Bulletin Program
Valley Health Plan Care Management Program works with Members to improve their health and quality of life. Our program consists of complex case management, care coordination and preventive health education, including chronic disease self-management. The Care Management Program encompasses two programs: Disease Management and Complex Case Management. VHP has partnered with McKesson Care Management to co-administrate these programs. McKesson is a leading provider of disease and care management services, offering more than 25 million enrolled patients immediate access to a broad range of health and disease management services. The Care Management Program is delivered by a team of specially trained registered nurses and other professional staff, using state-ofthe-art information systems to provide knowledge, support, and monitoring for patients between practitioner visits. Members are identified for the Complex Case Management and Disease Management programs through historical claims data (medical and pharmacy) along with requests for services requiring prior authorization and use of the health information line for Members with high and/or complex needs. Members and caregivers may also self-refer to the VHP Care Management Program by calling 1.855.624.5223. (Continued on pg. 2)
VOLUME 17, WINTER 2014
Provider
CARE MANAGEMENT
Care Management Program ............1 The Road to ICD-10............................2 Timely Filing of Claims....................3 Avoiding CCS Claims Denials.........3 National Provider Identifier (NPI) Required on All Claims....................3 Network Update for Compounding Pharmacies..............4 Prescription Drug Prior Authorization Request Form............5 Medication Adherence for Members with Depression...............6 Authorization Denial Disputes........8
Provider Network Change for InHome Supportive Services (IHSS) Members..............................................8 Valley Express Access.......................9 Updated VHP Identification (ID) Card.....................................................9 New or Departing Providers.........10 Changes in Your Information........10 Credentialing Process.....................10
Choosing Wisely速............................11
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