2013 Practitioner and Provider Manual - Presbyterian Healthcare ...

Care Coordinationthe program. If the provider is a radiology facility orhospital, or these procedures are provided in theprovider’s office, the provider should confirm thatHealthHelp ® has processed and approved therequest before scheduling an appointment. Thisensures payment of the claims submitted.Detailed instructions and reference guides areavailable on Presbyterian’s website athttps://www.phs.org/providers/clinicians-resourcesand includeScopeCurrent list of procedure codes thatHealthHelp ® managesProcess steps and contract informationFrequently asked questions, which includeroutine, expedited, retroactive, and emergentrequestsClinical information/fax formA demonstration of the HealthHelp ® webbasedprocessPresbyterian’s care coordination model facilitatesthe integration of physical health and behavioralhealth services into a seamless and coordinatedsystem of care. Our care coordination modelprovides our members with timely, appropriateservices in the least restrictive and most costeffectivesetting possible. This care coordinationmodel assists and supports providers and membersto improve the continuity of care. It is designed toenhance access to services and achieve optimalhealth and quality outcomes throughMember-centric care coordination thatencourages personal responsibility andmember engagementPopulation-based, predictive modeling thatincorporates claims, lab, and pharmacy datato identify care opportunities and to identifymembers who are at risk for future adverseevents that can benefit from care coordinationinterventionsHealth Risk Assessments (HRAs) forCentennial Care members are completedduring a new member’s onboarding that aredesigned to identify members in need of carecoordinationA Comprehensive Needs Assessment (CNA)designed to identify each Centennial Caremember’s holistic needsComprehensive care plans that addressphysical, psychosocial, behavioral, andfunctional needsInterdisciplinary Care Planning Teams (ICPTs)that work together and collaborate to meet thediverse and holistic needs of members acrossdomains of health careEvidence-based best practice guidelines andclinical pathwaysTechnology solutions and clinical decisionsupport toolsCare coordination, disease management, transitionof care, and utilization management are integralcomponents of our overall integrated care model forour Presbyterian members. Activities andinterventions are based on the needs of each6-52014 Practitioner and Provider Manual - Ver. 3