The Point Issue 1 2021

For more of The Point Provider Newsletter

IN THIS EDITION:

HEDIS Medical Records Requests

Martin's Point will be faxing HEDIS-related medical record requests to network providers from January through early May 2021. We ask for your support in responding to the request as quickly as possible to allow a timely audit by our reviewers.

We will include a phone number for you to use should you have any questions and a secure fax number and physical mailing address to expedite delivery of your records to Martin's Point.

The HEDIS fax number is 207-828-7853 and is only monitored January 1 to May 9.

A reminder that at no time should medical records be faxed to the Provider Inquiry department. 

Thank you for your assistance with this effort and for the excellent care you give our health plan members.

COVID-19 Provider FAQs

Your Most up-to-Date Source for Martin’s Point Pandemic-Related Policies and Procedures

Our COVID-19 Provider FAQs, available on our website, are intended to ease the administrative burden associated with patient care during the pandemic. They include helpful topics such as coding/billing guidelines, testing, vaccines, cost share and benefit changes, DME, home health, telehealth, SNFs, etc. As always, our phone lines remain open to respond to any additional questions you may have during this time. 

Want Timely Claim Payments and New Patient Growth?

Always keep your provider directory information up to date. We make it easy!

CMS requires us to regularly contact our network providers to confirm the accuracy of our directory information. Up-to-date directory information helps our members find new providers when they need care and ensures more timely and accurate claims processing.

There are two convenient, online tools you can use to keep your NPI-related practice/provider information accurate:

1. Provider DataPoint: Please use our web-based provider data management tool to submit real-time changes:
   • Change your practice information, including name, phone/fax, address, billing information, NPI, etc.
   • Add/delete a location to your already-contracted practice/group
   • Change provider information, including name, specialty, panel status, add a language, etc.
   • Add a provider who requires credentialing to your practice
   • Terminate a provider from your practice/group
   • Check the status of a previously submitted data change request
     Visit: https://www.martinspoint.org/For-Providers/Tools/Update-Your-Info. If you have any questions, please see the instructions on our website or speak to a Provider Representative.
2. National Plan and Provider Enumeration System (NPPES): CMS now allows providers to use the NPPES to certify their NPI data. Information and FAQs about using NPPES as a reliable source for provider directory data are available at https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/index. Please direct questions about the NPPES to Jeremy Willard at [email protected].

Tips for Practice Administrators

• Create a monthly tickler reminder to check the accuracy of your provider/practice information in Provider DataPoint.
• We no longer accept NPI-related updates/changes and credentialing applications via email or fax. They must be submitted online via Provider DataPoint.
• Radiologists, anesthesiologists, and midlevel providers (NP, PA) who do not practice as PCPs do not require credentialing.

Please provide 30 days advance notice of changes to your provider/practice information when possible.

Comprehensive Visit Program Continues in 2021!

We are pleased to announce that we will continue our Comprehensive Visit Program for 2021. This program supports the annual assessment of the health status of our qualifying Martin’s Point Generations Advantage members—promoting their health while ensuring compliance with CMS documentation requirements for Medicare Advantage plans. For added flexibility due to COVID-19, we expanded our qualifying visits types. To learn more about the program and these changes, visit https://martinspoint.org/for-providers/resources/clinical-documentation/comprehensive-visit-program.

Senior Savings Model for Insulins

New Generations Advantage Benefit for 2021

Martin’s Point is excited to announce that we are participating in the CMS Medicare program “Part D Senior Savings Model” for all Generations Advantage Part D members. This program offers a wide range of insulin types at a predictable cost of $35 per 30-day supply through the deductible phase, initial coverage phase and coverage gap phase of Part D coverage. Please note that, participation in this pilot program is voluntary and not every Medicare plan has enrolled.

Our goal in participating in this program is to provide lower and consistent out-of-pocket costs for insulin to encourage medication adherence and healthy behaviors for our members. CMS estimates that this program will save our members $446 a year, or 66%, in 2021 out-of-pocket costs.

The table below is our inclusive list of the names and types of Tier 3 formulary insulins included in this program.

Insulins that are used in a pump fall under the Part B Medical benefit, not Part D, and will be subject to a 20% cost share for members, like all Part B medications

We care about the health of our members and will continue to look for ways to keep out-of-pocket costs on prescription medications affordable. 

2021 Plan Benefit Updates Available

Please remember to confirm member benefits at the start of each plan year, as benefits can change annually. Updated 2021 plan year benefits for Martin’s Point Generations Advantage and the Martin’s Point US Family Health Plan are available through the Provider Portal as of 1/1/2021.

Generations Advantage: We have added and/or enhanced several benefits for 2021 (see member’s individual plan for potential coverage), including:

• Acupuncture for low back pain
• Comprehensive Dental (expanded the network in Maine and New Hampshire to Northeast Delta Dental’s Premier level)
• OTC Benefits through OTCHS/CVS (added over a hundred new eligible products)
• Telehealth
• Reimbursement for masks through the Wellness Wallet, available all year, not just during the public health emergency
• Part D Senior Savings Model (participation allows members to purchase select insulins at a $35 cost share for 30-day supply)

We will continue offering coverage in 2021 for existing benefits (see member’s individual plan for potential coverage), including:

• Hearing Aids (through Amplifon)
• Fitness Benefit
• Nutrition & Dietary Services
• Weight Management Programs
• Smoking Cessation
• Personal Emergency Response System
• Fall Prevention
• Bathroom Safety

Just for Kids

HPV Immunizations for Adolescents

About 80% of people will get an HPV infection in their lifetime. Recommended HPV vaccination for all 11–12-year-olds can protect them long before most will ever be exposed. CDC recommends two doses of HPV vaccine for all adolescents at age 11 or 12 years. 

Childhood Immunization Status

Childhood vaccines protect children from a number of serious and potentially life-threatening diseases such as diphtheria, measles, meningitis, polio, tetanus and whooping cough, at a time in their lives when they are most vulnerable to disease. Approximately 300 children in the United States die each year from vaccine-preventable diseases.

Martin’s Point Pediatric Behavioral Health Care Management Program

Martin’s Point annually monitors the quality of our pediatric members’ behavioral health through claims submission. Each year, one in six children aged 6-17 in the US experiences a mental health disorder.¹  At Martin’s Point, we work to close gaps in care by addressing the following the HEDIS measures for pediatric members.

Measuring the percentage of children and adolescents 1–17 years of age who had two or more antipsychotic prescriptions and had metabolic testing. The measure includes the percentage of children or adolescents that received the following testing yearly:

• Blood glucose testing
• Cholesterol testing

Follow-Up Care for Children Prescribed ADHD Medication (ADD)

• One visit within 30 days of when the first ADHD medication was dispensed.
• Two follow up visits within 9 months (for those who remain on the medication at least 6 months)

Initial Outreach and Follow up: 

• Complete a phone outreach to assess the family’s and child’s needs
• Collaborate with the care team
• Provide support and advocacy
• Find local resources, providers and community supports
• Provide additional education regarding their conditions and the importance of follow-up
• Assist in preparation for their office visits

To contact a Martin’s Point pediatric behavioral health care manager, please call 1-877-659-2403.

¹ https://www.nami.org/mhstats