken=ProblemReport

https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools and Resources/Policies and Protocols/Pre-Service_Required_Medical_Records_Guide_PCA11558.pdf

https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools and Resources/Policies and Protocols/Pre-Service_Required_Medical_Records_Guide_PCA11558.pdf


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Updating Notifications/Prior AuthorizationsAll updates must be made in the Notification/Prior Authorization Status transaction on UnitedHealthcareOnline.com, regardless of where the submission was initiated. If an update results in a request for more information, either the Fax or Attachment window will open.

For more information, refer to the quick reference guides at UnitedHealthcareOnline.com > Help > Optum Cloud Dashboard.

Checking Notification/ Prior Authorization StatusIf you initiated your submission on Optum Cloud Dashboard, you will see the Notification/Prior Authorization request status at the bottom of the home screen in the Eligibility & Benefits application. Click the applicable yellow arrow under “View Details” to:

• Check the status of each procedure code• See if additional documentation is required • View a list of your attachments and upload more• Update Clinical Notes

If you initiated your submission on UnitedHealthcareOnline.com, you must locate the Notification/Prior Authorization request by Service Reference Number in the “Search Cases by Case Number” tool in the middle of the Eligibility & Benefits home screen. You then will see the same details listed above and the Notification/Prior Authorization will automatically display on the bottom of the home screen on subsequent visits to the Eligibility & Benefits applications.


https://www.unitedhealthcareonline.com/b2c/CmaAction.do?channelId=c7eddcbe73e8e310VgnVCM2000002a4ab10a____

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

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