Blue Ink - Wellmark Blue Cross and Blue Shield
Blue Ink - Wellmark Blue Cross and Blue Shield
Blue Ink - Wellmark Blue Cross and Blue Shield
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FeatureSt. Luke’s Hospital Utilization Management department. Pictured left to right are: Breana Klein, precertification specialist, Marilinne Staub, utilizationmanagement specialist, <strong>and</strong> Suzie Lange, senior revenue cycle analyst.Utilization Management tool is put into actionSt. Luke’s shares early adoption experience <strong>and</strong> advice for other providersOn Dec. 15, 2012, <strong>Wellmark</strong> launched the new online UtilizationManagement tool for providers. The online tool enables providersto complete authorization requests for designated procedures<strong>and</strong> DME, inpatient notification/precertification, <strong>and</strong> dischargenotifications, as well as out-of-network referrals.When <strong>Wellmark</strong> initiated the selection of today’s UtilizationManagement tool, it made sense to work collaboratively withthe providers who would be relying on the online tool day in <strong>and</strong>day out. Underst<strong>and</strong>ing how providers use these tools was keyin delivering a product that saved them time <strong>and</strong> eliminatedinefficient steps.Beginning in July 2012, <strong>Wellmark</strong> reached out to a h<strong>and</strong>fulof willing providers from Iowa <strong>and</strong> South Dakota to become earlyadopters of this new process.Along the way, <strong>Wellmark</strong>’s teams carefully monitored usage <strong>and</strong>engaged in a series of weekly feedback meetings with theseproviders in an effort to craft the most efficient, effective onlinetool process.Marilinne Staub,RN, BSN, CCMUtilization management specialist,Marilinne Staub, RN, BSN, CCM, withSt. Luke’s Hospital — one of six earlyadopters — shares her experience with<strong>Wellmark</strong>’s Vice President <strong>and</strong> ChiefMedical Officer Timothy R. Gutshall, M.D.Dr. Gutshall: As a process improvement principle, <strong>Wellmark</strong>wanted to work with some providers as a small test of change tolearn about the good, the bad, <strong>and</strong> the ugly regarding lessonslearned in implementing this new tool prior to exp<strong>and</strong>ing its useto the entire network.How long has St. Luke’s Hospital been using the tool?Ms. Staub: St. Luke’s Hospital participated in the early adopterinitiative <strong>and</strong> started using the tool on Oct. 22, 2012.Utilization Management tool— continued on Page 6April 2013 blue<strong>Ink</strong> | 5
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