Provider Network Newsletter
In This Issue
Biometric Screenings
Meet Janelle Davis
Contracted Non-Credential Provider
Payment Effective Dates!
How to Speed up Payments
A Patient Representative
Acronums of the Month
Quick Links
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Issue: Number 4November 2015

It's official the holiday season is upon us! In this time of hustle and bustle we hope you are taking the time to enjoy the true spirit of the
Thank you for all that you do each day to support our families, friends, and neighbors living their healthiest lives.
We look forward to supporting your continued great work in
Cheers and Happy Holidays,
The Beacon Health Provider Network Team

Acronyms of the Month

Because they're just a part of healthcare!


 Can you decode the healthcare acronyms below?

  • ABMS            _________________________________
  • ALOS             _________________________________
  • CLASS           _________________________________
  • HCAHPS        _________________________________
  • SNF                 _________________________________

  Find the answers at the end of the newsletter.

EMHS Employee Medical Plan
Shares Biometrics with PCPs
EMHS is a leader in healthcare transformation, which is evident by the activities that are taking place in our hospitals, outpatient clinics, and now our wellness program. We have designed a multistep approach that was implemented last year with employee biometric screenings and other systemwide wellness offerings, and will continue to grow over the next three years to help support employees living their healthiest lives.
Employees and spouses / domestic partners who participate in biometric screenings are rewarded through the Total Health+ program. Metrics measured include blood pressure, BMI, cholesterol, and blood glucose.
It's likely your practice is receiving lab results, since we started screenings the first of October. If participants identify you as their provider we share the results. These tests are meant to help us better understand the overall health of our employees and not to make final diagnoses.  In an effort to reduce duplicate testing, Beacon Health is able to pull existing 2015 biometric measures from EMHS EMRs for eligible participants.  We will receive a second report after December 31, 2015 to include anyone who completed these measures with EMHS practices during our screening time frame.
Beacon Health will mail non-lab values to your primary care practices in January. We request that all records are scanned and flowcharted in a timely manner as employees will likely contact your practice with questions, looking for results, or to schedule appointments.  We encourage you to reach out to your patients with abnormal results, at your discretion.  Patients with abnormal results will be encouraged to follow up with their primary care provider as well.
In some instances, we are unable to receive EMR values for participants.  They will have an option to print a provider form for you to complete. 
From October first through 23, about 900 screenings have already taken place, and an additional 150 have submitted paperwork.  Including the "golden ticket" holders - those who'd completed all necessary screenings with their PCP, prior to screenings this year - it appears roughly 1,500 are slated to receive their biometric reward!
While you as PCPs have a good understanding of our patients who come to your practices, 75 percent of our employees consider themselves healthy yet a high number of them have not been to see their primary care provider for a preventive visit in many years, if ever.  We want to emphasize our belief in prevention and the promotion of healthy lifestyles as the cornerstone of this effort. This is not intended to replace the preventive visit with PCPs but rather prompt and encourage such an encounter. We appreciate your support and feedback as we go through this process.
Introducing... Janelle Davis, Credentialing Specialist
Janelle Davis is one of Beacon Health's credentialing specialists  working with our contracted TPA network of over 3,900 providers statewide.  Before joining Beacon Health, Janelle was the senior office administrator for more than six years at Hanger Clinic overseeing insurance billing, accounts receivables, MaineCare, and scheduling. 
Prior to that, Janelle worked for nine years in management in the retail sector. She is from Madison, Maine and currently resides in Bangor with her two children and their Belgium Shepard. When she is not working, Janelle can be found spending memorable times with her kids or out with her friends exploring and trying new things.  
When do I use the
Contracted Non-Credentialed Provider Data Form?
Beacon Health maintains a number of useful credentialing forms on our website. The Contracted Non-Credentialed Provider Data Form allows practices to set up for the EMHS Employee Medical Plan network of several types of providers that do not require full credentialing review, but will be billing for their services under their own name. 
GHP does not require facility-based pathologists, anesthesiologists, radiologists, emergency medicine specialists, or hospitalists/intensivists to complete the full credentialing process if:
  • they practice exclusively in an acute care hospital setting or within a free standing facility, and
  • they only provide care for EMHS Employee Medical Plan members as a result of the members being directed to the facility. 
Physician assistants and certain types of CRNPs, who are employed by an EMHS Employee Medical Plan participating provider, are not required to complete the credentialing process either, unless acting as a PCP. 
Interventional radiologists and any telemedicine, with the exception of teleradiologists, will need to be fully credentialed.
Complete Application Triggers
"Payment Effective Date"
Beacon Health is the credentialing agent for the EMHS Employee Medical Plan, and sends provider participation data to Geisinger Health Plan, the claims administrator, in a timely and efficient electronic fashion. Beacon has begun to honor the date of our receipt of a completed credentialing application as the "payment effective date" for new providers - meaning, the date that the EMHS Employee Medical Plan and Geisinger will set as the beginning of eligibility for contracted payments.
It usually takes Beacon Health about 30 days following receipt of a completed application to finalize a provider with the Beacon Health Credentialing Committee and send the file to Geisinger. After approval byour Credentialing Committee, Beacon Health sends the provider a welcome letter that indicates the committee decision date and the payment effective date for the provider with Geisinger. 
Given the payment effective date, the next question practices ask is, "When will my provider be loaded in the system?" This action takes about 30 days following the date of submission by Beacon Health to Geisinger.
The best way to determine when a provider is loaded and the plan is ready to receive claims is by looking up the provider on the Geisinger website's provider search, which is located at Beacon Health provider network and is specific to the EMHS Employee Medical Plan network.
Finding the provider on this site will indicate that they have been loaded by Geisinger and will allow the practice to confirm their benefit tier as well (in-network or in-system).
A patient representative who is an expert
 When recruiting patient representatives for the Beacon Health Population Management committee, the usual criteria includes experience with the local healthcare system and a willingness to discuss and advise on the underlying patient experience of care. Beacon Health is very lucky to have those qualities within their patient representative, Mary-Vesta Marston Scott of Orono.
However, many other Population Health committee members may not appreciate that Mary-Vesta also has impressive academic degrees and extensive knowledge in the field of health behavior - the very principles underlying how practices can engage their patients to adopt healthier behaviors and manage their own chronic illnesses.
After obtaining her nursing degree and spending a few years in the United States Indian Health Service with the Navajo people, Mary- Vesta turned her focus to public health, earning a doctoral degree specializing in psychology and health behaviors. After a stint in research at the United States Public Health Service in Baltimore, she played a key role in establishing the curriculum for doctoral programs in nursing while teaching at Boston University.
Thinking of the challenges facing practices these days, she wishes that behavioral health and healthy behaviors were emphasized more in medical schools and other clinical training programs. She sees the concept of patient self-efficacy as a key to practices becoming more efficient in this era of population health and payment reform.
"Practices can't work any harder; they need to work smarter and have their patients assume greater responsibility and autonomy," shares Mary-Vesta.
Mary-Vesta is excited about her work on the Beacon Health Population Health committee. She hopes her background and expertise can complement her practical patient-centered input, and assist practices in growing into a new model of health services. 
  • ABMS - American Board of Medical Specialties:Established in 1933, the ABMS is a nonprofit organization comprising 24 certifying boards (member boards) that develop and implement professional standards for the certification of physicians in their declared medical/surgical specialty. Certification by an ABMS member board is widely recognized as the highest healthcare industry standard for assuring a physician's knowledge, experience, and skills within a medical specialty.
  • ALOS - Average Length of Stay (also known as LOS - Length of Stay): The period of hospitalization as measured in days billed.
  • CLASS - Community Living Assistance Services and Support Act: Part of the United States healthcare reform legislation that creates a public insurance option for those employed to purchase community living assistance services and support. Enrollees must pay premiums for five years before they are eligible for benefits.
  • HCAHPS - Hospital Consumer Assessment of Healthcare Providers and Systems
    A nationally standardized survey developed by CMS (Centers for Medicare and Medicaid Services) and AHRQ (Agency for Healthcare Research and Quality) that asks consumers and patients to report on and evaluate their experiences with care provided in hospitals. Questions include the communication skills of providers and the accessibility of services.

  • SNF - Skilled Nursing Facility: An institution that provides skilled nursing care and related services to patients who no longer require hospital care but do require 24-hour medical care or rehabilitation services.