Provider Bulletin - CenCal Health

ProviderBulletin
Vol. 17 No. 5 • May 2008
Administrative Offices
110 Castilian Dr.
Goleta, CA 93117
805.685.9525
1288 Morro St., Suite 100
San Luis Obispo, CA 93401
805.543.4099
Toll Free 1.800.421.2560
CenCalHealth.org
IN THIS ISSUE
• Healthcare Quality
Awards Announced
• New Chief Medical
Officer
• The Credentials
Committee Needs YOU!
• Reporting Child and
Elder Abuse
• Claims Corner
• Perinatal Education
to Prevent Childhood
Obesity
• San Luis Obispo Office
Moving!
• New Provider Toolkits on
Obesity
• Holiday Closure
• Pharmacy Updates
- San Luis Obispo
Health Initiative
(SLOHI)
- Tamper Resistant
Prescription Pads
- NPI and Prescriptions
• Spring 2008 Member
Newsletter
• Formulary Update -
January – March 2008
HEALTHCARE QUALITY AWARDS ANNOUNCED
At the Department of Health California Services (DHCS) 2008 Quality
Conference in Sacramento, CenCal Health was the recipient of two
awards: a “Gold Quality Award” for outstanding performance as
demonstrated by the DHCS facility site and medical record review audit
results, and an “Honorable Mention Quality Award” for outstanding
performance as measured by HEDIS 2007.
The award for site audit performance is an outstanding achievement;
it is DHCS’s highest distinction for site review performance. It reflects
the commitment of our providers to ensure patient safety, and CenCal
Health’s commitment to administer an effective site review program
that is truly supportive of providers. The site audit program could
not have achieved such a result without the support and commitment
of all our Primary Care Physicians (PCPs) and their office staff. The
HEDIS award is also an exceptional acknowledgment for the overall
quality of care rendered by our providers and managed by our plan.
Congratulations to the CenCal Health provider network! We greatly
appreciate your efforts in providing outstanding care to CenCal
Health members.
NEW CHIEF MEDICAL OFFICER
It is our pleasure to introduce our new Chief Medical
Officer, Dr. Irwin Harris. Please join us in welcoming
Dr. Harris to the CenCal Health team.
Dr. Harris obtained his Bachelor’s degree from
Stanford University and his M.D. from Stanford
University School of Medicine. He also holds an
MBA, MSHA in Health Administration and Business
from the University of Colorado, Denver. Most
recently, Dr. Harris was Chief Medical Officer, Director of Medical
Education and Director of Ambulatory Clinics at Kern Medical Center
in Bakersfield, California. Prior to that, he was Senior Vice President,
Medical Affairs at Henry Ford Wyandotte Hospital in Wyandotte,
Michigan. He has also held the position of Vice President, Medical
Affairs at Good Samaritan Health Systems in Kearney, Nebraska.
Dr. Harris’ experience includes bringing physicians from multiple
cultural backgrounds and disciplines together successfully to achieve
common goals. He is a champion of clinical effectiveness, functional
outcomes and quality measurements. He is experienced in making
utilization decisions and improving care quality while at the same
time lowering costs. He has assisted in the development of a providersponsored
HMO and has served on the board.
As you can see, Dr. Harris comes to us with a terrific background and
experience. He has been joined in his transition to Santa Barbara by
his wife, Libby. Welcome, Dr. Harris!

THE CREDENTIALS COMMITTEE
NEEDS YOU!
CenCal Health’s Provider Credentials Committee
is currently comprised of six physician members
and is assisted by our Chief Medical Officer, our
Director of Legal Affairs, and several Provider
Services staff. We are seeking two physicians
contracted with CenCal Health, ideally one PCP
and one Specialist, who would be interested in
serving as additional members to represent San
Luis Obispo County.
The membership term is two years, with
unlimited reappointment possible. The
Committee meets quarterly or more frequently
if necessary, and occasionally meets via
teleconference. Physician members receive a
stipend of $100.00 per meeting for their time
and input, plus mileage reimbursement. The
meeting schedule is set for the convenience of
the physician members. The meeting location
will be changed to accommodate members from
both Counties. The meetings begin at 6:30
p.m., include dinner, and last approximately
two hours.
You may address your questions or express your
interest in the position to Jacqueline Wright,
Director of Provider Services, at (805) 685-9525
or (800) 421-2560, extension 1016.
REPORTING CHILD AND ELDER
ABUSE
Licensed clinicians have a legal responsibility
under state law to report suspected events
of child or adult abuse or neglect. If you
suspect either child or adult abuse or neglect,
you must report it! Below please find several
organizations to which reports can be made:
Adult Protective Services
Santa Barbara .........(805) 681-4550
Santa Maria ............(805) 346-8303
Lompoc ...................(805) 737-6020
San Luis Obispo ......(805) 781-8989
Child Protective Services Hotline
Santa Barbara .........(805) 367-0166
San Luis Obispo County Child Welfare
Hotline ................(805) 781-1700
Community Resource Hotline – dial 211
Childhelp USA .........(800) 422 -4453
Adult/Elder Abuse ..(888) 436-3600
CLAIMS
O
R
N
E
R
When submitting
Medicare Remittance
Advice (RA) or any other insurance
information to CenCal Health, please
include the Claim Control Number (CCN)
or the member’s name and member
number or CIN, so we can match the
information to the correct claim in our
system. If you are submitting invoices or
other pricing information, please include
the CCN or member information as well.
In order to expedite the processing of corrected
claims, please make sure the Claim Control
Number (CCN) is included on all documentation
submitted to the Goleta office for processing.
Before submitting a Tracer, please perform a
“Patient Profile” report through the restricted
area of the CenCal Health website to search if
the claim in question is in our system. If the
claim cannot be found, please submit the claim
to the following address:
CenCal Health
P.O. Box 1818
Bellflower, CA 90707-1818
PERINATAL EDUCATION TO
PREVENT CHILDHOOD OBESITY
Maternal obesity during pregnancy is associated
with childhood obesity. Early intervention
during pregnancy can therefore have a
significant impact on the child’s weight pattern
throughout life. To address this topic, the Santa
Barbara City College Adult Education Program is
hosting a program directed toward primary care
providers (PCPs), midwives, nurses and medical
support staff. An evidence-based curriculum
will focus on prevention of fetal adiposity,
addressing contributing factors, and maternal
and fetal risks. RN/LVN and CNA education
units are available. For more information
on this program, please call (805) 682-7640,
extension 252.
Saturday, May 3 rd – 9:00 a.m. – 4:00 p.m.
Room 30, Alice F. Schott Center
310 West Padre
Santa Barbara, California
2

SAN LUIS OBISPO OFFICE MOVING!
Our satellite office in San Luis Obispo is moving
to a new location! Below is the new address and
fax number. The phone number remains the
same. The actual move is scheduled for Friday,
May 2 nd , so the office will not be available for
provider assistance. If you require immediate
assistance, please call the Goleta office at
(805) 685-9525 and asked to be transferred
to the Provider Services Department. The San
Luis Obispo office will be up and running on
Monday, May 5 th .
1288 Morro Street
Suite 100
San Luis Obispo, CA 93401
Phone: (805) 543-4099
Fax: (805) 595-1492
The Provider Bulletin is produced as a timely
supplemental information service for provider
office staff and is published monthly by the
Provider Services Department. Questions and/or
suggestions for articles may be made to
NEW PROVIDER TOOLKITS ON
OBESITY
Less than one-third of overweight patients
report being counseled by their physicians
regarding obesity, yet in a recent survey 9 out
of 10 Californians said they want their doctors
to be their primary source of information about
nutrition, physical activity and other issues
associated with weight management.
The California Medical Association (CMA)
Foundation and California Association of
Health Plans have just released three Obesity
Prevention Provider Toolkits on the topics
of Child & Adolescent, Adult, and Pre/Post
Bariatric Surgery. The toolkits are easy-to-use
guides to help doctors assist their patients in
weight management and obesity prevention.
Each toolkit contains:
• Effective communication techniques to help
patients make decisions
• Culturally appropriate, ready to copy,
materials and handouts
• Identification of internet tools and information
• Strategies for managing overweight patients
• Patient education resources
• Guidelines and policy statements on obesity
prevention, weight management, diet, physical
activity counseling, body mass index (BMI)
screening and other measurements
The toolkits can be downloaded from the CenCal
Health website under “Breaking News” or at
the CMA website, www.calmedfoundation.org,
under “What’s New”. The latter has additional
information about the CMA Obesity Prevention
Project.
Suzzi Tyler (styler@cencalhealth.org)
Marina Gordon (mgordon@cencalhealth.org)
Faith Reeves (freeves@cencalhealth.org)
Jennifer Fraser (jfraser@cencalhealth.org)
Theresa Merkle (tmerkle@cencalhealth.org), or
Amy Abbott (aabbott@cencalhealth.org) at
110 Castilian Drive, Goleta, CA 93117-3028, or
by calling 805.685.9525 or 800.421.2560 ext. 1676.
HOLIDAY CLOSURE
CenCal Health will be closed on Monday, May
26 th in observance of Memorial Day.
3

more active.
heart problems.
• Start making healthy choices for your family!
¡Las madres pueden
hacer un cambio!
• Usted puede ayudar a su famili a comer
mejor y ser más activos.
• Cambios pequeños hoy dia pueden ayudar
Healthy Weight
for Children & Families
Get up and play hard
Try for 60 minutes each day.
Cut back on scr en time
No more than 1-2 hours of TV each day.
Eat more fruits and vegetables
One or two servings at each meal.
Drink water and low-fat milk
Cut back on sodas and sugary drinks.
Eat a healthy breakfast everyday
Include protein and fruit.
Watch your portions
Bi ger is not be ter.
PHARMACY UPDATES:
San Luis Obispo Health Initiative (SLOHI)
With our expansion into San Luis Obispo,
CenCal Health is pleased to report that
MedImpact has adjudicated over 15,000 paid
claims in the month of March for our San Luis
Obispo members which mirrors the State Medi-
Cal Fee-For-Service (FFS) experience. As a
reminder, we would like to inform you that:
• Certain medications are carved out of the
SBHI and SLOHI programs and thus are still
the State’s responsibility: Psychotropic, AIDS,
Detoxification, and Erectile Dysfunction (ED)
medications;
• Certain members with approved prior
authorizations have had their prescription
history grandfathered excluding carveout
medications and potential CCS eligible
medications;
• Our Formulary migration for PPIs is OTC
Prilosec and for Statins is Simvastatin;
• Medical Request Forms (MRFs) are to be
submitted by physicians only; and
• McKesson is our vendor for CenCal Health’s
Specialty Injectable Drug Program
If you have any questions regarding the above,
please contact the Pharmacy Department at
(805) 685-9525, extension 1639.
Tamper Resistant Prescription Pads
Effective April 1, 2008, all hand written Medi-
Cal prescriptions will be required to be written
on tamper resistant prescription pads. The
following are the requirements for these tamper
resistant pads:
• One or more industry recognized features
designed to prevent unauthorized copying of a
completed or blank prescription
• One or more industry recognized features
designed to prevent the erasure or
modification of information written on the
prescription by the provider
• One or more industry recognized features
designed to prevent the use of counterfeit
prescriptions.
The Centers for Medicare and Medicaid Services
(CMS) has announced that as of April 1, 2008,
a prescription pad must contain at least one of
the features above whereas effective October 1,
2008, one feature in all three categories must
be contained in the prescription pad. To locate
a vendor in your area that has been approved
to provide tamper resistant prescription pads,
please visit the following website: www.ag.ca.
gov/bne/security_printer_list.php.
NPI and Prescriptions
Effective May 23, 2008, all pharmacies will be
required to process transactions using their
National Provider Identifier (NPI) through our
Pharmacy Benefit Manager (PBM), MedImpact.
In addition, all prescribers will need to be
identified through their NPI. If you have
not already done so, please ensure that the
prescriber’s NPI is located on the prescription,
so pharmacies can fill and process prescriptions
in a timely manner. Your assistance is greatly
appreciated!
Spring 2008
Live Better, Make a Change
D
o you want good
health for you and
your family? Do you
want to help prevent
diabetes and heart disease in
you and your children? Our
new program, Live Better,
Make a Change, can help.
Live Better, Make a
Change provides an
information packet to families
to help them pick healthy
changes they can make. The
packet gives simple things
families can do to eat healthier
and be more active. According
to Suzanne Michaud, health
promotion educator for CenCal
CenCal Health
110 Castilian Drive
Goleta, CA 93117
Health
YOUR
WELCOME TO OUR NEW SAN LUIS OBISPO COUNTY MEMBERS
CenCal Health serves Santa Barbara and San Luis Obispo counties providing health coverage for Health Initiative,
Healthy Families, Healthy Kids, Prenatal Plus 2 and In-Home Supportive Services programs.
GET YOUR PACKET TO LIVE BETTER!
Parents can request a a Live Better,
Make a Change information packet by
calling 1-800-421-2560, extension 3126.
Health, “We know that moms
want the best for their
children and are usually in
charge of family meals and
activities. We want to
encourage moms to make
small changes that can make
a big difference later.”
Health plan members who
enroll in the Live Better,
Makes a Change program
will receive information and
referrals to nutrition education
services and community
resources. And families will
have the chance to win
rewards for making healthy
changes!
a prevenir una enfermedad seria después,
como la diabetes y problemas del corazón.
• ¡Empiece a tomar decisione saludables para
su familia!
in this ISSUE
page 2
page
page
3
4
Your Primary Care
Provider
Immunization
Registry
Silent but Serious:
Chlamydia
SPRING
2008
MEMBER
NEWSLETTER
Our latest Member Newsletter includes the
following topics:
• Live Better, Make a Change
• Your Primary Care Provider
• About the Immunization Registry
• Shield Yourself Against Shingles
• Silent but Serious: Chlamydia
553M
PRSRT STD
U.S. Postage
PAID
CenCal Health
4

CenCal Health has added several new drugs to our Formulary during the first quarter of 2008 based on provider request and cost neutral
pricing. All items are expansions of our current Formulary thus giving more choices to the prescribing physician. All drugs listed below are
now Formulary.
January - April 2008
Drug
Class
Formulary
Status
Restrictions/
Limits
Implementation
Date
Additions
Tekturna HCTZ (Aliskiren/HCTZ) Hypertention Formulary
Must have a
approved claim
for any ACE,
ARB, Diabetic
agent or
combination
3/1/2008
product that
contains an ARB,
Ace or Diabetic
agent
Gardisil (Human Papillomavirus Vac) Immunization Formulary 4/1/2008
Rozeram (Ramelteon) Behavior Health Formulary
No more that 30
tablets per
dispensing
3/1/2008
Veramyst (Fluticasone Furoate) Nasal Anti-Inflammatory Formulary 3/1/2008
Pulmicort Flexhaler ( Budesonide)
Vyvanse (Lisdexamfetamine)
Oral Inhaled
Corticosteroids
Formulary 4/1/2008
Formulary
Age: 20 years of
age or less with
up to a 90 day
supply
4/1/2008
Behavior Health
Novolog Flex Pens (Insulin Asp Prt/Insulin Asp) Diabetes Formulary 4/1/2008
Humalog Kwik Pens ( Insulin Npl/Insulin Lispro) Diabetes Formulary 4/1/2008
Changes
Marinol (Dronabinol) Antiemesis/Antivertigo Non-Formulary 3/1/2008