UPPER PENINSULA HEALTH PLAN

In This Issue....

New ID Cards                                                           Toll-Free Number Changes
Billing Updates                                                   Immunization Rate Comparisons
Member Satisfaction Survey                                             2000 Provider Surveys
Pediatric Specialty Clinics                                     Patient Self-Determination Act
New PCP Change Policy

Billing Updates....

• Conversion Information Packets have been mailed to each billing office. If you have not received one, please contact UPHP.
   
• High-risk pregnancy codes are diagnosis code specific. Be sure to follow the MSA Policy Manual when billing for high-risk pregnancies.
   
• UB92 Billing Manuals are available through MSA. UPHP will be implementing this form of billing starting January 1, 2001. Until that time, the “Z” codes will remain in effect for DOS prior to January 1, 2001.
   
• Effective January 1, 2001 you do not have to put an “M” in front of the Medicaid ID number. The new system does not require it.
   
• Just a reminder, UB92’s that are submitted with missing codes are not put on the line. If your claim is returned as a result of this, you are responsible for correcting and returning it as soon as possible, but not later than one year from the date of service or discharge.

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UPHP Childhood and Adolescent Immunization Rates as Compared with Michigan Medicaid

As indicated by the 2000 Health Employer Data Information Set (HEDIS) audit graphs, the immunization status of both our younger children and adolescents how room for improvement to attain the national performance goals of 90%. The data below resulted from the medical record audits we completed by HEDIS specifications earlier this year.

Without chart review, immunizations can only be tracked by claims data. Claims data does not provide the historical perspective needed to account for immunizations given in the past, therefore review will continue to be necessary. A major need exists for copies of current immunization records to reside in each member’s chart so that providers can review and provide timely assessment if needed and the accurate immunization status of our Upper Peninsula population is present when we complete our follow-up audits.

Efforts to improve our current immunization rates have, to date, included:

• Contacting providers and parents of members identified as needing updated immunizations
• Targeted provider and member educational mailings
• Provider Manual updates with current immunization recommendations and requirements
• Ongoing communication and collaboration with the local Health Departments

It is our hope that at sometime in the future, the state of Michigan Childhood Immunization Registry (MCIR) will be deemed adequate for this type of tracking, as their database is completed and validated.

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UPHP Member Satisfaction Survey

The results of the Consumer Assessment of Health Plans Study (CAHPS) are represented by graphs. The graphs include Ratings of Medical Providers and Medical Care for Adults and Ratings of Medical Providers and Medical Care for Children. These results are based on two member satisfaction studies conducted from February through May 2000. UPHP was one of 27 Medicaid Quality Health Plans surveyed in Michigan.

As represented below, UPHP is a strong performer on most satisfaction measures, with care delivery as a particularly exemplary area of performance. Other areas receiving high ratings from UPHP members are the Primary Care Provider (PCP) services, member’s ability to access care quickly, and overall health care. For all experiences with the plan, 64% of UPHP member’s rate it highly, compared to the 59% plan average for the state of Michigan. Areas for improvement include Emergency Department utilization and drug usage by our members.

If you would like a complete copy of these results, please contact our Clinical Services Department.

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Upper Peninsula Health Plan - 228 W. Washington Street - Marquette, MI 49855

1-800-835-2556 or  906-225-7500