Are You Prepared?

Changes and Updates to the EMHS Medical Plan!

News You Can Use and Important Updates
Keeping data safe and secure it's a fulltime commitment, changes to the EMHS Medical Plan, and working towards certification these topics and more in the June issue of the Beacon Health Provider Network Newsletter!
EMHS Employee Medical Plan Changes Behavioral Company

The EMHS Medical Plan is switching behavioral health management or "carve out" companies. This change is to support a better overall customer service experience when it comes to behavioral health needs.
As of July 1, 2016, Magellan Health will become the behavioral benefit management subcontractor. The company is experienced in transitioning health plans from a prior manager of claims and authorizations to their own network and operations. A grace period will be in place to allow providers to continue seeing EMHS Medical Plan members who are in treatment while they apply to be in the Magellan network, if that is needed.  
Magellan already has a significant profile in Maine, having served the state for many years. Recruitment of additional providers across Maine is also well underway. Providers not currently with Magellan have probably already received an outreach letter from the company, and those who may want to join or rejoin the Magellan network should respond to that letter or go to for more information.
The EMHS Medical Plan is committed to a smooth transition for its members and providers. Your attention to the transition is appreciated!  
Maine Coast Memorial Hospital Completes Move to EMHS Medical Plan

As of July 1, 2016, the remaining employees at Maine Coast Memorial Hospital will switch over to the EMHS Medical Plan for their health insurance coverage. Approximately 110 new subscribers will join the plan, which is administered by Geisinger Health Plan with population health coordination and services provided through Beacon Health. About 400 non-union employees switched to the EMHS Plan on April 1 of this year.  

Acronyms of the Month
Decode the  healthcare acronyms below... the answers are at the end of the newsletter
  • CAQH _______________________________________________________
  • COI     _______________________________________________________
  • EBM   _______________________________________________________
  • HEDIS_______________________________________________________
  • PSQIA_______________________________________________________
  • WIC    _______________________________________________________



Don't Forget to Document!

Beacon Health uses the CAQH (Council for Affordable Quality Healthcare) online application for both initial credentialing and recredentialing. To credential a provider with Beacon Health, it is imperative that the CAQH application be updated in a timely manner with current required documents attached, i.e.: current documents including Maine License, DEA with Maine address, malpractice insurance, and W9. Updates to Licenses, DEA, and Malpractice insurance require the updated documents to be faxed to CAQH.
When there are changes to the practitioner's information, remember to also update PECOS. Failure to update CAQH and PECOS can slow the credentialing process causing delays in effective dates and claim payments.
If there are any questions on the CAQH process, please contact the CAQH helpdesk directly at CAQH providerhelp or (888) 599-1771. Please go to PECOS directly about questions.
Dancing With Data

Sandy Schmand is the Information Systems (IS) and data manager for Beacon Health, and this role keeps her pretty busy. Her duties include organizing and managing all of the data for the ACO (accountable care organization) as it flows in and out of the organization. The sheer volume of data, downloads, reports, and remote access needs has grown tremendously during the past couple of years, and Sandy's job reflects that growth.
Her career has brought her from her early days at Norumbega Medical Group helping to grow it from one to six practices and implement the Centricity EMR, to positions within Eastern Maine Medical Center and EMHS managing growth, finances, and facilities, to finally joining Beacon two years ago.
Some of the more interesting challenges for Sandy involve managing the data through a system of shared folders for staff across Beacon Health to access, but only as needed. With protected patient information access is tightly controlled and yet easily gained by those who should rightfully have it. Patient information is managed carefully from its receipt from practices, Medicare or a commercial health plan, through important editing, merging and "scrubbing", on to incorporation into Beacon Health's proprietary database, and finally adaptation and use for analysis and reporting.  
In today's healthcare environment, data management is first and foremost about security and privacy. Protected data must be watched and tracked every moment, and at every exchange. The artistry comes from assuring this security along with ease of access for those who justifiably need to use the data for important patient care and business management purposes. Complex matrices of access rights are maintained for users inside and outside of Beacon Health and its partner organizations. Training and extensive documentation is required to establish these relationships, and strict compliance with rules and regulations is necessary at every step.  
To allow access to appropriate folders by those outside of Beacon Health, SharePoint is now being used to set up differential data rights according to the user. Each user logging on to SharePoint sees a different, customized site that reflects their privileges and permissions. Beacon Health's ability to track users and data access is critical to our compliance and security efforts.
Since Beacon Health is part of EMHS, we are challenged to integrate for efficiency and the benefits of our larger partner, yet maintain our separateness and security to protect patient information and the proprietary information of all non-EMHS participating providers and organizations. This balancing act can be tough at times, but the design of the larger EMHS system has enabled Beacon Health to accomplish this without sacrificing speed and capacity.
About Beacon Health, Sandy says, "What excites me the most is managing change. Also, it's great to see our practices changing, adding wellness and prevention, and caring for the whole patient." She's pleased to see more people across Maine taking note of Beacon Health. Certainly, her work on essential IS systems at Beacon Health has a lot to do with that!

Beacon Health Pursues New Credentialing Certification

Beacon Health's credentialing department is in the process of becoming NCQA (National Committee for Quality Assurance) certified. The rigorous standards of NCQA are an opportunity for Beacon Health to demonstrate the quality and precision of the credentialing processes we have created.
Beacon Health is able to expedite this effort with the help of Chelsey Plourde, our National Accreditation Coordinator (NAC). Chelsey is an occupational therapy student from Husson University, and we are fortunate to have her as an intern from the Hanley Institute internship program. Achieving this certification will deepen Beacon Health's ability to support the best patient care across our network.
Currently, the Beacon Health Care Coordination Program is NCQA accredited and is the first provider-driven program in the country to achieve this seal. ____________________________________________________________________________

Acronyms of the Month
Decode the  healthcare acronyms below... the answers are at the end of the newsletter
  • CAQH - Council for Affordable Quality Healthcare: An online repository (database) of healthcare provider information. The data is supported by two modules (Provider Module and Participating Organization Module) through which healthcare providers submit information via a free, internet-based service, and by which participating organizations are able to access the healthcare provider's data for various credentialing purposes.
  •  COI - Certificate of Insurance: A document of proof of malpractice insurance, general liability insurance as well as various other forms of insurance.
  •  EBM - Evidence Based Medicine: A term refers to that portion of the practice of medicine that is based upon established scientific findings as derived from clinical research studies. Most clinical guidelines, protocols, and care paths are based upon this type of evidence.
  •  HEDIS - Healthcare Effectiveness Data and Information Set: A standard set of performance measures developed in 1991 to measure the quality and performance of health plans by focusing on four aspects of healthcare; quality, access, and patient satisfaction, membership and utilization, and finance. HEDIS is sponsored and coordinated by the National Committee for Quality Assurance (NCQA) and has been updated several times since its inception.
  •  PSQIA - Patient Safety and Quality Improvement Act: As of July 29, 2005, the act was designed to create a national patient safety center to address medical errors within the healthcare system. It establishes patient safety organizations (PSOs) to which providers (individuals and entities) can voluntarily report medical errors and patient safety information. The PSOs will then take the information, analyze it, and provide feedback.
  • WIC - Women, Infants, and Children Program: A federal program that provides food, nutrition, education, and access to healthcare to low income pregnant women and new mothers, as well as to infants and children living below 185 percent of poverty line who are at nutritional risk.




Steve Ryan | Beacon Health | 207-973-9793 | | BeaconHealth.ME