Lawmakers are back on Capital Hill and the new Bush administration has celebrated one month in office. No time is being wasted in resurrecting last year’s unfinished business – by the administration or by members of Congress pushing pet proposals. Medicare reform, patient privacy, and patient’s rights – aka managed care reform – have all been rehabilitated over the past several weeks after having been confined to "bed rest" since August of last year. It will be interesting to see what the next several years and the 107^th Congress bring to health care. We’ll keep our finger on the pulse and report on the issues of interest to the managed care marketplace.

Please note that the recently revised UICPG referral policy outlined below only eliminated the paper referral process. Patients are still managed by their PCP. Information regarding referrals to Specialists should be placed in the patient medical records. Our Specialists understand the need to keep a PCP informed about their patients.

Effective immediately in order to streamline administrative processes, UICPG has revised its referral policy. The new policy requires completion of referral forms only when you are referring an eligible member outside of the University. The UICPG Medical Director must approve these referrals. Completion of referral forms to another UICPG physician will no longer be needed. This policy applies to all eligible members who have selected a UICPG as their Primary Care Physician (PCP) and UICPG is responsible for payment of these services. These members belong to the following financial classes:

Financial Class HMO Name

J02 HMO-Illinois-UIC site 141

J21 UIHMO Alumni-UIC

J35 UIHMO CampusCare-UIC

JAI Humana IPA Model-UIC

JAK Humana Premier HMO-UIC

JC6 UniCare-UIC

For members belonging to any other health plan or financial class, you must follow the required referral process of the individual health plan. Questions about this policy and procedural change should be directed to Vince Savickis at savin@uic.edu.

The following are recent changes to the J-Codes listing. Please update your file accordingly.

• JC-6 UniCare HMO
• JC-7 Cigna POS
• J-37 Cigna HMO
• J-42 Cigna PPO
• W-08 Corvel

• J-06 UniCare HMO-UIC (formerly Rush)
• J-24 Health Alliance HMO (formerly Carlecare HMO)

For a complete updated listing of the J-Codes please contact the Managed Care Office at X3-0286.

The Managed Care Finance Committee has reviewed reimbursement levels for products administered by UIC Physician Group (UICPG). Effective January 1, 2001 the following reimbursement levels will apply:

Product %Medicare Medicare Year Withhold

The change in reimbursement for Campus Care and Alumni Care from 100% of Medicare to 110% was made possible by a new contractual arrangement between UIHMO and UICPG. Under the new arrangement UICPG will receive 85% of premiums as opposed to 77% of premiums in past years. It is anticipated that 100% of the increased revenue will be distributed to either UICPG or UICMC. Questions should be directed to Mike Gibbs at x5.5767 or mgibbs@uic.edu .

A new Integrated Voice Response System (IVR) has been implemented to allow physicians and staff members an alternative method to complete the precertification and admission notification process. The system can be accessed at 1.800.523.0023.

This new system allows you to enter a minimal amount of information using the telephone keypad. The end result in most cases will be an authorization. In some cases, you will be informed if the case requires further review. Multiple notifications can be completed in one call without re-entering facility information and callback numbers. If you would like a training packet on the new system, please call the IVR Helpline 1.866.600.2860 to have one sent to you.

Humana’s Automated Information Line (AIL) is a voice response system for network physicians and medical office staff providing access to member eligibility and copayment information, referral status, physician claims status, and other patient inquiries.

The system uses a fax-back option to provide important details concerning these issues. Callers can make multiple inquiries regarding a single patient. The service is available 24 hours a day, seven days a week at 1.800. 4HUMANA (1.800.448.6262). Callers should have the following information available: physician tax ID number, patient ID number, patient date of birth, and when applicable, the dates of service, referral numbers and billed amounts.

Callers to the automated line can still talk to a Humana customer service representative by selecting that option on the system. Customer service reps are available from 8:00 am to 6:00 pm, Monday through Friday.

Humana’s online Drug List can be reached by clicking on the Providers link on the main page of Human’s web site at www.humana.com, and then clicking on Drug List link. The area also includes treatment and preauthorization guidelines. Questions should be routed to 1-800-4HUMANA.

The abortion pill is not available through pharmacies and consequently is not a covered benefit under the prescription drug program. It is only being distributed to physicians who agree to the terms and conditions of the provisions of the drug. It is a covered medical benefit if the policy includes coverage of elective abortions.

RU-486 is administered orally as three 200-mg tablets of RU-486 followed two days later with two 200-mg tablets of misoprostol (Cytotec). The cost for the RU-486 tablets is around $270.00 and the cost of the Cytotec is around $3.00. Any labs are an additional cost. The drug is administered in the physician’s office and the cost of the drugs is usually the responsibility of the provider or medical group. Questions concerning this benefit should be addressed to Vince Savackis at savin@uic.edu.

BCBS is making several, different blood glucose meters available at no out-of-pocket expense to all members with diabetes. This program lets the member choose from several different meters from two companies. Information about the meters may be accessed at the company web sites or by phone:

Bayer 1.877.229.3777 or at www.bayerdiag.com/products

LifeScan 1.866. 258.3496 or at www.lifescan.com

Patients can call the manufacturer’s toll-free number (above) to order their meter. The meter, complete instructions, and a sample kit of supplies will be shipped direct to their home in two to three weeks.

Members who have prescription drug coverage now have another way to obtain certain diabetic supplies, in addition to insulin and insulin syringes. The Diabetes Self-Management Training and Education Act specifies that certain diabetic supplies, including blood glucose test strips, be covered under the Prescription Drug Card Program of a plan if the employer group has drug card benefits.

Except for some self-funded plans, many patients will now be able to obtain their supplies under the drug card program. The following supplies are covered:

• Blood glucose test strips
• Lancets
• Other diagnostic agents used with urine testing and glucagon

Alcohol swabs and blood glucose meters are not covered under the prescription drug benefit. HMO members may use their prescription benefit to obtain the supplies at their local BCBSIL participating pharmacy or through the mail order program (Walgreen’s Health Care Plus). They many also continue to purchase their diabetic supplies and submit a claim form for reimbursement.

The department wishes every success to Jacqueline Petersen, who has taken a position with the UIC Department of Obstetrics and Gynecology. Jacqueline provided oversight of contract implementation and claims management functions and we will miss her enthusiasm and hard work! Best wishes and much success in your new role from everyone in Managed Care!

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.