REMINDER

March Vision is contracted with Molina to receive and process payment for all diabetic retinal exam services. If you have any questions, please feel free to contact 888-898-7969, Option 1 and 1. When billing vision services, please make sure to bill all medical diagnosis to Molina Healthcare of Michigan, Inc at PO Box 22668 Long, Beach, CA 90801.

Invitations have gone out to our providers in the Southeast Michigan area for the upcoming Provider Dinner Meeting being held on

August 21, 20075:30 PM – 7:30 PM

At The Marriott Hotel & Conference Center27033 Northwestern Highway, Southfield, MI 48034

HOPE TO SEE YOU THERE!!!

* DINNER MEETING FOR PROVIDERS LOCATED IN OTHER AREAS COMING SOON *

2007 Provider Dinner Meeting

100 W Big Beaver Road, Suite 600Troy, MI 48084

© 2007 Molina Healthcare, Inc.

All rights reserved.

Part# 2048Rev0807

I n T h i s I s s u e A Publication for Molina Healthcare Providers • Summer 2007

Page

What’s NewWhat’s New

5 6 1

What is the CDPS Risk Score?

• Health Plans are paid a capitated rate by the State of Michigan for members assigned to the Plan.

o AFDC (Aid to Families with Dependent Children)

•All Plans are paid the same rate for AFDC members. The State looks at statewide encounter information to determine regional rates by age/sex categories.

o ABAD (Aid to the Blind and Disabled)

• Health Plans are paid in a manner that reflects the illness and disability burden of their ABAD population. This is called the CDPS method

• CDPS is a payment system that Medicaid programs can use to make health –based capitated payments for disabled Medicaid beneficiaries.

• CDPS uses diagnoses from both ambulatory and inpatient encounter data.

o CDPS organizes diagnoses into 19 major categories, which correspond to body systems or types of diagnosis.

o Most of the major categories are further divided into several subcategories according to the degree of increased expenditure associated with the diagnosis.

o Each diagnosis category and subcategory is assigned a payment weight.

o The higher the acuity, the higher the payment weight.

Chronic Disease and Disability Payment System (CDPS) Risk Score

CDPS Risk Score ....................... 1

CDPS Risk Score Continued ....... 2

ePortal...................................... 2

Authorization Requirements ........ 3

Improve Your Lead Testing Rate ...... 4

Claims Submissions .................. 4

Authorization Reminder ............. 4

NDC Updates ........................... 5

Reminder.................................. 5

We are Pleased to Announce ..... 5

2007 Provider Dinner ................ 6

NDC UPDATES

Effective for dates of service on or after July 15, 2007, providers must report the 11digit NDC and its corresponding information in addition to the procedure code in the LIN Segment of LOOP ID

2410 to specify the physician administered drug that is part of the service described in SV1 for the professional and institutional 837 4010A1 claim formats. Providers must also report the quantity and unit of measures of the NDC as outlined below in Table 1a and Table 1b.

The NDC is a unique eleven digit (11digit) identifier assigned to a drug product by the labeler/manu-facturer under Federal Drug Administration (FDA) regulations. Claims submitted with invalid or missed NDC information or NDC’s by a drug manufacturer who does not have a signed rebate agree-ment with CMS will reject with Edit 995 (Missing or invalid National Drug Code (NDC) or Product Distributed by an Unapproved Manufacturer.

SEE ExaMPlE Of bIllIng

We are Here and Pleased to Announce

Molina Health Care of Michigan has been awarded ISABELLA COUNTY. We are excited about our network of Primary Care Physicians, and specialty providers that have signed on to make it possible to provide excellent, quality healthcare in Isabella County. Denise Hughes, Provider Services Rep II, will be delivering excellent customer service throughout the provider community in Isabella County. Isabella is nicely tucked away between Gratiot and Clare County.

Continued on page 2...

Molina Healthcare of MichiganWhat’s New

Claims Submission Requirements

Please mail all initial claims to:Molina Healthcare, Inc.PO Box 22668Long 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.

Want to Improve Your Lead Testing Rate?

2 3 4

How is the CDPS Risk Score Calculated?• Encounter Submission

• Physicians must report office encounters whether they are capitated or fee-for-service

• 50% of the Risk Score comes from physicians encounter and claims reporting

• Under reporting can cause the Health Plan’s score to plummet

What can PCPs Do to Help?

• Encourage your patients to come in for office visits

o Welcome Postcards, Calls, Reminder cards

• AFDC members should receive Well Child and Well Woman care as appropriate

• ABAD members should be seen at least 2 to 4 times per year

o An added benefit is fewer ER visits, fewer admissions, and higher compliance with treatment plans

• Submit accurate and timely encounters for every office visit.

• For members with chronic illness, always report the chronic illness on the claim form.

• Be specific on diagnosis coding, ill-defined diagnoses receive NO points in the CDPS scoring.

• Your claims must be submitted according to Michigan Uniform Billing Guidelines.

***bEWaRE Of SUPER bIllS PRE-POPUlaTED WITH nOn-SPECIfIC DIagnOSIS CODES***

Chronic Disease and Disability Payment System (CDPS) Risk Score

Many families find it difficult to get to the laboratory to get lab work done and also fear having a venous blood specimen drawn from their one-year-old child. Beginning in October 2005, a filter paper test became available for use in provider offices. Supplies are free from the Michigan

Department of Community Health laboratory. The blood sample is obtained in the office using a finger poke and mailed to the MDCH lab for processing. Results are then entered into the MDCH lead registry and sent to the provider.

Since early 2006, A Michigan Health plan has provided lead education to provider offices. Between May and October 2006, 61 provider offices received education about the importance of lead testing and a demonstration of the use of the newly available filter paper test method. For these offices, the lead testing rates prior to the education visit averaged 50%. Three months after the visit, the rates had increased to an average of 60%. For the offices where six months have passed since the lead education visit, the average testing rate was 57%. Nine months following the education visit, the average testing rate per office is 69% which is an increase from the baseline of 19% overall. Sustained improvement

was shown over the 9 month period.

Overall, lead testing rates increased from 62% for total enrollment and 68% for continuous enrollment in May 2006 to 74% and 81% respectively in May 2007.

To increase the lead testing rate for your office, please call Molina Health Plan of Michigan Quality Improvement Department at 1-888-898-7969.

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888-

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ePortal

Molina Healthcare, Inc. has implemented a new online e-Portal system for providers and members nation-wide. There have been many new enhancements to the Provider Self Service tool, with more to come, such as:

• Submitting National Provider Identification number (NPI).• Verify member eligibility• Submit and status prior authorizations• Status and submit claims• Print claim summaries• View and print patient listings• Contracted provider search

Features will continue to be added throughout the year. For more information, contact the ePortal Help Desk at (866) 449-6848 or check it out at www.molinahealthcare.com.

aUTHORIZaTIOn REMInDER

PLEASE FAX ALL AUTHORIZATION

DOCUMENTATION TO 800-594-7404