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A newsletter for SCFHP's providers
Vol. 6, Issue 10  October 2022

Reminder -- Provider contracting for DualConnect (HMO D-SNP) underway


Providers are reminded contracting is currently underway for a new dual eligible special needs plan called Santa Clara Family Health Plan DualConnect (HMO D-SNP). – and we encourage you to complete your contract as soon as possible.
 
Enrollment for new members is currently underway and will have an effective date of January 1, 2023. Our 10,300+ Cal MediConnect plan members will transition to DualConnect on January 1, 2023. There will be no gap in the transitioning members’ Medi-Cal, Medicare and Medicare Part D prescription drug benefits.
 
DualConnect will coordinate both Medicare and Medi-Cal services under one umbrella, making health care easy for members – with one primary care doctor, one membership card, and one phone number to call for help. The plan will be introduced to our members later this summer.
 
“We’re committed to building on our strong provider relationships with our new DualConnect plan,” says Janet Gambatese, Director of Provider Network Operations. “We appreciate our provider partners and the outstanding professional health care they provide to our members.” 
 
Don’t delay – complete your DualConnect contract today!

Please return your completed contracting agreement to SCFHP right away. If you need more information or did not receive a contract, please email us at contracting@scfhp.com.

Medicare Annual Wellness Visits for Cal MediConnect Members


The end of the year is almost here! Medicare Annual Wellness Visits (AWV) are a good opportunity to create or update your member’s personalized prevention plan and assess all of their active and chronic diagnoses.

Why is assessing and reporting diagnoses so important?
Every January 1st, Medicare will start with a blank slate on the diagnosis profile of a member. Therefore, diagnoses such as amputations and diabetes must be reported via claims yearly. If not, Medicare assumes these chronic conditions are resolved.

Assessing and reporting chronic conditions annually leads to:
  • better overall patient care
  • an accurate picture of the member’s health status
  • accurate payments to the health plan
 
Use the following billing codes for your AWV claims:
a. G0438 initial AWV
b. G0439 subsequent AWV
 
AWVs have a Health Risk Assessment (HRA) component. If your practice does not have a HRA patient questionnaire, you can use SCFHP’s at https://bit.ly/scfhpHRAquestions.
If you would like a list of your member’s outstanding chronic conditions contact Risk Adjustment at riskadjustment@scfhp.com.

 

Spirometry Testing in the Assessment and Diagnosis of COPD (SPR)


The Global Initiative for Chronic Obstructive Lung Disease (GOLD) and the National Committee for Quality Assurance’s (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS®) measure both emphasize the importance of spirometry testing as a tool in diagnosing Chronic obstructive pulmonary disease (COPD).

Spirometry testing is the most reproducible, objective, noninvasive, and attainable test for diagnosing COPD. The test measures the volume of air exhaled at different points after a maximal inhalation. However, spirometry testing is underutilized in diagnosing COPD; as a result, NCQA evaluates testing through the HEDIS® spirometry measure. The measure assesses adults 40 years of age and older with newly diagnosed or newly active COPD who received spirometry testing to confirm the diagnosis.

Please use the following CPT Codes when billing for spirometry in diagnosing COPD:


 
CPT Code CPT Description
 94010  Breathing capacity test
 94014  Patient recorded spirometry
 94015  Patient recorded spirometry
 94016  Patient recorded spirometry
 94060  Evaluation of wheezing
 94070  Evaluation of wheezing
 94375  Respiratory flow volume loop
 94620  Pulmonary stress testing
 
Read more about this from the NCQA here.

The 2022 GOLD guidelines recommend all patients be prescribed rescue short-acting bronchodilators for immediate symptom relief. If a patient’s response to initial treatment is inadequate, adjust treatment as clinically appropriate.

Read the complete 2022 GOLD guideline here.

To see list of SCFHP and Medi-Cal Rx’s covered COPD drugs click here.

 

Tips on Communicating about Flu Vaccine

Remember every visit is an opportunity to recommend flu vaccine.

•Keep it simple
•Complement statistics with personal stories
•Avoid repeating the incorrect information
•Tie Flu vaccine to protecting your loved ones
•Position annual flu vaccination as an important component to overall management of health

Source: https://www.cdc.gov/flu/professionals/vaccination/prepare-practice-tools.htm

 

Remember the SHARE Model
in discussing flu vaccine


•SHARE the reasons
•HIGHLIGHT positive experiences
•ADDRESS patient questions
•REMIND patients that influenza vaccines help protect them and their loved ones
•EXPLAIN the potential costs of getting influenza
Provider Link
Visit providerportal.scfhp.com to download your member roster and report cards, check authorizations and claims status, and check member eligibility.
  • Gaps-in-Care and PPP report cards are now available on the portal
Interactive Voice Response (IVR)
Call our IVR line at 1-408-874-1473 to verify member eligibility, check claims status based on your TIN, and request confirmation of eligibility verification or claim(s) processed.

Resources on our website Resources from the County
Find important updates, the COVID-19 case report form, information about PPE, and much more on the Santa Clara County website.

Questions?
Please contact Provider Services at ProviderServices@scfhp.com.

SCFHP by the numbers

Providers (unique NPI)
Primary care
Medi-Cal: 822
Cal MediConnect: 545
 
Specialists
Medi-Cal: 5,435
Cal MediConnect: 3,413
 
Ancillary
Medi-Cal: 892
Cal MediConnect: 395
Pharmacies
Cal MediConnect: 148
 
Members
Medi-Cal: 307,490
Cal MediConnect: 10,469
Total: 317,959
 
As of October 2022
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