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Page 1 El Paso First Quarterly Provider Meeting Wednesday March 18, 2009.

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Presentation on theme: "Page 1 El Paso First Quarterly Provider Meeting Wednesday March 18, 2009."— Presentation transcript:

1 Page 1 El Paso First Quarterly Provider Meeting Wednesday March 18, 2009

2 Page 1 Program Agenda Children with Special Needs Guest Speaker – Martha Payan THSteps Oral Evaluation and Fluoride Varnish Certification and Hearing and Vision Training Date – Michelle Anguiano Health Services preauthorization process updates – Jim Voiland Provider Relations Updates – Rene Duran Question and Answer Session.

3 Page 1 Provider Relations THSteps Oral Evaluation and Fluoride Varnish Certifications and Hearing and Vision Training Date

4 Page 1 Oral Evaluation and Fluoride Varnish in the Medical Home Training and Certification for Medical Providers EPSDT

5 Page 1 What providers need to know THSteps Pediatric Providers (Physicians, Physician Assistants, Advanced Practice Nurses) are trained and certified to provide a Dental Home for this population. Providers will conduct intermediate oral evaluation and application of fluoride varnish during a THSteps medical checkup.

6 Page 1 What providers need to know about on line training via webinar: 1.It is important for you to know that you will not receive a certificate via . 2.The DSHS will provide your contact information to TMHP so they can update the Master Provider Enrollment File. 3.Once completed the provider will receive an e- mail confirming file has been updated and an effective date to begin rendering this service. 4.Then, this file will be distributed to the Health Plans in an effort to update the providers record in their system so you can bill for this service.

7 Page 1 Billing In order to bill for this application, the providers must submit proof of certification on this training to El Paso Firsts Provider Relations Department by sending this documentation via fax to (915) This Department will forward this documentation to the appropriate contacts in order to process your claim.

8 Page 1 For more information For complete guidelines and certification information please visit and search for July/August Texas Medicaid Bulletin No. 216, page 48. You can find the links to obtaining a copy of the presentation and to order supplies to provide this service please go to To access dates for webinars of in-person trainings please go to:

9 Page 1 For further assistance If you have any questions regarding this billing process, please contact the Provider Relations Department at ext Thank you for your collaboration in this project.

10 Hearing and Vision Training Goal: To provide attendees with Hearing and Vision assessment and skills to screen for early detection and treatment. Date: April 13 thru April 17, 2009 Time: 8:00 am to 5:00 pm –(Lunch on your own from 11:30 am to 12:30 pm) Location: Department of State Health Services 401 E. Franklin El Paso, Tx rd Floor Conference Room RSVP: Claudia Diaz via phone at , fax at or via at

11 Page 1 Health Services Jim Voiland Director of Health Services

12 Page 1 Pre Authorizations Authorizations for OUTPATIENT/Scheduled procedure requests, INPATIENT notifications and Clinical Information must be directed to Health Services Department if out of network. All Prior Authorizations must be submitted by Fax to : (915) – Outpatient/Scheduled Procedures (915) – Inpatient Notifications 72 hour turnaround time applies to all Prior Authorization Requests

13 Pre Authorization List Please Note: All Requests must be received by fax. Appropriate forms may be located at: om/Providers.html NCB = Not Covered Benefit

14 Updates/Changes Notifications Provider Relations UPDATES AND CHANGES

15 Provider Relations needs to know : Changes in address locations Name Changes Billing company changes Phone and fax updates, etc. Any changes we need in order to update our system and your records. Changes in address locations Name changes Billing company changes NPI/TPI updates Phone and fax updates, etc. Any changes you consider we may need in order to update our system and your records. Provider Relations needs to know :

16 Claims Authorizations Payments Importance of notifying El Paso First Not notifying El Paso First may affect:

17 Reporting changes to El Paso First Contact the Provider Relations Department or your Provider Relations Representative. Fax over letter notifying us of the changes. Assigned Representative will contact the provider once we have updated our system and their records. Provider Relations- Ph ext Fax

18 Utilizing El Paso First Web Site Utilizing El Paso Firsts Web Site Access to web portal sign in. Provider Forms (i.e.inpatient/outpatient pre-cert forms) Information on all programs under El Paso First. View provider directories for all programs. Upcoming News and Events. Provider Manual (STAR/CHIP/CHIP Perinatal) Provider Newsletter

19 El Paso Firsts Newsletter Mailed out to providers once every Quarter. Newsletter located in El Paso Firsts website. Updates/changes News/events

20

21 Page 1 Questions and Answers

22 Page 1 On behalf of El Paso First Thank you for your attendance and all your hard work!


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