What’s New
Michigan Newsletter • Spring 2011
Molina Healthcare’s New President!
Molina Healthcare is pleased to announce that
Craig Bass has been named president of its health
plan subsidiary, Molina Healthcare of Michigan.
As president, Bass will be responsible for the operational oversight of the Michigan health plan as
well as the implementation and execution of various
strategic initiatives. Bass has more than 17 years of
managed care experience in the health care industry.
Prior to joining Molina Healthcare, Bass served as a
Medicaid regional vice president for Aetna. He holds
a bachelor of science in health care administration from Indiana University
– Bloomington as well as an MBA and a master’s of hospital and health care
administration from the University of Minnesota in Minneapolis.
M-CEITA and Molina
Healthcare Partner
Helping Providers use Electronic Health Records
M-CEITA is Michigan’s Federally-designated Health IT Regional Extension Center, and is dedicated to helping providers navigate the complex
EHR marketplace by offering neutral, unbiased information and technical
assistance. M-CEITA assists providers throughout the health IT adoption
process, from selecting and adopting an EHR to meaningfully using it to
improve their quality of care and meet the criteria required to receive Medicaid and Medicare incentives. For more information about M-CEITA, visit
http://www.mceita.org. Molina Healthcare will work with M-CEITA
to identify providers in its network who need assistance with electronic
health records.
In This Issue
Molina Healthcare’s New President!
pg 1
M-CEITA and Molina Healthcare Partner
pg 1
Molina Healthcare of Michigan Expands
to Ingham County
pg 2
Molina Healthcare PCP Access
to Care Standards
pg 2
ICD-10 Looming
pg 3
Molina Healthcare’s Outreach Efforts
pg 4
I2D2 Helping Detroit Kids
pg 4
ePortal Update
pg 4
Coordination of Benefits Claims Submission
pg 5
Claims Submission Requirements
pg 5
Remittance Advice Upgrade
pg 5
PROVIDERNETpg 5
Nurse Advice Line
pg 6
Claims Submission
Requirements
Please mail all initial
Medicaid claims to:
Molina Healthcare, Inc.
PO Box 22668
Long Beach, CA 90801
Please mail all initial
Medicare claims to:
Molina Healthcare Options Claims
PO Box 22811
Long Beach, CA 90801
Please do not submit initial claims to the Troy
address as this will delay the processing of
your claims, and your claim may be returned.
Please contact the Claims Department with
any questions or concerns at 1-888-898-7969.
The following MQIC guidelines have been
updated this year:
•
•
•
•
•
Management of Diabetes Mellitus
General Principles for the Diagnosis and
Management of Asthma
Management of Asthma in Children 0 to
4 Years
Management of Asthma in Children 5 to
11 Years
Management of Asthma in Youth 12 Years
and Older Adults
Please update your guideline. For a complete
list of the MQIC guidelines please visit the
Molina Healthcare Provider Website and click
on the MQIC link. www.MolinaHealthcare.com 1
What’s New • Spring 2011 • Michigan
Molina Healthcare of Michigan Expands to Ingham County
DETROIT, Michigan – December 7, 2010 – Molina Healthcare of Michigan recently expanded its Medicaid services
to include Ingham County, which could add approximately 1,000 new members from the area. The enrollment effective date began on December 1, 2010.
“We are pleased to begin serving the community in Ingham County,” said Brenda Lever, Director, Provider Services
and Enrollment Growth of Molina Healthcare of Michigan. “As Molina Healthcare of Michigan continues to expand
to serve more members throughout the state, providing high quality care will always be our priority.”
Molina Healthcare of Michigan is the third largest Medicaid company in the state. It currently serves 226,000 members in 48 counties (including Ingham County) and provides healthcare services to families and individuals eligible
for government-sponsored programs including Medicaid, Medicare SNP and MIChild services. Molina Healthcare of
Michigan is a subsidiary of Molina Healthcare, Inc.
About Molina Healthcare
Molina Healthcare, Inc. provides quality and cost-effective Medicaid-related solutions to meet the health care needs
of low-income families and individuals and to assist state agencies in their administration of the Medicaid program. Our licensed health plans in California, Florida, Michigan, Missouri, New Mexico, Ohio, Texas, Utah, Washington,
and Wisconsin currently serve approximately 1.6 million members, and our subsidiary, Molina Medicaid Solutions,
provides business processing and information technology administrative services to Medicaid agencies in Idaho,
Louisiana, Maine, New Jersey, and West Virginia, and drug rebate administration services in Florida. More information about Molina Healthcare is available at www.molinahealthcare.com.
Reminder Regarding: Molina Healthcare PCP Access to
Care Standards
adequate for caseload, inclusive of healthcare support staff,
A Primary Care Provider (PCP) may be any of the following type of provider: family or general practice, internal
paraprofessionals, and other healthcare professionals.
medicine, OB/Gyn, pediatric, physician assistant and/or
2. Emergent Appointments. Emergencies must be
nurse practitioner.
handled immediately or the member must be referred
to a hospital emergency room.
A PCP must be accessible 24 hours a day, seven days a
week, either personally or through coverage arrangements 3. Urgent Appointments. Urgent appointments scheduled on the same day or referred to urgent care facility.
with a designated contracted PCP. After-hours coverage
4. Routine Appointments. Routine appointments
must meet the requirements below:
scheduled within seven (7) to ten (10) days.
Provides instructions for an emergency situation
5. Health Assessment. Well examination and physical
Provides means of reaching an on-call physician
scheduled within four (4) to six (6) weeks after the
initial request.
The PCP must make every effort to schedule members for
appointments using the following recommendations:
6. After-Hours Care. PCP must provide member access
and availability to physician services, 24 hours per
1. Office Hours. PCP must be available at least 20 hours per
day, seven days a week and provide means of reaching
week. The PCP must provide staffing patterns, which are
an on-call physician.
2www.MolinaHealthcare.com
What’s New • Spring 2011 • Michigan
ICD-10 Looming: Early Preparedness Key
2013 is right around the corner! Will you be ready?
Switching from a five-digit numeric code to a sevendigit alphanumeric code will just be one of the hurdles
those in the healthcare industry face toward meeting the
upcoming transition to ICD-10 by 2013. Notwithstanding these hurdles, we must move forward and take heed
to the immortal words of Ben Franklin, “By failing to
prepare you are preparing to fail.”
The long journey toward the October 2013 compliance
deadline is fast approaching. The original proposal for
ICD-10 implementation was October 2011, but after a
successful health industry lobbying effort an extension
was granted until 2013, citing the cost and complexity
of conversion.
Being behind the eight-ball is somewhat the state –of-affairs for all wishing to get a jump on developing strategic
plans and taking action now to reduce late-stage rushes
to compliance.
The positive take away about the new ICD-10 changes:
• The more descriptive and better-categorized
ICD-10 codes will enable diagnosis classifications
that more completely represent the severity of
medical conditions
• Increase capacity for quality measures
• Improve interoperability of electronic health
records (EHRs)
• Facilitate more equitable reimbursement.
With ICD-10 codes affecting clinical, IT, finance, reimbursement and human capital areas, physicians and hospitals need to start thinking about all of these issues now.
It is important for them to act soon to assess the potential
impacts, define gaps and work toward bridging the gaps,
so that when the compliance date arrives, they are not in
panic mode.
Don’t delay, start today!
Where to Begin:
For starters, the magnitude of the transition may leave
some at a loss for where to begin. Bread and butter processes should be addressed first. For example, ICD-10
codes will affect payers’ and providers’ software systems,
including billing and payment, clinical systems (e.g.,
EHRs and personal health records), decision support
and other ancillary systems, as well as clinical and billing workflows and payment methodologies. There are
no easy paths in this transition. However, the ICD-10
conversion presents an opportunity to make administrative and clinical simplifications that improve clinical and
financial performance over the long haul.
The many obstacles to preparedness
All health care entities – including physicians, hospitals
and payers – will be affected by the ICD-10 code set
changes. Physicians and hospitals certainly have major
adjustments to implement – including working with their
vendors to assess where their operations stand relative to
the ICD-10 final rule.
www.MolinaHealthcare.com 3
What’s New • Spring 2011 • Michigan
Molina Healthcare’s Outreach Efforts
Molina Healthcare is continuously seeking ways to partner with our providers and community agencies for events. If
you have any upcoming events please notify us at 866-449-6828 ext 155822!
I2D2 Helping Detroit Kids Get the Edge on Health
The word is spreading about Detroit children needing
help in healthy living. With the adult population’s increase in obesity and those overweight causes concern
for the kids that look up to and imitate their behavior.
Several recreation centers in Detroit have closed leaving
limited access to safe places for kids to engage in physical activity. Grocery stores where nutritious food can be
acquired are found far and few between. In collaboration with Van Zile Elementary School, Farwell Middle
School, the Youth Connection, and the Detroit Health
and Wellness Promotion Department, comes the
I2D2 campaign. Funded by Molina Healthcare and the Johnson and
Johnson Community Health Care Program, the I2D2
educational program introduces kids 6 to 12 years old
to the Fit and Fun Family Club Workshop. On February
9th, the campaign kicked off its weekly program. For 6
consecutive Wednesdays at 3:30 p.m. the families meet
at Van Zile Elementary. By teaching the benefits of fruit
and vegetable intake the program hopes to encourage
families to make better food choices. This also includes
limiting sugary drinks and replacing them with alternatives, such as water. “Screen time” activities, such as
television, computers, and video games, are limited, and
time spent exercising is increased.
The I2D2 campaign is a fantastic way for families to
work together to change the bad habits they’ve learned.
By including the parents/guardians with the learning
process will increase success in maintaining healthier
lifestyle for the whole family. Hopefully this trial program will reach the goal to help the community, and we
will see more of them in other areas of the city. Detroit
needs to overcome the labels “overweight” and “lazy”,
and I2D2 is a great way to start.
Look for future articles expanding on this program, its
founders, and what the future holds for Detroit’s health.
Please subscribe above to have these articles sent directly
to your email as soon as they are published.
ePortal Update
Please be advised, that if you have not logged on to
ePortal for usage within the last twelve (12) months,
your access has been deleted. We ask that you please
take the time to re-register. If you have questions, or
require assistance with your ePortal registration, please
contact your Territory Manager directly or the Provider
Services Department at 866-449-6828 ext 155822 and
the Provider Services Administrator will provide you
with assistance.
www.MolinaHealthcare.com 4
What’s New • Spring 2011 • Michigan
Coordination of Benefits Claims Submission
GOOD NEWS! Effective immediately you may submit your coordination of benefits (COB) claims electronically. If
you are unsure how to submit your COB information electronically, please reference your “EDI companion guide”. A
copy of the companion guide can be found on the website @ www.molinahealthcare.com
Claims Submission Requirements
Just a reminder! Paper claims are not considered to be clean claims; if you are not billing electronically your claims
payment will be delayed. Please submit your claims electronically to ensure prompt processing. If you require assistance with billing electronically to Molina Healthcare through ePortal, please contact your assigned Territory Manager or Provider Services Department at 866-449-6828 ext 155822 and the Provider Services Administrator will provide
you with assistance. If you must submit your claims on paper, please mail your claims to Molina Healthcare, Inc., PO
Box 22668, Long Beach, CA 90801.
Remittance Advice Upgrade
Effective 03/28/2011, Molina Healthcare’s Remittance
Advice (RA) will have a ‘new look’. The reason for this
new look is to accommodate Health Insurance Portability
and Accountability Act (HIPAA) Electronic Remittance
Advice (ERA) language. We are also working to make the
RA available to you online, and will keep you updated regarding this progress. Though there will be slight changes
in formatting, including some changes in column headings as well as a few new data elements, the RA will still
provide you the same information it has in the past.
What will be new on the updated version of the RA:
Molina Healthcare’s explanation description at
each claim and/or claim line level along with the
following:
o HIPAA Adjustment Group
o Adjustment Reason Code
o Claim Remark Code (when applicable)
A crosswalk table with the description of each of
the above
If you would like more information regarding the
HIPAA Code Sets, you can visit the WPC-EDI
Website at: http://www.wpc-edi.com/content/
view/711/401/. Molina Healthcare believes these
changes and additions will make this a more userfriendly document. If you have questions or concerns regarding this document and/or its contents,
please contact Provider Services toll free at (866)
449-6828, ext 155822.
“PROVIDERNET” - Electronic Remittance Advice Access
Is Coming To Your Fingertips!
Effective May 15, 2011 you will be able to retrieve all of your electronic Remittance Advice’s from the Portal of ProviderNet; an Electronic Remittance Advice (RA) Vendor that will house your payers’ RA’s electronically for your
immediate access and convenience. You will also be able to sign up for Electronic Funds Transfer (EFT) directly
through the vendor as an automatic link to Molina. Molina will provide you with more details next month.
5www.MolinaHealthcare.com
100 West Big Beaver Road, Suite 600
Troy, MI 48084
6649MI0511
Questions about your health?
Call Our Nurse Advice Line!
1-888-275-8750 English
1-866-648-3537 Spanish
OPEN 24 HOURS!
Your family’s health is our priority!
For the hearing impaired please call
TTY/866-735-2929 English
TTY/866-833-4703 Spanish
Editor: Brenda Lever
Co-editior: Leann Conway
6www.MolinaHealthcare.com