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Provider Bulletins

Bulletin

January 23, 2012

PREPARING FOR HEDIS®   2012 

In collaboration with our network physicians and providers, Medica HealthCare Plans, Inc. is committed to improving the quality of care provided to our members. Our data collection effort for the National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data Information Set (HEDIS®) 2012 Clinical Effectiveness of Care measures is one way in which we strive to accomplish this goal.

HEDIS ®    is an important standard set of nationally reported measures that are utilized to assess the quality of care provided to our members and your patients.   While designed to improve care for all patients, the HEDIS ®  measures also directly impact the CMS 5 STAR Plan Rating. Medical records from our members' physicians are required in order to compile the necessary data for some of these measures. The audits will be scheduled during March through May 2012.

 As a result of this process, one or more of your patients' medical records maybe selected for review for measurement year 2011.  In order to minimize the time required by your staff, Medica Healthcare Plans, Inc has contracted with Health Data Vision, Inc. (HDVI) a national HEDIS ®      medical record software and abstraction  organization, to retrieve the necessary records. HDVI will contact your office to schedule a method of retrieval, i.e., mail, fax or onsite scanning for the targeted patients. 

Any information shared with HDVI during the HEDIS ®    audit activities and reviews will be  kept in the strictest confidence and in accordance will all applicable State and Federal laws regarding the confidentiality of patient records, including HIPAA. Disclosure of medical information to Medical Healthcare plans, Inc. and to HDVI, acting on our behalf, is permitted by a written consent signed by all our members at the time of initial enrollment in our health care program.

  Bulletin

  September 9, 2011 

Prevention and Control of Influenza

Yearly flu vaccination should begin in September and continue throughout the flu season, usually through January.

Influenza vaccinations are available through network pharmacies such as Walgreens, CVS, Publix, Costco, Winn Dixie, Wal-Mart, Target, or Navarro Pharmacies.

In addition, pneumonia vaccination should be considered for people 65 and older, the very young, and people with special health problems such as alcoholism, heart or lung disease, kidney failure, diabetes, HIV infection, or certain types of cancer.

*Recommendations of the Advisory Committee on Immunization Practices (ACIP)

  Bulletin

August 11, 2011                                                                                                    Via Facsimile: 8/12/2011

Dear Provider:

In order to better serve your needs, effective August 22, 2011, Medica HealthCare Plans, Inc. (MHP) will implement the following telephone lines directly and exclusively for the use of health care providers.

Medical Management and  Eligibility and Benefit Verification: 

                         (305) 421 1220 or (954) 986 0266

TOLL FREE:    (866) 273 9444                                                     

Claim Disputes and Appeals:   

                        (305) 460 0650 or (800) 348 5548                   

Providers who call any other MHP telephone number(s) for these services will be redirected and asked to call these telephone numbers directly; calls may not be transferred to these telephone lines by any MHP employee.

Thank you.