August 1, 2014  
Announcing Iowa Product Changes for 2015announcingproductchanges
Our Iowa products are changing for 2015, as we will no longer sell CoOportunity Choice, our statewide three-tiered product. In addition, we will offer CoOportunity CorePlus,* a new select network product with out-of-network benefits.
  
The CorePlus select provider network is a subset of Midlands Choice providers who will also support the 2015 CoOportunity Preferred product.
  
We will share more about CorePlus over the next few months.
  
*Pending Centers for Medicare & Medicaid Services (CMS) and state approval
  
Watch for New Upcoming Training Opportunitieswatchfornewupcomingtrainingopportunites
To help you prepare for 2015 and the upcoming Marketplace Open Enrollment, we'll offer new training options in the fall. Watch future Provider Alerts or coOportunityhealth.com/Training for information.
  
Note: A special program will be available to help Certified Application Counselors (CACs) and Navigators prepare for the 2015 Open Enrollment period, which starts for individual purchasers on November 15, 2014. Employer groups will also start renewing in November 2014 for next year.
 
Encourage IMCP Members to Complete Reenrollment Process IMCPreenrollment
Iowa Medicaid Enterprise (IME) has begun the process of reenrolling members covered by the Iowa Marketplace Choice Plan (IMCP). Members who do not reenroll will be terminated from the Qualified Health Plan (QHP).
 
If one of your patients with IMCP coverage has questions about reenrollment or needs assistance, please refer him or her to one of the following contacts:
schedule2014routinepreventiveexamsSchedule 2014 Routine Preventive Exams for Iowa Marketplace Choice Plan Members
When you provide an annual routine preventive exam, members covered by Iowa Marketplace Choice (IMCP) not only learn more about their healthcare status, they may save money.
  
As you may have read, the Iowa Department of Human Services provides incentives for Iowa Health and Wellness Plan members - including IMCP members - who complete the following steps in 2014:
  • Receive an annual physical.
  • Complete a health risk assessment.
IMCP members who complete both steps may not be required to pay a 2015 monthly premium for their healthcare coverage.
  
Added Member Bonus
When IMCP members covered by CoOportunity Health receive their routine preventive exam and complete the health risk assessment on our secure site at coOportunityhealth.com/Member, they satisfy the IME requirement (we notify IME) and earn a one-time $100 VISA� gift card from us.
 
Note about the $25 provider reimbursement: The $25 Iowa Medicaid Enterprise (IME) reimbursement is only available for Iowa Wellness Plan beneficiaries, and is not available for members covered by IMCP. If you have questions, check the Iowa Department of Human Services provider toolkit or contact Iowa Medicaid Provider Services at 1.800.338.7909.
 
Upcoming Preventive Care Benefit Changesupcomingpreventivecarebenefitchanges
Over the next several months, the following services will be covered as preventive benefits by plans - like ours - that are compliant with Affordable Care Act requirements. These changes are based on preventive care recommendations issued by the US Preventive Services Task Force.
 
Until the changes are effective, the services are subject to a member's cost share amount.
 
Covered as preventive effective October 1, 2014:
  • Breast cancer medication for primary breast cancer prevention for women at increased risk for breast cancer and at low risk for adverse medication effects; clinicians should offer to prescribe risk-reducing medications, such as tamoxifen or raloxifene.
Covered as preventive for reenrolling or new members effective January 1, 2015, and effective for employer groups as they renew in 2015:
  • CT scans for lung cancer screening for members over age 55 with a history of smoking.
  • Application of fluoride varnish to teeth in a primary care medical setting for children birth through age 5. Does not apply to dentists or dental coverage.
You'll find more preventive care coverage information on our medical policy/coverage criteria page:
Reminder: Routine preventive care is covered at 100 percent when provided by Tier 1 providers for the CoOportunity Choice product, or an in-network provider for all of our other products. Your network status may not be the same for all products. If you need additional assistance in determining your status, check our Provider Directory for each product or contact Member Services at 1.888.324.2064.
 
Medical Policy Update: Weight Loss Surgery - Iowamedicalpolicyupdateweightlosssurgery
We've posted the following update to the medical policy for Weight Loss Surgery - Iowa. You'll find this change under the covered indications:
Members who do not have surgery within one year of completion of a Weight Loss Surgery Program phone course may be asked to repeat the course.
 
This change was effective July 2, 2014.
 
Reorganized Website Page Guides You to Correct Form reorganizedwebsitepage
To make it easier to locate the form you're looking for, we've reorganized our Forms website page to include links to more of our forms under these five categories:
  • Claims
  • Admissions
  • Behavioral Health
  • Medical Policy
  • Pharmacy
The forms previously listed under the General tab can now be found under the following tabs:
New and Updated Forms Availablenewandupdatedformsavailable
SNF Admission/Discharge Notification Form - New
A new Skilled Nursing Facility admission notification form is now available. You'll find the form under the new Admissions tab of the Forms page and with the Skilled Nursing Facility medical policy.
 
Procedure Prior Authorization Form - Updated
In response to questions received about the Procedure Prior Authorization Form, we've more clearly identified the requesting and procedural provider fields. You'll find the updated form under the Medical Policy tab of the Forms page and with descriptions of medical policies that use this particular form.
 
ICSI Guidelines - New & Revised Guidelinesicsiguidelines
Institute for Clinical Systems Improvement (ICSI) health care guidelines represent the most appropriate medical practice for the range of common preventive services, chronic diseases and acute conditions.
 
A Health Care Protocol is a step-by-step statement of a procedure routinely used in the care of individual patients to assure that the intended effect is reliably achieved. Order Sets are a standard set of orders for in-patient care for particular conditions.
 
Health Care Guidelines and Order Sets or Protocols that have recently been developed or updated:

Please review the updates to determine if it is appropriate to implement some or all of them within the clinical practice of your medical group.

 
For complete copies of all ICSI Guidelines, Protocols and Order Sets, visit the ICSI website, or call ICSI at 1.952.814.7060 to obtain a hard copy.
  
For New Providers and Staff Members: Links to Help You Work With Usfornewprovidersandstaffmembers
Access these tools to learn more about us at coOportunityhealth.com/Provider.

For access to our secure Provider website tools, contact your organization's site delegate or register today.