Fourth Quarter 2016

D.C. Healthy Families/D.C. Healthcare Alliance

Newsletter

WE AREWASHINGTON

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Coordination of Care MedStar Family Choice members often need follow-up care by the primary care provider after an inpatient admission when care was provided by specialists and when laboratory or diagnostic testing was performed. It is important that there is a process for ensuring that care is delivered seamlessly across a multitude of delivery sites by different providers. There should be mechanisms in place to ensure that members and clinicians have access to and take into consideration all required information on the member’s conditions and treatments to ensure that the member receives appropriate healthcare services. Therefore, it is important for the specialist to list on the referrals the name of the member’s primary care physician (PCP). This is particularly important for Ob/Gyns, who refer members for a Pap smear or mammogram. In most cases, the PCP is not aware that the member had a Pap smear or mammogram. Specialists, PCPs, ambulatory facilities and hospitals are to share reports and other documentation with each other in order to provide the quality of care our members need. At the same time, members are to assume responsibility by informing their PCPs and specialists of their current health status, as well as ensure that their doctors are aware of hospitalizations or recent tests that have been ordered. They need to inform the appropriate practitioner so that the results can be obtained. The Quality, Outreach and Provider Relations departments at MedStar Family Choice will be working with the providers and members to try to improve this process. Please contact Provider Relations at 855-210-6203, option 5 with suggestions, comments and questions.

Provider

Visit the MedStar Family Choice Website for Valuable Information ....................................2

New Clinical Practice Guidelines for Pediatric UTI .............................2

Credentialing and Re-Credentialing ...........................3

Pharmacy and Therapeutics Committee .....................................3

Clinical Practice and Preventive Guidelines ......................................4

Updates to the MedStar Family Choice Formulary ..........................5

EPSDT Providers HealthCheck ...5

Grievance and Appeal Process ...6

Member Complaint/Grievance and Appeal Process ......................7

Vaccines For Children Program ..8

Member Rights and Responsibilities .............................9

Quality Monitoring Programs ..................................... 12

MedStar Family Choice Complex Case Management and Disease Management Programs ............ 14

Cultural Communication and Interpreter Services ................... 15

MedStar Family Choice Site Evaluations .................................. 15

1099 Statements ........................ 15

Benefits of Health Information Exchange (HIE) ........................... 16

IN THIS ISSUE uu

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The MedStar Family Choice website has valuable member information, including updates on our quality improvement programs and Find-A-Provider, a searchable provider directory. It’s easy to find a provider on the MedStar Family Choice website. You can search by:

• Doctor

• Hospital

• Language

• Location

• ZIP code

• Name/group

• Male/female

• Specialty

• Number of miles from your home

Visit the MedStar Family Choice Website for Valuable Information

New Clinical Practice Guidelines for Pediatric UTIThe MedStar Ambulatory Best Practices Committee has recently released a new clinical practice guideline for pediatric urinary tract infections. This guideline, in addition to other clinical practice guidelines, can be found on the MedStar Health StarPort. (StarPort.MedStar.net/MSH/Pages/Default.aspx)

Acute urinary tract infection is a common infection in children. In fact, eight percent of girls and two percent of boys will have a UTI before seven years of age. Each year, pediatric UTIs account for 1 million office visits and 13,000 admissions. Prompt diagnosis and treatment of both lower and upper urinary tract infections is imperative as urinary infections are associated with permanent renal damage. The guideline reviews outpatient diagnoses and management of urinary tract infection in the pediatric population.

In addition, our website contains detailed provider information, such as office hours, education and board certification information. Members may contact Member Services at 888-404-3549 for any additional information and doctor office updates.

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Credentialing and Re-CredentialingAll new providers wishing to participate in the MedStar Family Choice provider networks are required to complete and submit a MedStar Family Choice Council for Affordable Quality Healthcare medical data sheet (CAQH medical data sheet) along with a copy of their Disclosure of Ownership and Control interest statement. We use our CAQH medical data sheet to add new providers to our CAQH provider roster. Existing groups that participate in MedStar Family Choice products do not need to complete this form for re-credentialing but must complete our CAQH form and attach a copy of their Disclosure of Ownership and Control interest statement as part of their request to credential new providers who have joined their group. Provider requests for initial credentialing will not be processed if the request is not on our CAQH medical data sheet or if the Disclosure of Ownership and Control interest statement is missing and/or incomplete. Providers who are not a member of CAQH can complete the Maryland Uniform Credentialing Form (MUCF). Please contact Provider Relations with questions at 855-210-6203, option 5.

Pharmacy and Therapeutics CommitteeMedStar Family Choice has an active Pharmacy and Therapeutics Committee that meets the second Wednesday of every other month from noon to 1:30 p.m. Please consider getting involved and bringing your expertise and input to this committee. Some of the activities of the committee include:

• Reviewing and updating policies and procedures for pharmaceutical management

• Assessing drug utilization patterns and making recommendations for projects to address issues as they arise

• Reviewing the MedStar Family Choice closed formulary, at least annually, and evaluating requests for additions/deletions to the formulary

• Developing interventions to ensure the safe use of medications. If you are interested in joining the Pharmacy and Therapeutics committee, please contact your Provider Relations representative at 800-905-1722, option 5.

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Participating providers should review the clinical practice guidelines, as well as the preventive guidelines, posted on the MedStar Family Choice website, MedStarFamilyChoice.com, for updates. These guidelines are updated every two years. Currently, the clinical practice guidelines include the following:

• Management of Pediatric ADHD

• Diagnosis and Management of Asthma

• Treating Acute Asthma Exacerbations in Adults and Children

• Management of Acute Low Back Pain in Adults

• Management of Bronchiolitis in Pediatrics

• Bronchitis – Adults

• Bronchitis – Children and Adults

• Diagnosis, Management and Prevention of COPD

• Outpatient Treatment of DVT with LMWH

• Identification and Management of Clinical Depression in Adults

• Management of Adult Diabetes Mellitus

• Assessment and Prevention of Falls in the Elderly

• Assessment and Treatment of Hyperbilirubinemia

• Management of Hypercholesterolemia

• Assessment and Treatment of Hypertension

• Adult Immunization Schedule 2016

• Pediatric Immunization Schedule 2016

• Prescribing Naloxone in the Outpatient Setting

• Child and Adolescent Overweight/Obesity Guidelines

• Evaluation and Treatment of Overweight/Obesity in Adults

• Management of Osteoporosis

• Managing Otitis Media in Children Ages 6 months to 12 years

• Cervical Cancer Screening for the Primary Care Physician

• Guideline for Perinatal Care

• Diagnosis and Management of Streptococcal Pharyngitis – Adult and Pediatric

• Community Acquired Pneumonia – Adult

• Community Acquired Pneumonia – Pediatric

• Preventive Screening Recommended Guidelines 2016 – Adult

• Preventive Screening Recommended Guidelines 2016 –Pediatric

• Outpatient Use of Proton Pump Inhibitors

• Sinusitis – Adult

• Outpatient Management of Pediatric Urinary Tract Infection

All clinical practice guidelines are PDFs and can be downloaded. Alternatively you may contact Provider Relations at 855-210-6203, option 5 to request hard copies of these guidelines.

Clinical Practice and Preventive Guidelines

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EPSDT Providers HealthCheckPrimary care providers seeing patients under the age of 21 are required to complete the District’s HealthCheck Provider Training prior to joining our network and every two years after the initial training. Providers who are not up-to-date on their training may not be re-credentialed with our health plan. This program is accessible online at DCHealthCheck.net and requires a provider’s NPI to log in. The training program is free for participating MedStar Family Choice providers who are due to receive the training. Upon completion of the online training module, providers receive five free continuing medical education (CME) credits.

Updates to the MedStar Family Choice FormularyDistrict of Columbia - Healthy Families Plan

Changes from the September 2016 Pharmacy and Therapeutics Committee Meeting

Updates of the entire formulary as a PDF file will continue to be available quarterly on this website. More frequent updates are available on ePocrates, too.

Paper booklets of the 2016 Formulary have been mailed. If you have not received a copy or would like additional copies, please contact your Provider Relations representative. The updated PDF was posted for the July 1, 2016 update.

Additions that have or will go into effect in the next few weeks:

• Rosuvastatin

• Levocetirizine

• Hemangeol™ (propranolol HCl oral solution) for children less than 6 years of age

• Alclometasone 0.05 percent cream and ointment

Additions with Prior Authorization effective on or around Oct. 1, 2016:

• None

Removals effective on or around Oct. 1, 2016:

• Zepatier (elbasvir/grazoprevir) – Harvoni and Sovaldi remain on the formulary

Removal of Prior Authorization:

• None

Managed Drug Limitations and Step Therapy:

• None

Grievance and Appeal ProcessProvider Appeal Process

MedStar Family Choice providers must follow steps when submitting both administrative and clinical appeals as a result of a denial or reduction in reimbursement for services rendered. All appeals must be sent to us in writing and within 90 days of the denial date on the coordination of benefits (COB). In order to help providers address simple administrative appeal requests and formal clinical appeal requests, we have created templates to help with this process. Using the templates is optional and the forms include a Medicaid Administrative Claim Reconsideration form, a Medicaid Provider Claim Assistance/Project Request, a Medicaid Claim Appeal and/or a Formal Clinical Appeal form.

For administrative appeal requests, providers can submit one or more of the following forms:

• Medicaid Administrative Claim Reconsideration Form: This form can be used when asking MedStar Family Choice to re-consider a previously submitted claim that was denied for timely filing

(proof of timely filing required), a claim that was denied as a duplicate in error, a corrected claim (including modifiers), submission of information previously requested by MedStar Family Choice, coordination of benefits (COB), service not paid at contracted rates, processed PAR provider as out-of-network in error, claim processed with a TIN that was different from the TIN billed, denied for lack of authorization in situations where an authorization was obtained, requests for refunds/stop payments or other administrative type claim denials.

• Medicaid Provider Claim Assistance/Project Request: This form can be used when providers request the assistance of Provider Relations with larger claim issues that involve multiple claims issues for one member or single claim issues for multiple members.

• Medicaid Claim Appeal: This form is a formal claim appeal that can be filed as the last step in the appeal process within 90 business days of the denial. The appeal must outline reasons for the appeal with

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all necessary documentation including a copy of the claim and the explanation of benefits.

For formal clinical appeal requests, provider can submit:

• Formal Medical Necessity Appeal: This form should be used when the provider is acting on their own behalf and is disputing an adverse determination when the service has already been provided to the member.

Clinical claims appeals should be requested within 90 business days of the denial and include a written request outlining reasons for the appeal with all necessary documentation including a copy of the claim and the explanation of benefits. Providers will receive a response to their appeal within 30 calendar days. If a provider is not satisfied with the decision of the appeal because the initial denial of the claim was upheld, a second appeal can be submitted. Second level appeals must be sent within 30 calendar days of the first level appeal response. The second level appeal is the final level of appeal. Providers will receive a response within 30 calendar days of the receipt of the second level appeal. An acknowledgement of receipt of the appeal (first and second level) will occur within five business days of receipt.

Appeals should be sent in writing to: MedStar Family Choice 901 D St., SW, Suite 1050 Washington, DC 20024 Attn: Claims Appeals Department

Claim denials that are overturned on appeal will be paid within 30 calendar days of the decision.Templates for claims appeals can be found in our provider manual and on our website at MedStarFamilyChoice.com. Providers can also request hard copies of all forms by contacting Provider Relations by calling 855-210-6203, option 5.

Member Complaint/Grievance and Appeal Process The MedStar Family Choice complaint/grievance and appeal procedure that members follow can be found on our website at MedStarFamilyChoice.com and in your provider manual. If you do not have access to our website or a provider manual, you may call Provider Relations at 855-210-6203, option 5, for a copy of the manual.

The process will tell you the following:

• How members can file a complaint, grievance or appeal and the differences between them

• How quickly we will respond to the member and the provider

• What to do if the member does not agree with our decision Please note that providers may not appeal a decision on the member’s behalf without written permission from the member. A form is available on our website that permits providers to appeal on a member’s behalf. Members have the right to contact MedStar Family Choice Monday through Friday, from 8 a.m. to 5:30 p.m., at 855-210-6203, option 3, when they have a concern about a decision made by MedStar Family Choice.

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The Vaccines for Children (VFC) program is part of the D.C. Department of Health Immunization program. It is a federally funded entitlement program that provides vaccines free of charge to providers with eligible patients. Requirements for Participation By participating in the VFC program, you agree to:

• Screen all children for eligibility.

• Submit documentation to the VFC program for each vaccine dose administered.

• Follow the recommended immunization schedule established by the ACIP, the American Academy of Pediatrics, the American Academy of Family Practitioners and state law, except where medically contraindicated.

• Not to charge for VFC-supplied vaccine

• Provide vaccine information materials as prescribed by law.

• Complete the Provider Profile and Enrollment form.

• Allow VFC staff access to your practice for technical assistance and program review. To become a VFC provider you may request a provider enrollment packet through the VFC program at 202-576-7130, ext. 11.

Vaccines For Children Program

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MedStar Family Choice members have certain rights and responsibilities. These rights and responsibilities are reviewed annually and were last updated on June 6, 2014. Please contact MedStar Family Choice Provider Relations at 855-210-6203, option 5, with any questions and comments or to request a hard copy of all materials.

MedStar Family Choice members have the right to:

• Be treated with respect and dignity, no matter their race, color, creed, ancestry, marital status, political affiliation, national origin, age, sexual orientation, religion, gender, personal appearance, physical or mental disability, or type of illness or condition.

• Have access to care no matter their race, color, creed, ancestry, marital status, political affiliation, national origin, age, sexual orientation, religion, gender, personal appearance, physical or mental disability, or type of illness or condition.

• Privacy. Their medical records and all information about their health are private and will only be shared in a manner that follows District and federal laws.

• Privacy during treatment

• Information. They may ask for and receive information about MedStar Family Choice, its services, its doctors and other caregivers, and about their rights and responsibilities as a member of the health plan.

• Make recommendations regarding their rights and responsibilities as a member of MedStar Family Choice.

• Ask for qualifications of the people treating them.

• Choose a primary care provider (PCP) from MedStar Family Choice’s listing of doctors and change their PCP.

• Be told what their health problem is, what treatment they will be given and what risks are related to their illness and treatment. This must be told to them so that they understand the information.

• Talk to their doctor and help make choices and decisions about their health care and treatments.

• Choose someone who will have the legal right to make healthcare choices for them if they become unable to do so themselves.

• Refuse any treatment by a provider, and be told what might happen if they don’t have the treatment.

• Discuss all of the appropriate or medically necessary treatment options, regardless of the cost or whether they are covered by their health plan. MedStar Family Choice does not restrict providers from discussing all of the appropriate or medically necessary treatment options with members.

• D.C. Healthy Families members may receive family planning services and supplies from the provider of their choice. D.C. Healthcare Alliance members may receive family planning services and supplies from the provider of their choice from within the MedStar Family Choice network.

• Obtain medical care without unnecessary delay.

Member Rights and Responsibilities

(continued on page 10)

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• Receive information on advanced directives or a living will, develop advanced directives or a living will and choose not to have or continue any life-sustaining treatment.

• Continue treatment they are currently receiving until they have a new treatment plan.

• Receive interpretation and translation services free of charge if they need them.

• Refuse oral interpretation services.

• Get an explanation of prior authorization procedures.

• Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation.

• Request and receive a copy of their medical records, and request that they be amended or corrected as allowed by law.

• Exercise their rights and know that the exercise of those rights will not adversely affect the way that MedStar Family Choice, or our providers, treat them.

• File a complaint, appeal or grievance with us and have it resolved in a reasonable amount of time. For example, the complaint, appeal or grievance could include a concern about the care they received.

• Request an appeal or fair hearing if they feel we were wrong in denying, reducing or stopping a service or item.

• Request that ongoing benefits be continued during an appeal or fair hearing.

• D.C. Healthy Families members may receive a second opinion from another doctor in the MedStar Family Choice network if they don’t agree with their doctor’s opinion about the services that they need. If another in-network provider is not available, MedStar Family Choice will help them arrange a second opinion outside of the MedStar Family Choice network at no cost to them. D.C. Healthy Families members can contact us at 888-404-3549 for help with this. D.C. Healthcare Alliance members may receive a second opinion from another doctor in the MedStar Family Choice network if they don’t agree with their doctor’s opinion about the services they need. D.C. Healthcare Alliance members do not have out-of-network benefits.

• Receive a copy of the MedStar Family Choice member handbook.

• Obtain summaries of customer satisfaction surveys.

• Receive MedStar Family Choice’s Dispense As Written policy for prescription drugs.

• Receive other information about us, such as how we are managed, our financial condition and any special ways we pay our doctors. They may request this information by calling 888-404-3549.

All enrollees are entitled to copy of our practice guidelines upon request. To receive a copy, please call member services at 888-404-3549.

Member Responsibilities

It is the member’s responsibility to:

• Read this handbook so that they can understand the services provided, and how to contact MedStar Family Choice with questions.

(continued from page 9)

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• Be courteous and respectful to MedStar Family Choice staff and healthcare providers.

• Tell the truth about their health. They must tell us about any illnesses they had before. They must tell us about operations they had before. They must tell us what medicines they used in the past. They must tell MedStar Family Choice and their healthcare providers any information we may need in order to provide care to them.

• Do what their doctor tells them to do to get well or stay well. Follow the plans and instructions for their care that they and their healthcare provider have agreed to.

• Live a healthy lifestyle that includes seeing their doctor regularly and following preventive care guidelines, such as screenings and immunizations.

• Accept what might happen to them if they refuse treatment or if they do not follow the advice given to them.

• Tell their doctor if their health changes in any way that they did not expect.

• Know the name of their primary care provider (PCP) and get their PCP’s okay before getting care from anyone else.

• Make appointments with their PCP during office hours instead of using the Emergency department for things that are not emergen-cies. The Emergency department should only be used when they have a medical emergency.

• Be on time for all their appointments. Let the office know at least 24 hours ahead of time when they cannot keep an appointment.

• Help their doctor get medical records from providers who have treated them in the past.

• Follow the rules of the D.C. Medicaid Managed Care program.

• Carry their ID card and photo ID with them always. Tell the people in the doctor’s office, lab, drugstore or anywhere that they are getting health care that they are a MedStar Family Choice member.

• Ask questions about their care. Make sure that they understand what their health problem is and their treatment. Participate in developing treatment goals that both they and their doctor agree on.

• Notify MedStar Family Choice of any car accidents, falls, etc. where someone else may be at fault.

• Complete their renewal applications in a timely manner to prevent gaps in their health insurance.

• Report any other health insurance coverage to the Economic Security Administration at 202-727-5355.

• Give their doctor a copy of their living will and advanced directive if they have one.

• Report any known or suspected fraud and abuse as it relates to benefits, services or payments. For more information please see page 49 of the D.C. Healthy Families handbook and/or page 37 of the D.C. Healthcare Alliance handbook.

MedStar Family Choice staff may read MedStar Family Choice member medical records to make sure that they are getting the care they need.

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Quality Monitoring ProgramsMedStar Family Choice (MFC) strives to ensure that its members receive high quality health care services. To achieve its quality improvement goals, MedStar Family Choice participates in the following Quality Monitoring Programs:

1. National Committee for the Quality Assurance (NCQA) Accreditation – NCQA is an organization that develops standards for how health plans should operate and the services and programs they should have for members. Health plans that are accredited by NCQA have met high quality standards. MedStar Family Choice achieved full accreditation in 2015 and will be resurveyed in 2018.

2. Healthcare Effectiveness Data & Information Set (HEDIS®): HEDIS® is a tool from NCQA that helps health plans score how well their members are doing in areas like preventive care (well visits, Pap smears, mammograms and immunizations), care of pregnant women and treatment of chronic diseases like asthma and diabetes. Highlights of initiatives for improving member health and HEDIS® scores in 2016 to 2017 include:

1. The Women’s Health Outreach team to improve prenatal/postpartum care and cervical and breast cancer screening

2. Community health screenings and education to improve diabetes, asthma, heart disease, obesity, hypertension and behavioral health

3. Pediatric asthma and birth outcome improvement joint projects with the Department of Health Care Finance (DHCF)

4. Case management programs for members with diabetes, asthma, HIV, substance abuse, developmental disabilities and congestive heart failure

5. The availability of doctor home visits for members who have trouble getting to their PCP

*HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA)

3. Early and Periodic Screening, Diagnostic and Treatment (EPSDT) – MedStar Family Choice supports the goals of the EPSDT program to provide comprehensive preventive, dental, mental health, developmental and specialty care services for children under age 21 who are enrolled in Medicaid. Highlights of EPSDT program improvements developed in 2016 include:

1. Additional resources were dedicated to outreaching members in need of EPSDT care

2. The Outreach department collaborated with physician offices to hold Wellness Days exclusively for MedStar Family Choice members

3. Outreach home visits were made to members who were behind schedule with physicals, lead testing and immunizations

4. A lead testing program to improve testing for children 1 to 2 years of age

4. Satisfaction Surveys: MedStar Family Choice conducts annual member and provider satisfaction surveys.

1. Member Survey – the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey was done in 2016 by WBA Research. Highlights of the results include:

2. For children, members gave their highest satisfaction ratings to their personal doctor at 89 percent and Specialist at 85 percent.

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3. For children with chronic conditions, members gave their highest satisfaction ratings to their personal doctor at 91 percent and their customer service at 90 percent.

4. For adults, members gave their highest satisfaction ratings to their customer service at 89 percent and how well doctors communicate at 93 percent.

5. Provider Survey: A survey was done by WBA Research in 2015 to primary care providers to obtain information about their experiences with MedStar Family Choice. Highlights of the results include:

1. 77 percent reported overall satisfaction with MedStar Family Choice.

2. Overall satisfaction and all composite measures (groups of questions totaled together) increased from 2015 rates.

6. Quality of Care Review: The Quality Improvement department routinely reviews clinical issues to ensure that our members are getting the best possible care. When the quality of care provided to a member is below standards, MedStar Family Choice works with the physician, provider or hospital to correct problems and improve care.

7. Systems Review Audit: Every year, DHCF hires a company to perform a complete audit of MedStar Family Choice departments and procedures including utilization and case management; complaints, denials and appeals; provider network; quality; credentialing and enrollee rights. MedStar Family Choice is proud to report that the 2015 audit was completed with no issues or corrective actions required.

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MedStar Family Choice has a highly qualified staff of nurses and social workers who are available for MedStar Family Choice members with serious medical conditions or have complex and/or special needs. Our nurses and social workers are responsible for specific programs, based on their areas of expertise. They provide support and guidance to those members who need or would like extra assistance with their health care. Our case managers can also assist with care coordination. Below are some examples of medical conditions or circumstances where Case Management or Complex Case Management may be helpful:

Disease Management

• Pediatric Asthma

• Hypertension

• Adult Respiratory

• Adult Diabetes

• High-risk Pregnancy

• HIV

• Pain Management

• Substance Abuse

• Wound Care

• Pediatric Diabetes

Complex Case Management

• Transplants

• Multiple chronic illnesses with high utilization

• Catastrophic conditions/special needs requiring coordination of care

• Special needs populations, who require assistance with coordination of care and are not covered in a MedStar Family Choice Disease Management program

• COPD

If you would like to refer a member to our Complex Case Management program, please fax a referral to 202-243-5496, or call our Case Management department at 855-210-6203. We are available Monday through Friday, 8 a.m. to 5:30 p.m. Any faxes or voice messages received after hours will be handled the next business day.

MedStar Family Choice Complex Case Management and Disease Management Programs

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Cultural Communication and Interpreter ServicesCultural and linguistic differences can create barriers between providers and patients. These barriers may hinder healthcare professionals from understanding patient needs.

Providers can positively enhance a patient-physician relationship by:

• Being focused on the patient during the visit

• Asking clear and concise questions

• Following up with additional questions to ensure the member understands the provider’s instructions For members that are hearing impaired or not proficient in English, MedStar Family Choice will provide telephonic interpretation services and/or professional on-site interpreters. Please contact our Care Management department at 855-210-6203, option 2, to schedule telephonic translation services or call Provider Relations at 855-210-6203, option 5, to coordinate an in-office interpreter. Please be aware that Provider Relations will need no less than five business days prior to a member’s appointment to coordinate an on-site interpreter. In addition, MedStar Family Choice is contracted with La Clínica del Pueblo, available by calling 202-462-4788, to perform interpretation services for MedStar Family Choice members.

Providers may contact La Clínica del Pueblo directly for these services.

MedStar Family Choice Site Evaluations Site surveys are completed for all MedStar Family Choice PCPs and specialists at the time of initial credentialing and at recredentialing. Recredentialing site audits will occur every three years thereafter. If a member complaint is received about the physical condition of the provider office, a follow-up site audit will be performed. New provider sites and site additions also require a site evaluation after MedStar Family Choice Provider Relations is notified of the change or addition. If you have any questions or comments regarding minimum standards for site evaluations, please contact your provider representative at 855-210-6203, option 5.

1099 Statements MedStar Family Choice will be mailing 1099 statements during the month of January. The 1099s are mailed to the last W-9 address we have on file. It is possible that you may not receive your statement in the mail if MedStar Family Choice was not notified that the W-9 address we have on file for your office changed in the previous year. Providers who need to update their billing address information should fax their updated billing information along with a W-9 to MedStar Family Choice Provider Relations at 855-600-3077. Your information will then be updated in our system. If your W-9 address did not change and you received your 1099 statement for the last calendar year through the mail, then you do not need to send an update. All requests for a copy of a 1099 statement should be directed to 800-261-3371. Please contact Provider Relations with questions and concerns at 855-210-6203, option 5.

901 D St., SW Suite 1050 Washington, D.C. 20024 855-210-6203 PHONE

The MedStar Family Choice Newsletter is a publication of MedStar Family Choice.

Submit new items for the next issue to Arion Long, MedStar Family Choice, at arion.k.long@medstar.net.

Kenneth A. Samet, FACHE President and CEO, MedStar Health

David Finkel President, MedStar Family Choice

Arion Long Managing Editor, Health Plan Communications Specialist

MedStarFamilyChoice.com16-MFCDC-4492.122016

District of Columbia Health Information Exchange (DC HIE) offers providers and payors a window into the complete patient record. D.C. HIE will offer providers advanced HIE services including encounter notification, a portal for querying patient medical history and encounter reporting. Paired with D.C. HIE’s Direct Secure Messaging (Direct), these services will enable detailed patient information to be available from a single Electronic Health Record (EHR) sign-on allowing for more efficient patient management and better coordinated care. D.C. HIE services will assist healthcare stakeholders in managing priorities, assessing up-to-date patient information and working with others involved in patient care. The following is a list of the benefits of HIE by stakeholder.

Patients

• Improved payment coordination

• Improved clinical outcomes

• Improved transitions of care

• Reduction or elimination of duplicative or unnecessary procedures or tests

• Improved visit experience and satisfaction Providers

• Reduced health care costs

• Achievement of Meaningful Use objectives

• Access to valuable clinical data

• Improved monitoring of patient movement and disease management

• Improved patient satisfaction and provider experience

Access to an established and robust health information architecture to set the stage for future opportunities such as:

• Cross-facility utilization and re-admissions

• Opportunities for trend and pattern analysis

• “Frequent flyer” identification (high utilizers)

• Care management platforms

• Advanced financial and clinical analytics

Government/Public Health

• Improved understanding of clinical needs for District residents and patients

• Access to public health and population health data in a more timely manner than retrospective claims analysis

• Support DHCF/DC Medicaid in developing and prioritizing programs to improve health of District residents

Visit DHCF.DC.gov/Page/Subscribe-DC-HIE to sign up.

Source: dhcf.dc.gov/page/benefits-health-information-exchange

Benefits of Health Information Exchange (HIE)