VHP Provider Bulletin Spring/Summer 2018

R E D I V O PR A MESSAGE FROM

Debra Halladay, COO

I would like to thank you for the opportunity to assume the position of Chief Operating Officer (COO) for Valley Health Plan (VHP). I have worked with the Santa Clara Valley Health & Hospital System since 2015 working in the capacity of the Director of Planning, Business Development, and Managed Care and the Director of Office of System VHP Chief Operating Officer Integration and Transformation leading the implementation of Whole Person Care, a pilot program supported by the Medi-Cal 2020 Waiver.

Prior to my arrival at the County, I worked in executive roles at a number of managed care organizations, including for example, Centene Corporation and Breakthrough Behavioral Health, a start-up acquired by MDLIVE. Throughout my career I have taken roles that allowed me to build high performing teams characterized by the desire to pursue innovative change in the health care industry focused on the most vulnerable individuals in our community. I look forward to working with my new VHP team to create value for the County and those we serve.

N I T E L BUL Table of Contents Upoming Formulary Change Notice.............................p.2 Postpartum Depression Screening/CPT Code........... p.2 Pharmacy Network Expansion......................................p.3 Metabolic Syndrome...................................................... p.3 Follow-Up Care for Children Prescribed ADHD Medication (ADD)........................................................... p.4 Provider Satisfaction Survey......................................... p.7 Communication Matters - Exchange of Information Between Psychiatrists, Non-Medical Behavioral Health Practitioners & PCPs...................................... p.8 Health Education & Wellness Programs....................p.8 Reporting Suspected Fraud.......................................... p.9 Provider Information Updates....................................... p.9 Timely Access Information...................................p.10 Protected Health Information (PHI).............................. p.11 Member Fraud Notice.................................................... p.11 VHP Provider Bulletin is Going Green!........................ p.12

VOLUME 22 | SPRING & SUMMER 2018

UPCOMING FORMULARY CHANGE Notice Effective July 1, 2018, Valley Health Plan will implement the following formulary changes: The purpose of this letter is to notify you of an upcoming change in the prescription drug coverage for Opioid Agonists and Combinations. As of 07/01/18, quantity limits (QL) will be added to the drugs listed below. *DRUG NAME

NEW STATUS EFFECTIVE 07/01/2018

Hydrocodone/Acetaminophen capsule Oxycodone/Acetaminophen capsule Oxycodone/Acetaminophen tablet Oxycodone/Aspirin tablet

QL exceeding 30 capsules/tablets per 7 days requires PA‡

Oxycodone tablet Hydrocodone/Acetaminophen tablet Hydrocodone/Acetaminophen solution Oxycodone/Acetaminophen solution Oxycodone solution Oxycodone concentrate solution

QL exceeding 450 mls per 7 days requires PA‡ QL exceeding 150 mls per 7 days requires PA‡ QL exceeding 30 mls per 7 days requires PA‡

*Please note: All drugs listed may not be covered on your patient(s) formulary. Please refer to VHP Drug Formulary available at www.valleyhealthplan.org for a complete list of covered drugs. ‡PA: Prior Authorization

If your patient(s) is affected by these changes, a letter has been sent to the affected patients.

The Formularies are reviewed and selected by VHP Plan Providers on the VHP Pharmacy and Therapeutic Committee in accordance with professionally-recognized medical standards for their medical and cost effectiveness.

How do I submit a prior authorization request?

You can download a Prescription Drug Prior Authorization or Step Therapy Exception Request Form from our website at www.valleyhealthplan.org and fax the complete form to 1.855.668.8551. If you have additional questions, please contact Navitus at 1.866.333.2757.

What if I need further assistance?

For any questions regarding this Formulary update, please contact the Provider Relations Department at 408.885.2221 or Navitus at 1.866.333.2757.

POSTPARTUM DEPRESSION Screening/CPT Code HEDIS requires that women should be screened for postpartum depression 8 weeks or 21-56 days after delivery.

Last summer, VHP reviewed our data to see how we are doing and found that many women that delivered between 2016 and 2017 were not meeting the HEDIS measure. However, upon further health record analysis, it was found that a lot of these women were indeed being screened for postpartum depression, though it is believed that a standard Current Procedural Terminology (CPT) code is not being used to capture the screening. This is why VHP would like to promote the standardization of postpartum depression screening documentation by encouraging practitioners to use the CPT code G9357. We appreciate the work that you all do and want to ensure that the care you deliver is being appropriately captured, especially in HEDIS scores. Thank you for your help.

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PHARMACY NETWORK Expansion

Retail Pharmacy Network:

• Nationwide Walgreens Pharmacies • Nationwide Safeway and affiliates Pharmacies • Nationwide Costco Pharmacies – NEW • Select Local Pharmacies • Valley Health Center Pharmacies (VHC) Some retail pharmacies may offer to mail prescription drugs, your patients may inquire at their local network pharmacy.

Prescription Mail Order Service: Effective July 1, 2018, VHP will begin using Costco Pharmacy as its new prescription drug mail order provider.

VHP will no longer be using Novixus Pharmacy services.

Physicians can prescribe by:

- Calling: 1.800.607.6861

- Fax: 1.888.545.4615

- E-Prescription: Costco Mail order, 215 Deninger Circle, Corona, CA

NCPDP: 5633753 If you have any questions about pharmacy benefits, please visit www.valleyhealthplan.org or call VHP Provider Relations at 408.885.2221 or Navitus Customer Care at 1.866.333.2757.

METABOLIC SYNDROME VHP values our members and want to ensure they are receiving the best care possible. This is why VHP wants to take this opportunity to remind providers to screen members for metabolic syndrome if they are on medications that heighten their risk. Metabolic syndrome is a group of combined conditions including excess body fat around the waist, high blood sugar, hypertension and high cholesterol or high triglyceride levels. Having these conditions together increases the risk for heart disease, stroke, diabetes and increased cardiovascular morbidity and mortality. Metabolic syndrome is especially prevalent among individuals who are prescribed antipsychotic medication for psychotic disorders, including schizophrenia. The American Diabetic Association/ American Psychiatric association consensus guidelines recommends that members who are taking antipsychotic medications be screened regularly. This screening should include:

- hemoglobin A1c screening or fasting glucose

- blood pressure screening

- fasting lipid screening

- abdominal girth measurement

- weight (BMI)

Improved communication and coordination between the behavioral health care practitioner and the primary care practitioner can help ensure that this screening is completed. With heightened awareness, improved communication and vigilant screening, together we can improve the lives and outcomes of our members living with schizophrenia who are at risk for metabolic syndrome.

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Follow-Up Care for Children Prescribed ADHD Medication

FOLLOW-UP CARE FOR CHILDREN

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Follow-Up Care for Children Prescribed ADHD Medication (ADD) Prescribed ADHD Medication (ADD) SUMMARY OF CHANGES TO HEDIS 2017  No changes to this measure.

Description The percentage of children newly prescribed attention-deficit/hyperactivity disorder (ADHD) medication who had at least three follow-up care visits within a 10-month period, one of which was within 30 days of when the first ADHD medication was dispensed. Two rates are reported.  Initiation Phase. The percentage of members 6–12 years of age as of the IPSD with an ambulatory prescription dispensed for ADHD medication, who had one follow-up visit with practitioner with prescribing authority during the 30-day Initiation Phase.  Continuation and Maintenance (C&M) Phase. The percentage of members 6–12 years of age as of the IPSD with an ambulatory prescription dispensed for ADHD medication, who remained on the medication for at least 210 days and who, in addition to the visit in the Initiation Phase, had at least two follow-up visits with a practitioner within 270 days (9 months) after the Initiation Phase ended.

Definitions Intake Period

The 12-month window starting March 1 of the year prior to the measurement year and ending February 28 of the measurement year.

Negative Medication History

A period of 120 days (4 months) prior to the IPSD when the member had no ADHD medications dispensed for either new or refill prescriptions.

IPSD

Index Prescription Start Date. The earliest prescription dispensing date for an ADHD medication where the date is in the Intake Period and there is a Negative Medication History.

Initiation Phase

The 30 days following the IPSD.

C&M Phase

The 300 days following the IPSD (10 months).

New Episode

The member must have a 120-day (4-month) Negative Medication History on or before the IPSD.

Continuous Medication Treatment

The number of medication treatment days during the 10-month follow-up period must be ≥210 days (i.e., 300 treatment days – 90 gap days).

Treatment days (covered days)

The actual number of calendar days covered with prescriptions within the specified 300-day measurement intervalCare (e.g.,for a prescription of a 90 days supply dispensed on Follow-Up Children Prescribed ADHD Medication the 220th day will have 80 days counted in the 300-day interval).

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Eligible Population: Rate 1—Initiation Phase Note: Members in hospice are excluded from the eligible population. Refer to General Guideline 20: Members in Hospice.

Product lines

Commercial, Medicaid (report each product line separately).

Ages

Six years as of March 1 of the year prior to the measurement year to 12 years as of February 28 of the measurement year.

Continuous enrollment

120 days (4 months) prior to the IPSD through 30 days after the IPSD.

Allowable gap

None.

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Continuous enrollment

120 days (4 months) prior to the IPSD through 30 days after the IPSD.

Allowable gap

None.

Anchor date

None.

Benefits

Medical and pharmacy.

Event/ diagnosis

Follow the steps below to identify the eligible population for the Initiation Phase.

Step 1

Identify all children in the specified age range who were dispensed an ADHD medication (Table ADD-A) during the 12-month Intake Period.

Table ADD-A: ADHD Medications Description

Prescription

CNS stimulants

 Amphetaminedextroamphetamine  Dexmethylphenidate

 Dextroamphetamine  Lisdexamfetamine

Alpha-2 receptor agonists

 Clonidine

 Guanfacine

Miscellaneous ADHD medications

 Atomoxetine

 Methylphenidate  Methamphetamine

Note: NCQA will post a comprehensive list of medications and NDC codes to www.ncqa.org

by November 1, 2016.

Step 2

Test for Negative Medication History. For each member identified in step 1, test each ADHD prescription for a Negative Medication History. The IPSD is the dispensing date of the earliest ADHD prescription in the Intake Period with a Negative Medication History.

Step 3

Calculate continuous enrollment. Members must be continuously enrolled for 120 days (4 months) prior to the IPSD through 30 days after the IPSD.

Step 4

Exclude members who had an Care acutefor inpatient encounter for mental or chemical 3 Follow-Up Children Prescribed ADHDhealth Medication dependency during the 30 days after the IPSD. Any of the following meet criteria:  An acute inpatient encounter (Acute Inpatient Value Set) with a principal mental

Administrative Specification: Rate 1—Initiation Phase health diagnosis (Mental Health Diagnosis Value Set).

Denominator Numerator

An 1 acute inpatient encounter (Acute Inpatient Value Set) with a principal The Rate eligible population. diagnosis of chemical dependency (Chemical Dependency Value Set).

An outpatient, intensive outpatient or partial hospitalization follow-up visit with a practitioner with prescribing authority, within 30 days after the IPSD. Any of the following code combinations billed by a practitioner with prescribing authority meet criteria:  ADD Stand Alone Visits Value Set.  ADD Visits Group 1 Value Set with ADD POS Group 1 Value Set.  ADD Visits Group 2 Value Set with ADD POS Group 2 Value Set. Note: Do not count a visit on the IPSD as the Initiation Phase visit.

Eligible Population: Rate 2—C&M Phase Note: Members in hospice are excluded from the eligible population. Refer to General Guideline 20: Members in Hospice.

Product lines

Commercial, Medicaid (report each product line separately).

Ages

Six years as of March 1 of the year prior to the measurement year to 12 years as of February 28 of the measurement year.

Continuous enrollment

Members must be continuously enrolled in the organization for 120 days (4 months) prior to the IPSD and 300 days (10 months) after the IPSD. Members who switch product lines between the Rate 1 and Rate 2 continuous enrollment periods are only included in Rate 1.

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Ages

Six years as of March 1 of the year prior to the measurement year to 12 years as of February 28 of the measurement year.

FOLLOW-UP CARE FOR CHILDREN Continuous Members must be continuously enrolled in the organization for 120 days (4 months) prior

enrollment the IPSD and 300 (ADD) days (10 months) after the IPSD. Prescribed ADHDtoMedication

Members who switch product lines between the Rate 1 and Rate 2 continuous enrollment periods are only included in Rate 1.

Allowable gap

One 45-day gap in enrollment between 31 days and 300 days (10 months) after the IPSD. To determine continuous enrollment for a Medicaid beneficiary for whom enrollment is verified monthly, the member may not have more than a 1-month gap in coverage (i.e., a member whose coverage lapses for 2 months [60 days] is not considered continuously enrolled).

Anchor date

None.

Benefits

Medical and pharmacy.

Event/ diagnosis

Follow the steps below to identify the eligible population for the C&M Phase.

Step 1

Identify all members who meet the eligible population criteria for Rate 1—Initiation Phase.

Step 2

Calculate continuous enrollment. Members must be continuously enrolled in the organization for 120 days (4 months) prior to the IPSD and 300 days (10 months) after the IPSD.

Step 3

Calculate the continuous medication treatment. Using the members in step 2, determine if the member filled a sufficient number of prescriptions to provide continuous treatment for at least 210 days out of the 300-day period after the IPSD. The definition of “continuous medication treatment” allows gaps in medication treatment, up to a total of Care for period.

Children Prescribed ADHD 4 [1 90 days during the Follow-Up 300-day (10-month) (This period spans theMedication Initiation Phase month] and the C&M Phase [9 months].)

Gaps can include either washout period gaps to change medication or treatment gaps to refill the same medication.

Regardless of the number of gaps, the total gap days may be no more than 90. Count any combination of gaps (e.g., one washout gap of 14 days and numerous weekend drug holidays).

Step 4

Exclude members who had an acute inpatient encounter for mental health or chemical dependency during the 300 days (10 months) after the IPSD. Any of the following meet criteria:  An acute inpatient encounter (Acute Inpatient Value Set) with a principal mental health diagnosis (Mental Health Diagnosis Value Set).  An acute inpatient encounter (Acute Inpatient Value Set) with a principal diagnosis of chemical dependency (Chemical Dependency Value Set).

Administrative Specification: Rate 2—C&M Phase Denominator

The Rate 2 eligible population.

Numerator

Identify all members who meet the following criteria:  Numerator compliant for Rate 1—Initiation Phase, and  At least two follow-up visits with any practitioner, from 31–300 days (9 months) after the IPSD. One of the two visits (during days 31–300) may be a telephone visit (Telephone Visits Value Set) with any practitioner. Any of the following code combinations identify follow-up visits:  ADD Stand Alone Visits Value Set.  ADD Visits Group 1 Value Set with ADD POS Group 1 Value Set.  ADD Visits Group 2 Value Set with ADD POS Group 2 Value Set.

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 ADD Stand Alone Visits Value Set.  ADD Visits Group 1 Value Set with ADD POS Group 1 Value Set.  ADD Visits Group 2 Value Set with ADD POS Group 2 Value Set.  Telephone Visits Value Set.

Exclusions (optional) Exclude from the denominator for both rates, members with a diagnosis of narcolepsy (Narcolepsy Value Set) any time during their history through December 31 of the measurement year.

Note  For members who have multiple overlapping prescriptions, count the overlap days once toward the days supply (whether the overlap is for the same drug or for a different drug).  Refer to Appendix 3 for the definition of prescribing practitioner.  Organizations may have different methods for billing intensive outpatient encounters and partial hospitalizations. Some methods may be comparable to outpatient billing, with separate claims for each date of service; others may be comparable to inpatient billing, with an admission date, a discharge date and units of service. Organizations whose billing methods are comparable to inpatient billing may count each unit of service as an individual visit.

The unit of service must have occurred during period Follow-Up Care for Children Prescribed ADHDthe Medication 5 required for the rate (e.g., within 30 days after or from 31–300 days after the IPSD).

Data Elements for Reporting Organizations that submit HEDIS data to NCQA must provide the following data elements.

Table ADD-1/2: Data Elements for Follow-Up Care for Children Prescribed ADHD Medication Administrative Measurement year Data collection methodology (Administrative) Eligible population Number of optional exclusions Numerator events by administrative data Numerator events by supplemental data Reported rate Lower 95% confidence interval Upper 95% confidence interval

  Each of the 2 rates Each of the 2 rates Each of the 2 rates Each of the 2 rates Each of the 2 rates Each of the 2 rates Each of the 2 rates

PROVIDER SATISFACTION SURVEY

Your Feedback Matters!

This is a reminder to our providers about the annual 2018 Provider Satisfaction Survey. This survey is to be administered by VHP’s survey vendor, Center for the Study of Services, via fax.

VHP is committed to providing quality care to our members and improving the working experience for VHP’s providers as best as possible. In line with our commitment to continuous improvement, we are asking providers to participate in the Provider Satisfaction Survey.

If your office receives a survey via fax to participate in this important survey, don’t miss out on the opportunity!

The survey should take around 10 minutes to complete.

We want to thank you in advance for taking the time to share your opinions and thoughts with us.

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COMMUNICATION MATTERS

Exchange of Information between Psychiatrists, Non-Medical Behavioral Health Practitioners & PCPs VHP believes that it is important for all health care practitioners involved in managing the care of a VHP member to be able to share information so they can deliver the high quality care our members deserve. The sharing of health care information helps practitioners coordinate care for our members. Effective coordination of care improves safety, avoids duplicate assessments, procedures, testing, and results in better treatment outcomes. VHP believes that effective coordination of care is a key determinant of overall health outcomes.

The potential barriers to accurate communication between doctors include perceived lack of authority to share information, time constraints, increased workload, interruptions in workflow, and complexity of the medical conditions restricting ability to share information. Other barriers that affect communication can be limitations of the communication medium and accuracy of contact information, incompatible information systems, and misinterpretations of privacy concerns related to the Health Insurance Portability Accountability Act (HIPAA).

Studies have shown that up to 63% of PCPs and 35% of specialists, including Psychiatrists and non-medical Behavioral Health practitioners, are dissatisfied with inter-provider communication. Specialists are concerned with the timeliness and adequacy of the information in referral notes sent to them by PCPs. On the other hand, PCPs are complaining that they get no information back from the specialists within 30 days of the initial specialty visit. Both types of practitioners agree that this information would have been very helpful in appropriately managing the care of the patient.

The following problems have been reported as a result of poor coordination of care:

- Practitioners find it difficult to comprehensively reconcile medications

- Repeated tests or procedures because results were unavailable at time of visit

We know your offices are very busy seeing our members and understand that sharing information with another practitioner can take a significant amount of your time. But, it is a critical step that can go a long way in improving outcomes. Remember that at the end of the day, it is our members and your patients who benefit from good communication!

HEALTH EDUCATION & Wellness Programs ADULT DIABETES PREVENTION PROGRAM VHP encourages Providers to inform our Members of the healthy lifestyle options available as a part of our plan. VHP is partnering with the YMCA to offer a 16-week Diabetes Prevention Program (DPP) including YMCA membership during the program at no-cost. The DPP can help people make lifestyle changes to improve their overall health & well-being while lowering their disease risk. This is a prevention program for individuals who are at high risk, not for people who already have diabetes.

Contact the YMCA Diabetes Prevention Program at ymcadpp@ymcasv.org or call 408.351.6440.

Visit www.ymca.net/diabetes-prevention to learn more about the program.

WEIGHT WATCHERS® VHP encourages providers to inform our members of the healthy lifestyle options available as a part of our plan. VHP is proud to partner with Weight Watchers® to offer VHP members a 50% subsidy for both the online plus membership and in person meetings membership. Weight Watchers® is for patients looking to integrate healthy habits into their lives.

The Weight Watchers® scientifically proven approach works by providing techniques and skills to help people lose weight, harness positive energy, and stay active. The Weight Watchers® Freestyle Program helps participants eat what they love, do what moves them and shifts their mindset. To learn more, visit www.valleyhealthplan.org.

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REPORTING SUSPECTED FRAUD Valley Health Plan (VHP) is committed to providing our members with quality care. We encourage our members, providers and community to notify VHP of any suspicion or situations regarding healthcare fraud. This allows us to investigate and take necessary actions to protect our members from unlawful activities. Fraud and abuse in health care may occur in many different forms, including, but not limited to, the following:

- Medical identity theft;

- Unbundling;

- Billing for unnecessary services and items;

- Billing for non-covered services or items;

- Billing for services or items not rendered;

- Kickbacks; and

- Beneficiary fraud.

- Upcoding;

PREVENTION BY PROVIDERS In addition to reporting potential fraud and abuse practices, providers may take steps to prevent fraud and abuse, including:

- Knowing the regulations and laws governing the services offered by the practice;

- Screening potential and existing employees and contractors for current exclusion, or grounds for exclusion; and

- Implementing a compliance program.

HOW TO REPORT FRAUD AND ABUSE If you believe you’ve experienced or are aware of any fraud (waste or abuse of VHP health care resources), please contact the VHP Compliance Department at 408.885.5606. It is against VHP policy and the law to retaliate against anyone who reports, participates, testifies or assists in a potential fraud investigation.

PROVIDER INFORMATION Updates

Have you recently moved your office or changed your phone number, email address, or any other demographic information? If you move, it is important for members to be provided your new information. Visit www.valleyhealthplan.org/sites/p/Pages/provider-directory-change-form.aspx to update your directory information within seven days of the change.

Has your TIN, business name or billing address changed?

Upon enrollment and contracting with VHP, you were required to complete a W-9, CA 590 or CA 587 tax form and ACH enrollment. In the event any of this information changes, you must provide an update to us in writing by summarizing the changes in your demographics and by completing all forms again with your new information.

Visit www.valleyhealthplan.org/sites/p/fr/Forms/Pages/Providers-Forms-Home.aspx to find the forms.

You may forward your updates to your Provider Relations Specialist by email or fax your updates to 408.793.6648.

If your information is not updated, it will result in returned mail or delayed or suspended payments and/or remittances.

Has your office added new providers?

You must notify VHP Credentialing of any new providers 90 days prior to their start date so that VHP may credential them prior to practicing.

Authorization Requirements Visit www.valleyhealthplan.org/sites/m/mm/FormsResources/Pages/auths.aspx for authorization requirements for X-ray pursuant to Specialty Visits effective 3/27/2018.

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TIMELY ACCESS Information

What is Timely Access?

The Department of Managed Health Care (DMHC)’s Timely Access to Non-Emergency Health Care Services Regulations became effective in 2010. The Timely Access Regulations required health plans and its contracted providers to ensure that health care services are provided to members in a timely manner appropriate for the nature of the patient’s condition and consistent with good professional practice.

The evidence is clear that timely access to health care services results in better health outcomes, reduced health disparities, and lower healthcare spending, including avoidable emergency room visits and hospital care. VHP is committed to adhere to DMHC’s timely access standards and ensure that our contracted providers are aware of the requirements and providing appropriate access to quality of care to members.

What is Timely Access Standards?

Below is the Summary of Timely Access Standards Regulations for the Department of Managed Health Care (DMHC).

VHP requests you to review the following standards in order for you to better understand these requirements.

Appointment Wait Times:

Urgent appointments

Maximum wait time after request

PCP, appointment that do not require prior authorization

48 hours (next available appointment is within)

Appointment REQUIRED Prior authorization (Specialist & Mental Health Providers)

96 hours

Non-urgent appointments

Maximum wait time after request

PCP

10 business days

Non-physician mental health care provider (Master Degree Providers, PhD and above, Psychologists)

10 business days

Specialist (Cardiologists, Endocrinologists, Gastroenterologists, Psychiatrists)

15 business days

Ancillary Services (Physical Therapy, Mammogram & MRI appointments)

15 business days

Timely Access During Office After Hours (PCPs & Mental Health Practitioners) Contracted PCPs & Mental Health Practitioners are required to ensure services are provided to patients 24 hours per day, 7 days per week, and triage or screening services by telephone which includes: 1. Provided in a timely manner appropriate to the member’s condition, and that the triage or screening wait-time does not exceed 30 minutes (Triage or screening wait-time means the time to wait to speak by telephone with a physician, registered nurse, or other qualified health care professional).

2. Caller will be informed regarding the length of wait for a return call from the practitioner (No more than 30 minutes).

3. How the Caller may obtain urgent or emergency care, including, when applicable, how to contact another practitioner who has agreed to be on-call to triage or screen by phone, or if needed, deliver urgent or emergency care.

Sample of After-Hours Script that would meet Timely Access Standard “Thank you for calling the office of Dr. Smith. Our office hours are [insert office’s hours]. We are unable to take your call at this time. If this is a medical emergency, please hang up and dial 911 or seek attention at your nearest 10 Provider Bulletin | Spring & Summer 2018

emergency room. If this is not a medical emergency, you may leave a message after the tone and Dr. Smith or a covering practitioner will return your call with 30 minutes. You may also call your health plan’s 24-hour a day Nurse Advice Line for no cost medical advice. The number is on the insurance card provided by your plan.”

VHP would like to thank you for helping us meet our member’s needs in timely manner and for your commitment to providing high quality care.

PROTECTED HEATH INFORMATION (PHI)

Valley Health Plan (VHP) does not share your health information with anyone without your authorization, unless we are permitted to do so by law.

We understand that information about you and your health is confidential and personal. We are committed to protecting health information about you. We create and maintain a record of the care and services you receive through VHP. We need this record to provide you with quality care and to comply with certain legal requirements.

We are required by law to:

- make sure that PHI that is linked to you is kept private and confidential (with some exceptions);

- give you a Privacy Notice about our responsibilities and privacy practices about your PHI; and

- follow the terms of the Privacy Notice that is currently in effect.

Unless permitted by law, VHP will not use or share your PHI unless you have signed an authorization form that allows us to do so. You have the right to cancel the permission by requesting it in writing, except if we have used or shared your PHI when you first gave us permission to do so. The law limits how we can use and disclose some PHI related to treatment of drug and alcohol abuse, HIV infection, and mental illness.

form, you can visit www.valleyhealthplan.org/sites/ ccp/mm/ FormsResources/Pages/Resources.aspx or contact VHP Member Services at 1.888.421.8444 (tollfree).

You have the right to request that health care communications regarding sensitive services you receive be sent to an alternate address. These sensitive services can include, but are not limited to, services and treatment for mental health, pregnancy, sexually transmitted diseases, sexual assault, drug or alcohol treatment, HIV and counseling. Members 12 years of age and older can request that sensitive service confidential communications be sent to an alternate address by contacting VHP Member Services at 1.888.421.8444 (toll-free).

The VHP website provides members with information regarding their health coverage. When browsing the website, information may be collected and stored regarding your site visit such as the date, time, and number of visits. No identifying information is collected.

The complete VHP Privacy Notice including a list of your rights and how VHP uses your health information can be found at www.valleyhealthplan.org/Pages/ PrivacyNotice.aspx. If you have questions about this Privacy Notice, please contact VHP Member Services at 1.888.421.8444 (toll-free), Monday – Friday, 9:00am to 5:00pm.

VHP may use, share or disclose your PHI when necessary as required by law and for treatment, payment, and other health care operations.

You may elect to share your PHI information with an authorized representative such as a friend, family member or anyone you choose. For this type of sharing to happen, you must complete “The VHP Authorization for use/or disclosure of Protected Health Information” form. This form will be placed in your file and VHP will follow your instructions on what information to share.

All members 18 years of age or older wishing to share their PHI, must complete this form. For a copy of this www.valleyhealthplan.com 11

VHP CHIEF MEDICAL OFFICER Dolly C. Goel, MD VHP MEDICAL ADVISORS Stephen Harris, MD Michael Meade, MD Gary Steinke, MD BOARD OF SUPERVISORS Cindy Chavez Dave Cortese S. Joseph Simitian Mike Wasserman Ken Yeager COUNTY EXECUTIVE Jeffrey V. Smith

VHP PROVIDER RELATIONS Is Going Green!

This will be our last VHP Provider Bulletin sent by mail. Visit www.valleyhealthplan.org/sites/p/Bulletinand-Updates/Pages/Provider-Bulletin-and-Updates.aspx to find all bulletins and updates.

Has your office gone green yet?

VHP takes part in 837 electronic claims, 835 electronic remittance and ACH/EFT electronic payment.

To enroll in 837 and or 835, please contact your clearinghouse who will then connect with our clearinghouse UHIN: https://uhin.org/. You may also contact UHIN to inquire about initiating service.

If you are interested in electronic payment ACH/EFT, visit www.valleyhealthplan.org/sites/p/fr/Forms/ Pages/Providers-Forms-Home.aspx for the ACH enrollment form and return it to your Provider Relations Specialtst for processing.

2480 N. First Street, Suite 160

l San Jose, CA 95131 l 1.888.421.8444 (toll-free) l www.valleyhealthplan.org

12 Provider Spring&- Summer 2018 Provider Bulletin Bulletin | Spring Summer 2018