Welcome to the April edition of our newsletter. In it you’ll find information about the upcoming "open enrollment" period for University employees as well as the latest updates from several health plans. We open with a letter from Dr. Charles Rice, Vice Chancellor for Health Affairs, inviting University employees to consider the advantages of selecting UICMC for their health care needs.

Dear UIC Employee:

It's that time of year again! You have the opportunity to examine your previous choices in health benefit coverage and determine what, if any, changes you wish to make for the coming year. From May 1 to May 31, 2001 all eligible employees will be asked to decide if it is necessary to change from a currently selected health benefit plan and/or health care provider to one that will better suit their needs. I encourage each of you to consider a health plan that enables you to select a University of Illinois at Chicago Medical Center primary care physician (UICMC-PCP).

Here are just a few of the countless advantages of choosing UICMC:

• Access to the most current and effective treatment approaches and cutting edge technological advances
• Health care assessment and management provided by outstanding clinicians and researchers
• Broad base of primary care physicians including Family Medicine, Internal Medicine, Pediatric Medicine, and OB/GYN
• No hassle, paperless referral process when accessing the many specialists and support services afforded UICMC patients
• Centralized, secure electronic health records for total patient management and continuity of care
• Convenient and centrally located facilities

When choosing a health plan, please take the time to review the list of participating network providers associated with each plan. We are confident that you will feel secure in your decision to seek both primary and specialty care at UICMC, the source for health and healing for the people of Illinois for more than 100 years.

Sincerely,

Charles L. Rice, MD

Vice Chancellor for Health Affairs

Effective July 1, 2001 Aetna U.S. Healthcare will no longer be offered to State of Illinois employees and their family members. Current Aetna members will need to re-select during the upcoming open enrollment period. State of Illinois employees and their family members interested in utilizing the University of Illinois Medical Center and Physician Group may do so by enrolling in Unicare HMO, Humana HMO, Humana POS, or the traditional Quality Care Health Plan (QCHP). Additional information can be obtained by stopping by the UIC Physicians Group table at the open enrollment meetings held on campus from 10:00 am to 2:00 pm on April 26, 2001 and April 30, 2001.

The deadline to file a claim, against American Health Care Providers Inc., for covered eligible services rendered on or before the liquidation date (May 11,2000) is November 12, 2001. A completed claim form is required in order to participate in any distribution of assets of the company as a timely filed claim. If you have any question, please feel free to call:

Effective August 20, 2001 UIHMO will no longer provide benefit coverage for AlumniCare members. Currently 280 members are covered under UIHMO AlumniCare. A number of individual options are being offered. UIHMO has scheduled a Health Fair in May where all members will be given the opportunity to meet with insurance representatives to discuss alternative health benefit coverage.

Members who have selected the Humana Point of Service (POS) have the option to self-refer or receive services from their selected Primary Care Physician (PCP). If the PCP is referring to a Specialist, a referral form must be completed prior to receiving services. This form should be sent directly to Humana in order for the claim to be processed at the highest benefit level. This applies to referrals from a UIC PCP to a UIC Specialist. To verify Humana members’ eligibility call 800.852.9556. Questions regarding member services should be directed to Humana at 312.441.1414. The mailing address for claims and referrals is:

Effective immediately IDPA has implemented a new claim imaging system for scanning paper claims. At this time, all paper claims with the exception of the UB-92 are being imaged. The following technical guidelines will minimize processing delays. Providers must follow these guidelines or claims may be returned as unprocessable. The technical guidelines for preparing documents for imaging processing are:

1. Claims that are illegible will be returned to the provider.
2. Claims with extreme print qualities, either light or dark, will not image.
3. Equipment used to produce claims must be maintained to ensure good print quality. Ink ribbons/cartridges should be replaced often.
4. Use only one font style on a claim. The font should be easy to read. Do not use bold print, italics, script, or any font that has connecting characters.
5. Claims should be typed or computer-printed in capital letters. The character pitch must be 10 to 12 printed charters per inch, which is the size of most standard pica or elite typewriters. Handwritten entries should be avoided.
6. All entries must be within the specified boxes. Do not write in margins. Ink smudges or tracking residue create processing delays or errors and should be avoided.
7. Use only black ink for entries on the billing form, attachments and provider signature. Do not use any color of ink. Red ink does not image. Attachments with red ink or print should be photocopied if the information is needed for processing of the claim.
8. If corrections need to be made, reprinting the claim is preferred. Correction fluid should be used sparingly.
9. Remove the pin-feed strips on claims at the perforations only. Do not cut the strips, as it may alter the document size.
10. Attachment should be paper-clipped or rubber-banded to claims. Do not fold invoices or fasten attachments with staples.
11. Attachments containing a black border as a result of photocopying with the copier cover open cannot be imaged. Attachments must have a minimum one-half inch white border at the top and on the sides to ensure proper imaging of the document.
12. If attachments contain gray areas, either as part of the original or as a result of photocopying a colored background, print in the gray area is likely to be unreadable. If information in this area is important, the document should be recopied to eliminate the graying effect as much as possible without making the print too light.
13. Only use envelopes supplied by the Department. Do not use envelopes that require the claim and/or attachments to be folded.

The Department offers claims scannability/imaging evaluations. Please send sample claims with a request for evaluation to:

Provider must use the official claim forms designated by the Department. The department supplies all claim forms except the UB-92. Questions regarding this notice should be directed to the Bureau of Comprehensive Health Services at 217.782.5565.

Over the next few months, Karon Batie, Managed Care Credentialing Representative, will meet with each department to review credentialing procedures and answer questions regarding the managed care credentialing process. Sharing information about contracted plan requirements and providing guidance to department liaisons and physicians should help resolve some of the problems that occasionally occur during this process.

As a reminder – physicians who have not completed and returned the Aetna applications should do so as soon as possible. Delays in processing credentialing applications can impact reimbursement for health care services and causes other administrative problems for both the patient and the provider. Questions may be addressed to Karon at X3.9429 or by e-mail at kbatie@uic.edu

Prior Authorization Process: UnitedHealthcare does not require prior authorization for covered benefits. They do ask that you call 1.888.541.8504 to determine if there are any coverage limitations or to notify them for this short list of procedures and services before you provide or order them:

Paper Referrals: UnitedHealthcare does not require paper referrals for any of its products. They do ask that primary physicians coordinate necessary care and document referrals and consultant findings in the patient’s record.

We are very pleased to announce that Ms. Michelle Parchem joined the department as Senior Contract Specialist on April 15, 2001. In her new role, Ms. Parchem is involved in contracting and other business development activities.

Ms. Parchem gained extensive experience in various aspects of managed care administration during her tenure at Anthem BlueCross & BlueShield in Indiana, Rush-Presbyterian St. Luke’s Medical Center, and the University of Chicago Hospitals. Join us in extending a warm welcome to Ms. Parchem. She is located on the second floor of the AOB building and can be reached at X5.4295.

The Office of Managed Care, University of Illinois at Chicago, presents Managed Care News online. Comments or requests should be addressed to the editor at mgm@uic.edu. Roger Carlson, Director of Managed Care.