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July is UV safety month
Skin cancer is the most common type of cancer in the United States. Ultraviolet (UV) rays from the sun are the main cause of skin cancer. UV damage can also cause wrinkles and blotchy skin. These are just some of the reasons why ODS is proud to participate in UV Safety Month and help raise awareness of the risks of sun damage. During the month of July, ODS will work to encour age members to take action to prevent skin cancer and reduce the risk of UV damage.
August is National Immunization Awareness Month
National Immunization Awareness Month is the perfect time to promote immunizations and remind family, friends, and coworkers to get caught up on their shots. |
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HEDIS� Medical Record Reviews:
ODS Quality Programs Says "Thanks"!
The ODS Quality Programs team would like to extend a BIG THANK YOU to all the provider office staff and members who assisted in the successful chart review program as part of our 2012 HEDIS� project.
ODS Health recognizes that our network providers perform an important function within the healthcare delivery system by providing care to our members, documenting interactions and providing member education and outreach. ODS Health is pleased to report we have partnered with Inovalon, formerly MedAssurant to collect selected HEDIS information as part of the review process.
We thank you for your cooperation and for improving the quality of care and service to our members, your patients. The ODS team is also interested in your comments and feedback, too. Please contact ODS HEDIS Project Manager, Fred Rouzpay, at 503-265-2930. |
Medical Necessity Criteria Updates
ODS posts a listing of Medical Necessity Criteria information in the Provider Resources section of its website at www.odscompanies.com/medical/medical_criteria. To promote quality care, patient safety and the most appropriate use of healthcare resources, ODS utilizes the evidence-based Milliman Care Guidelines� for several areas of care. The Milliman Care Guidelines are developed using the industry's most rigorous evidence-based methodology. All content is reviewed annually and updated as necessary by doctors and nurses who cite more than 15,000 unique references, including peer review journals in the current seven-product Care Guidelines series. Milliman Care Guidelines epidemiologists then examine databases that cover a significant portion of the United States population to validate that these published research results are achievable in real-life situations.
Effective October 1, 2012, ODS will revise the status of the following Nasal/Sinus Endoscopy codes to experimental/investigational, and prior authorization will now be required: 31295, 31296, 31297. For  more information, visit the ODS website or call the Customer Service team at 503-243-3962. |
Coordinated Care Organizations
Under these newly formed CCOs, the Oregon Health Plan benefits will not change. However, today the system separates physical, behavioral and other types of care. That makes things more difficult for patients and healthcare providers, and ultimately more expensive for the state.
These new CCOs will have the flexibility to support new models of care that are patient-centered and team-focused, while also helping to reduce health disparities. By creating single entities, CCOs will be able to better coordinate services across providers while also focusing on preventive care, chronic illness management and person-centered care. They will have flexibility within their budget to provide services alongside today's OHP medical benefits with the goal of meeting the Triple Aim of better health, better care and lower costs for the population they serve.
A third-party state commissioned analysis has shown that the potential cost savings of CCOs for Oregon are substantial -- more than $3 billion over the next five years - which will ensure that our most vulnerable citizens maintain coverage, while freeing limited resources for other public priorities.
In the spirit of partnership and collaboration, ODS Community Health, Inc. (ODS) and Greater Oregon Better Health Initiative (GOBHI) have joined together to create a collaborative to serve twelve of Oregon's rural Eastern Oregon Counties (Wheeler, Gilliam, Sherman, Morrow, Umatilla, Lake, Harney, Grant, Union, Wallowa Baker, and Malheur). This new CCO will be known as the Eastern Oregon Coordinated Care Organization (EOCCO). Both organizations have extensive experience managing the Oregon Health Plan benefit and look forward to continuing to serve OHP members in this region.
Oregon has long been a pioneer in finding new approaches to healthcare, and the introduction of Coordinated Care Organizations (CCOs) certainly follows in that tradition. CCOs will help to provide a new and different way of delivering healthcare coverage to Oregon Health Plan (Medicaid) members by creating local networks of integrated healthcare providers. |
Supreme Court Rules,
Health Care Reform Stands
Beginning January 1, 2013:
- FSAs will be limited to $2,500 for the calendar year of 2013 and will adjust annually for inflation.
Beginning January 1, 2014:
- The Health Insurance Exchanges are to be established.
- Premium Tax Credits will be available to help low-income individuals.
- Individual mandate will encourage citizens to obtain health insurance or be subject to a penalty tax.
- Employers will also be mandated to provide coverage or be subject to a penalty tax.
- Pre-existing Condition exclusions will be prohibited.
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ODS Patients Using Dialysis Services
ODS is working with members with end-stage renal disease who are undergoing kidney dialysis, to promote timely enrollment in Medicare Part B. Over the course of treatments, Medicare Part B coverage provides significant cost savings to patients requiring ongoing dialysis treatments for ESRD.
Dialysis patients must enroll in Medicare Part B within the first three months of dialysis treatments to take advantage of Medicare Part B coverage, and this coverage takes effect beginning with the 42nd dialysis treatment.
Based on claim information, ODS is targeting members for outreach in order to help facilitate enrollment in Medicare Part B, within the first three months of dialysis treatments.
ODS requests your partnership in encouraging ODS ESRD patients undergoing kidney dialysis to enroll in Medicare Part B within their first three months of dialysis visits.
For additional information or questions, please contact the Customer Service team at 503-243-3962
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ODS Health Plan Selected for
National Leadership Program
Three ODS employees have been selected to participate in a year-long executive leadership program designed to tackle racial and ethnic disparities in healthcare. Sara Gardner-Smith, Karis Stoudamire-Phillips and Dr. Robert 'Neal' Mills are among 40 individuals from 15 healthcare organizations from around the United States to be selected for the Disparities Leadership Program 2012-2013.
The Disparities Leadership Program, the first of its kind in the nation, is designed for leaders from hospitals, health insurance plans and other healthcare organizations seeking to develop practical strategies to eliminate racial and ethnic disparities in healthcare. The program is led by the Disparities Solutions Center at Massachusetts General Hospital (MGH) in Boston, Massachusetts.
"This program is about developing new leaders and taking action. It is about helping individuals and their healthcare organizations understand the critical connection between improving quality and eliminating disparities in care through a concerted, coordinated effort to change our healthcare system," said Joseph R. Betancourt, MD, MPH, Director of the Disparities Solutions Center at MGH, and a member of the Institute of Medicine (IOM) Committee, which produced the 2002 landmark report Unequal Treatment: Confronting Racial/Ethnic Disparities in Health Care. This report revealed striking disparities in the quality of healthcare services delivered to minority and white patients -- even for patients of the same socioeconomic background and access to care. "These healthcare organizations are clearly distinguishing themselves as national leaders by taking action to identify and address disparities," Dr. Betancourt said.
"We are very excited and honored to be accepted into the Disparities Leadership Program. We believe this partnership and collaboration with similar organizations will further help ODS refine and advance our efforts in becoming a CLAS-competent organization," said Sara Gardner-Smith, CHES, Health Promotion and Quality Improvement Specialist at ODS Health Plan. "We hope to make the most of this opportunity to better serve our members, providers, and our community." |
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ODS Medical Professional Configuration
For provider updates, call 503-265-5711 or email providerupdates@odscomapnies.com
Credentialing Department
For credentialing questions and requests, call 1-855-801-2993
or email credupdates@odscompanies.com
ODS Medical Customer Service team
All other inquires, including claims review, adjustment requests, and/or billing policies, call 503-243-3962
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Disclaimer: Not all plans have access to all resources or tools referenced in this newsletter. Please refer to your Member Handbook, or call your ODS Sales and Account Services Representative for plan-specific information.
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Benefit Tracker
Check claims status, benefits and eligibillity.
To contact an ODS Benefit Tracker Administrator, call 503-265-5616, toll-free at 877-277-7270 or email
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