For more information

Call our Provider Service Centerat 800-690-1606

Visit www.UHCCommunityPlan.com

Articles ofImportance to Read:

Clinical Resources• HEDIS® Hints . . . . . . . . . . . . . . . . . 1• Medical Record Review ResultsIndicate the Need for Focus onDocumentation of RequiredTENNderCare ScreeningComponents. . . . . . . . . . . . . . . . . . . . 1

• Quality Improvement Program . . . . . 3• Vision Vendor Change for DualComplete HMO SNP . . . . . . . . . . . . 3

Take Action• Provider Demographic Changes . . . . 3

Take Note• ADHD Information . . . . . . . . . . . . . 4• Aging and Alcohol Abuse . . . . . . . . . 4• Comorbidity Information . . . . . . . . . 6• Cultural Needs . . . . . . . . . . . . . . . . . . 7• Early Periodic Screening,Diagnosis, and Treatment(EPSDT)/TENNderCareScreening Reminder. . . . . . . . . . . . . . 7

• One Face, One Name. . . . . . . . . . . . . 8• TennCare Managed CareOrganization Collaboration . . . . . . . . 9

• Together, Improving HealthCare Quality. . . . . . . . . . . . . . . . . . . 10

e-Business Updates• Website Update . . . . . . . . . . . . . . . . 10

Pharmacy• Pharmacy Updates . . . . . . . . . . . . . . 11• UnitedHealthcare CommunityPlan Preferred Drug List Updates . . 11

Important information from UnitedHealthcare for physicians and other health careprofessionals and facilities serving UnitedHealthcare Medicaid members

Clinical Resources

HEDIS® Hints

Hone up on HEDIS 2012 first year performance measures:

• Human Papillomavirus Vaccine for Female Adolescents: Thismeasure assesses the percentage of 13-year-old females who hadthree doses of the HPV vaccine by their thirteenth birthday. Themeasure evaluates compliance with Centers for Disease Controland Prevention (CDC) and Advisory Committee onImmunization Practices immunization guidelines.

• MedicationManagement for People with Asthma:This measureassesses the percentage of people five to 64 years of age who wereidentified as having persistent asthma and were dispensedappropriate medications that they remained on during thetreatment period (earliest prescription date through the endof the year)

Please familiarize yourself with these measures and, as appropriate,incorporate the care into your clinical practice.

Medical Record Review Results Indicate the Need forFocus on Documentation of Required TENNderCareScreening Components

An Annual Early Periodic Screening Diagnosis and Treatment(EPSDT) Medical Record Review (MRR) is conducted each year inorder to confirm the documentation of comprehensiveTENNderCare screens. In the spring of 2011, the statewide EPSDTMRR was conducted on records from office visits between Apr. 1,

Winter 2011

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2010 and Sept. 30, 2010 by nursing consultantsfrom the Division of Quality Oversight, at theBureau of TennCare.

The statewide overall weighted average for thedocumentation compliance rate for the 2010 datayear was 92.2 percent.

The UnitedHealthcare Community Plan Eastregion fell below the statewide average individualcomponent compliance rates on immunizationswith a percentage rate of 93.7 percent and apercentage rate of 88.4 percent on physicalexamination. This is greater than one standarddeviation below the state average. Children aged19-20 years had the lowest rating indocumentation of the immunization componentand 15-18 year olds had the lowest rating in theunclothed physical exam component.

The Centers for Disease Control and Prevention(CDC) recommends routine vaccination toprevent 17 vaccine-preventable diseases thatoccur in infants, children, adolescents, or adults.Discussion of the benefits of and risks fromvaccination is sound medical practice and isrequired by law. Appropriate and timelyvaccination documentation helps ensure not onlypersons in need of recommended vaccine dosesreceive them, but also that adequately vaccinatedpatients do not receive excess doses.Immunizations should be given in accordancewith current American Academy of Pediatrics(AAP) recommendations. Current immunizationschedules can be found athttp://www.cdc.gov/vaccines/recs/schedules/default.htm.

In accordance with AAP periodicity scheduleand the TNAAP guidelines, a fully unclothedphysical exam should be performed on infantsand young children at the required ages. For ageappropriate physical exams, older children shouldalso be unclothed or suitably draped. Whetherunclothed or suitably draped, please documentthat the exam was performed in this manner. As

a reminder, TNAAP continues to offer courseson coding and medical documentation.

The UnitedHealthcare Community Plan WestRegion fell below the statewide averageindividual component compliance rates on healthhistory with a percentage rate of 87.9% and apercentage rate of 92.9 percent on healtheducation. This is greater than one standarddeviation below the state average. Children aged19- 20 years had the lowest rating ondocumentation of the health history componentand children aged 15 – 18 years had the lowestrating on the health education component.

Health history documentation will includeinitial, family, and interval history. It alsoincludes behavioral and developmentalassessments. Anticipatory guidance is also anintegral part of the screening. Age appropriatetopics/information must be presented duringeach screen. Specific topics discussed or writteninformation distributed must be documented inthe medical record. Completion of the healthhistory and health education components isrequired under the Medical Record Review.

It is important that providers are educated on thesignificance of documentation of all of the sevenrequired components and we provide you thefollowing information so that you can help usimprove those rates. Success of the medicalrecord review is dependent upon compliance anddocumentation of all seven screeningcomponents.

TennCare requires that an EPSDT screen (alsocalled TENNderCare) include the followingseven EPSDT screening components:

• Comprehensive health history (including past,family, and interval history) anddevelopmental/behavioral assessment

• Comprehensive unclothed physicalexamination

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• Appropriate laboratory tests according to ageand health history

• Health education

• Vision screening

• Hearing screening

• Immunizations in accordance with currentAmerican Academy of Pediatrics (AAP)recommendations

As a reminder, all of these components must becompleted and documented in the member’srecord at each and every EPSDT screening.Please partner with us in helping our members’live healthier lives and by giving them the accessto the care they need and deserve.

Quality Improvement Program

UnitedHealthcare Community Plan’s QualityImprovement Program works to give ourmembers better care and services.

Each year UnitedHealthcare Community Planreports how well they are providing health careservices. Many of the things we report on aremajor public health issues. In 2010 we improvedthe number of screenings our members had forcervical cancer and appropriate treatment ofchildren with upper respiratory infections. For2011 we are trying to improve childhoodimmunization rates, well baby visits, breast andcervical cancer screenings, prenatal andpostpartum visits, and asthma and diabetictreatment.

We also conduct member surveys so we can seehow well we are meeting our member’s needs.Our 2010 surveys showed that most of ourmembers rate the health care that they receiveabove national averages. We are listening to ourmembers and in 2011 are working to improveour customer service center.

If you would like to know more about ourQuality Improvement Program and our progresstowards meeting goals please call 800-690-1606.

Vision Vendor Change for DualComplete HMO SNP

Effective Jan. 1, 2012 the UnitedHealthcareDual Complete HMO SNP vision vendor inTennessee will change from Spectera to MarchVision Care. March Vision Care manages visionand eye care benefits for more than 2.3 millionmembers nationwide, assisting health plans inachieving better health outcomes throughenhanced communication and outreach.

Take Action

Provider Demographic Changes

Beginning Oct. 10, 2011 demographicsubmissions to the JDHDPEMO email boxmust include the new information as well as theinformation that is being replaced if applicable.The following verbiage will be sent back on anysubmissions that do not contain both.

"We are returning your provider update requestbecause it requires additional information inorder to accurately complete the update in oursystems. We now require submissions fordemographic updates to contain the new addressupdate in addition to the old addressinformation. Additionally, we need to know ifthe current is being replaced with the newaddress or if the intent is to add the new addressto the provider record as an additional address."

This information is necessary because ifreplacing an address, we will need to terminatethe old address.

Thank you for helping us ensure accuracy of ourprovider data by providing this additionalinformation.

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Take Note

ADHD Information

Attention-Deficit/Hyperactivity Disorder(ADHD) is one of the most commonlydiagnosed childhood behavioral health disordersaffecting an estimated three to nine percent ofschool-age children. HEDIS has also establisheda set of measures to monitor treatment adequacyfor patients between the ages of six and twelveyears old with ADHD.

These measures are based on established researchand reflected in many treatment guidelines.

Compliance is monitored for:

• The percentage of children newly prescribedattention-deficit/hyperactivity disorder(ADHD) medication who have at least threefollow-up care visits within a 10-monthperiod, one of which is within 30 days of whenthe first ADHD medication was dispensed.Two rates are reported:

– The percentage with a new prescriptiondispensed for ADHD medication that hadone follow-up visit with a practitioner withprescriptive authority within 30 days of the\initiation of treatment (Initiation Phase).

– The percentage with a prescription dispensedfor ADHD medication that remained on themedication for at least 210 days and had atleast two additional follow-up visits with apractitioner within nine months after theInitiation Phase ends

– The appropriate diagnosis of ADHDrequires a comprehensive medical evaluationto rule out potential physical conditions. Thereliability of diagnosing ADHD improveswhen appropriate guidelines are used, andwhen additional history is collected fromboth parents and teachers.

Treatment works best with a team approachwhen behavioral health clinicians, doctors,parents, family, the child, teachers and otherhealth care professionals all work together. Thetreatment plan usually includes behavioraltherapy, medication, parent training andeducation. This combination aids the child tofocus his or her attention and to control anybehavior issues. It is important to monitor thechild’s progress. Visits with a behavioral healthclinician are recommended at least monthly untiloptimal results are achieved.

Aging and Alcohol Abuse

Anyone at any age can have a drinking problem.The fact is that families, friends, and health careprofessionals often overlook their concerns aboutolder people's drinking. Sometimes trouble withalcohol in older people is mistaken for otherconditions that may occur as people age. Butalcohol use deserves special attention and shouldbe assessed during general medical examinations.Because the aging process affects how the bodyhandles alcohol, the same amount of alcohol canhave a greater effect as a person grows older.Over time, someone whose drinking habitshaven't changed may find she or he has aproblem. Patient education about aging andalcohol is important. Below are a few key pointsthat you can share with your patients whenindicated.

Facts about Alcohol and Aging• Some research has shown that as people age

they become more sensitive to alcohol's effects.In other words, the same amount of alcoholcan have a greater effect on an older personthan on someone who is younger.

• Some medical conditions, such as high bloodpressure, ulcers, and diabetes, can worsen withalcohol use.

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• Many medicines—prescription, over-the-counter, or herbal remedies—can be dangerousor even deadly when mixed with alcohol. Thisis a special worry for older people because the

average person over age 65takes at least two medicines aday and may have more thanone prescribing physician.Patients taking anymedications should beencouraged to talk with youor their pharmacist about anyrisk associated with drinkingalcohol. The followingexamples may help illustratethat risks include over-the-counter medication:

– Aspirin can cause bleeding in the stomachand intestines; the risk of bleeding is higherif you take aspirin while drinking alcohol.

– Cold and allergy medicines (antihistamines)often make people sleepy; when combinedwith alcohol this drowsiness can be worse.

– Alcohol used with large doses of the painmedicine acetaminophen can raise the risk ofliver damage.

– Some medicines, such as cough syrups andlaxatives, have high alcohol content.

Effects of AlcoholEven drinking a small amount of alcohol canimpair judgment, coordination, and reactiontime. It can increase the risk of work andhousehold accidents, including falls and hipfractures. It also adds to the risk of car accidents.

Heavy drinking over time also can cause certaincancers, liver cirrhosis, immune system disorders,and brain damage. Alcohol can make somemedical concerns hard for doctors to find andtreat. For example, alcohol causes changes in theheart and blood vessels. These changes can dullpain that might be a warning sign of a heart

attack. Drinking also can make older peopleforgetful and confused. These symptoms couldbe mistaken for signs of Alzheimer's disease. Forpeople with diabetes, drinking affects bloodsugar levels.

People who abuse alcohol also may be puttingthemselves at risk for serious conflicts withfamily, friends, and coworkers. The more heavilythey drink, the greater the chance for trouble athome, at work, with friends, and even withstrangers.

How to Know if Someone Has a DrinkingProblemDrinking problems may have an early or lateonset. Some people have been heavy drinkers formany years. Over time the same amount ofliquor has stronger effects. Other people developa drinking problem later in life. Sometimes thisis due to major life changes like shifts inemployment, failing health, or the death offriends or loved ones. Often these life changescan bring loneliness, boredom, anxiety, anddepression. In fact, depression in older adultsoften goes along with alcohol misuse. At first, adrink seems to bring relief from stressfulsituations. Later on, drinking can start tocause trouble.

Not everyone who drinks regularly has adrinking problem, and not all problem drinkersdrink every day.

Getting HelpStudies show that older problem drinkers are asable to benefit from treatment as are youngeralcohol abusers. There are many types of supportand treatments available. Some, such as 12-stephelp programs, have been around a long time.Others include detoxification; taking prescriptionmedicines to help prevent a return to drinkingonce the person has stopped; and individual orgroup counseling. Newer programs teach peoplewith drinking problems to learn which situations

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or feelings trigger the urge to drink as well asways to cope without alcohol. Because thesupport of family members is important, manyprograms also counsel married couples andfamily members as part of the treatment process.

Programs may also linkindividuals with importantcommunity resources.

Scientists continue to studyalcohol's effects on people and tolook for new ways to treatalcoholism. This research willincrease the chance for recoveryand improve the lives of problemdrinkers.

For More Information:National Institute on AlcoholAbuse and Alcoholism(NIAAA)www.niaaa.nih.gov

Project Corkwww.projectcork.org

Source: National Institute on Aging (NIA). Public domain(accessed August, 2008; adapted for providers, October, 2011).

Comorbidity Information

Comorbidity can be broadly defined as “the co-occurrence of mental and physical disorders in thesame person, regardless of the chronological orderin which they occurred or the casual pathwaylinking them.” Studies have shown that morethan 68 percent of adults with a mental healthdisorder reported having at least one generalmedical disorder and 29 percent of adults with amedical disorder had a comorbid mental healthcondition. Since there is a complex relationshipbetween mental and physical health and there aremany ways comorbid disorders can develop,coordination of care between professionals isextremely important.

Patients with mental illness are increasinglybenefiting from coordination of medical and

behavioral health care. People who experienceboth physical and mental health problems maynot always receive care that is adequate andappropriate to meet all their needs. PrimaryCare Providers may attribute symptoms ofdepression or anxiety to physical illness, whilemental health practitioners may overlookphysical symptoms or consider thempsychosomatic. Understanding the interactionbetween physical and mental health andproviding care that recognizes the physical andmental health needs of individuals is essential.

Primary Care Providers who recognize that apatient has a need for mental health care mayrefer that patient to a behavioral health provider.However, studies have repeatedly shown thereare high rates of unrecognized and untreatedmedical disorders in individuals with mentalillness and many of these individuals arereceiving psychiatric treatment yet do not have aprimary care physician. Therefore, behavioralhealth professionals may be the first to identify aphysical health issue. It is especially importantfor inpatient providers to be aware as manyindividuals with comorbid disorders report thelast physical examination they had was during apsychiatric hospital admission.

UnitedHealthcare Community Plan annuallyreviews the number of inpatient hospitalizationsand the number of Primary Care Providersreferral/appointment outcomes for members.While the percentage of members attendingappointments in each region is improving, thereis still a very high percentage of members whoare either not attending the follow-upappointment or are refusing the services entirely.It is imperative, with the high number ofindividuals affected by comorbid disorders, thatproviders take opportunities to educate membersabout the importance of follow-up medical care,as well as the benefits of sharing information andcoordination of care.

The National Instituteon Alcohol Abuse andAlcoholism, part of theNational Institutes ofHealth, recommendsthat people over age65 who choose todrink have no morethan one drink a day.Drinking at this levelusually is notassociated withhealth risks.

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References• Druss, B. & Walker, E. Mental disorders and medicalcomorbidity. February 2011

• Williams, D., Health Business Blog, March 11, 2011• Kertesz, L., Here’s to Your (Mental) Health, AHIP Coverage(September/October 2006)

• Lunnay, B. & Bywood, P., Co-morbidity of mental and physicalillness: Meeting unmet care needs, Research Roundup Issue 18,August 2011

• Hahm, H. & Segal, S., Failure to Seek Health Care Among theMentally Ill. American Journal of Orthopsychiatry, 2005, Vol 75,No. 1, 54-62

Cultural Needs

UnitedHealthcare Community Plan believes thatits members have a right to receive care that isculturally competent and respects their culturaland ethnic background and origins. Uponenrollment, information regarding primarylanguage is obtained. UnitedHealthcareCommunity Plan provides access to a LanguageLine for translation of communication betweenUnitedHealthcare Community Plan staff andnon-English speaking members. The languageline use is tracked by the Customer ServiceCenter and reported regularly to the health plan.Each health plan then assesses its practitioneravailability to insure that the cultural, ethnic,racial, and linguistic needs of its members arebeing met.

The Provider Directory is available on the web atUHCCommunityPlan.com, and lists thelanguages spoken in the provider’s office.

Early Periodic Screening, Diagnosis,and Treatment (EPSDT)/TENNderCareScreening Reminder

UnitedHealthcare Community Plan recognizesthat preventive care is an essential component ofa child’s well being. The American Academy ofPediatrics (AAP) and Bright FuturesTM publishRecommendations for Preventive PediatricHealth. Since each child and family is unique;these recommendations are designed for the careof children who are receiving competentparenting, have no manifestations of anyimportant health problems, and are growing and

developing in satisfactory fashion. AdditionalTENNderCare visits are necessary ifcircumstances suggest variations from normal.

Developmental, psychosocial, and chronic diseaseissues for children and adolescents may requirefrequent counseling and treatment visits separatefrom preventive care visits.

These guidelines represent a consensus by theAAP and Bright Futures. The AAP continues toemphasize the great importance of continuity ofcare in comprehensive health supervision and theneed to avoid fragmentation of care. UnitedHealthcare Community Plan endorses theconcept of the Medical Home as a model of carethat greatly facilitates these concepts.

Providing all seven of the components of theTENNderCare visit including vaccines takes fulladvantage of the member’s presence in the clinicand eliminates another visit being needed inthe office.

These components include:

• Comprehensive health history

• Comprehensive unclothed physicalexamination

• Appropriate laboratory tests according to ageand health history

• Health Education

• Vision Screening

• Hearing Screening

• Immunizations in accordance with The Centerfor Disease Controls’ Advisory Committee onImmunization Practices (ACIP) athttp://www.cdc.gov/vaccines/

As a best practice, all office staff includingphysicians, nurses, and front office personnel canask members, with whom they have any contact,if they have had their well visit and vaccines.Please perform the EPSDT exam when the

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office workflow allows when members arealready in the office for other reasons.

These AAP/Bright Future guidelines can befound athttp://brightfutures.aap.org/pdfs/Guidelines_PDF/20-ppendices_PeriodicitySchedule.pdf

One Face, One Name

UnitedHealth Group’s health benefit businesses– Commercial, Medicare and Medicaid – arealigning to support a single brand that peoplecan turn to for health care benefits at all stagesof life. Through this brand transition,UnitedHealthcare, UnitedHealthcareCommunity Plan, UnitedHealthcare MedicareSolutions and UnitedHealthcare Military &Veterans Services are now sharing theUnitedHealthcare brand name.

The branding transition began in late 2010 andwill continue into 2012. For additionalinformation about a specific line of business,please click on one of the following links:

UnitedHealthcare Medicare Solutions

UnitedHealthcare Community Plan (selectspecific state plan)

UnitedHealthcare Commercial Businesses

UnitedHealthcare/Oxford

UnitedHealthcareWEST, formerly known asPacifiCare

Recent ActivityMedicare: Medicare SolutionsIn September you received a notification letteralong with a set of Frequently Asked Questions(FAQ's) that helped explain how the brandtransition will work. To find additional

information available today on the ProviderPortal, including a presentation on therebranding transition and a comprehensive set ofFAQ's, Click Here.

Your UnitedHealthcare Medicare Advantagepatients began being notified of the plan nameand brand changes in August. Messaging willcontinue through the end of this year. Becauseany of these touch points could lead a patient toask their provider about these health plan brandchanges, here is a summary of all of these touchpoints and the general time frame:

September• TV and Radio brand change advertising in

some markets

• Letter to Evercare and SecureHorizonsmembers

• Annual Notice of Change (ANOC) to allMedicare Advantage members

• Insert in ANOC mailing for AARPMedicareComplete members

• Customer Service hold messages for allMedicare Advantage members (continuingthrough 2011)

October• Member Newsletter article for

SecureHorizons and AARPMedicareComplete members

• Insert in Provider Directory mailing to allMedicare Advantage members

• Message on health plan website

November• Brand change Reminder Mailer to Evercare

Dual Eligible members

December• Member ID Card mailing to all Medicare

Advantage members - December

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We will continue to keep you updated as wemove through this process with a remindernotification letter. You may also be contacted byyour physician or hospital advocate to presentthe information directly to you.

Medicaid: Community PlanThe brand transition for Arizona and Michiganwill be complete on January 1, 2012. This is thesecond step of the transition as logos on the IDcards will now display “Community Plan” next tothe UnitedHealthcare logo instead of “ArizonaPhysicians IPA” in Arizona and “Great LakesHealth Plan” in Michigan as they are shown onthe current ID cards. Note that the only changeyou will see is the logos on the ID cards.

In addition we are soon transitioning fromEvercare Long Term Care to UnitedHealthcareCommunity Plan in six states: AZ, FL, HI,MA, NM and TX. Providers in these states arereceiving communications regarding the detailsof this transition. For additional details on thebranding change, please see the grid belowdescribing the details of the transition includingthe date of transition, product name change andlogo change.

TennCare Managed Care OrganizationCollaboration

Over the last year, UnitedHealthcareCommunity Plan has been participating in twocollaborative workgroups with the TennCareBureau, and the two other TennCare ManagedCare Organization (MCOs); AmeriGroup andVolunteer State Health Plan. The twoworkgroups have been focusing their efforts toaddress maternity care and diabetes managementfor TennCare members. The original goal ofthese groups was to bring the MCOs togetherfor a common purpose; promote a substanceabuse free pregnancy and provide education toTennCare members to help with diabetesmanagement. Not only have the workgroupsdone this, but they have also found opportunitiesto combine the expertise of multiple internaldepartments within each MCO with resourcesfrom external organizations and support groups,helping to streamline efforts and programsavailable to members across the state ofTennessee.

Since the beginning of this partnership, thecollaboration between the MCOs has exceededall expectations. While working together, theworkgroups have conducted lunch and learnsessions with OB/GYN physician offices,developed co-branded educational materials,participated in community outreach events andhosted clinical screening events all acrossTennessee.

UnitedHealthcare Community Plan is leadingthe efforts for the TennCare collaborative groupsand working to cultivate innovative outreachinitiatives that could truly impact quality andimprove the lives of those we serve. We hope tofollow up with more information in the nearfuture as we continue to work within thiscollaboration and collect data from pilotprograms from across Tennessee.

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Together, Improving HealthCare Quality

The excellent care you deliver to your patients isreflected in the quality of our health care plans.By taking a big picture view of quality andincorporating feedback from your patients’ healthcare experience and working with you, we canprovide higher quality health care plans to yourpatients — and our members — and, together,help them live healthier lives.

UnitedHealthcare is committed to providinghigh quality health care products for yourpatients. From the time your patient enrolls inone of our plans, our quality initiatives touchevery claim, phone call and physician visit. Ourevidence-based wellness and care managementprograms help your patients achieve the bestpossible health, in coordination with physicianslike you and with the support of our ownclinicians. We’ve built a quality infrastructure tomeasure our performance and quality, and makehealth care simpler and more efficient.

Cooperation with quality improvementactivitiesAll participating physicians and providers mustcooperate with all quality improvement activities.These include, but are not limited to, thefollowing:

• Timely provision of medical records uponrequest by us or our contracted businessassociates;

• Cooperation with quality of care investigationsincluding timely response to queries andcompletion or improvement action plans;

• Participation in quality audits, including sitevisits and medical record standards reviews,and annual Health Care Effectiveness Dataand Information Set (HEDIS®) record review;

• If we request medical records, provision ofcopies of such records free of charge duringsite visits or via email, secure email, orsecure fax.

Medicare Advantage and PrescriptionDrug PlansSeveral industry quality programs, including theCenters for Medicare & Medicaid Services(CMS) Star Ratings, provide external validationof our Medicare Advantage and Part D planperformance and quality progress. Quality scoresare provided on a one to five star scale, with onestar representing the lowest quality and five starsrepresenting the highest quality. Star Ratingsscores are derived from four sources:

1. Consumer Assessment of HealthcareProviders and Systems (CAHPS) or patientsatisfaction data,

2. Health Care Effectiveness Data andInformation Set (HEDIS) or medical recordand claims data,

3. Health Outcomes Survey (HOS) or patienthealth outcomes data, and

4. CMS administrative data on plan quality andmember satisfaction.

To learn more about Star Ratings and viewcurrent Star Ratings for Medicare Advantageand Part D plans, go to CMS’ consumer websiteat www.cms.gov.

e-Business Updates

Website Update

UnitedHealthcare Community Plan's innovativeonline provider portal, UnitedHealthcareCommunity Plan Online (formerlyAmeriChoiceOnline), has beenupdated with new features in2011.

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One new enhancement offers the provider theoption to search by member for both theTENNderCare EPSDT Screening Measures andthe Preventive Health Screening MeasuresReports. Click on either the "TENNderCareEPSDT Report by Member" link, or "PHMReport by Member" link to view an individualreport for a member enrolled in your panel.Providers can search for an individual memberby UnitedHealthcare Community Plan MemberID number, member name, last name or date ofbirth. Searching by Member ID number is thefastest and most accurate search method.

Another enhancement allows the provider tocontact the health plan through the online portalwith questions regarding data on theTENNderCare EPSDT or Preventive HealthMeasures report, such as dates of screening. Thegoal is to facilitate communication, relating toreports that are available for providers. To submita query or comment to the health plan, providerswill only have to click the “notify plan” link, enterand submit form information/comment relatingto the TENNderCare EPSDT Screening orPreventive Health Screening Measures Report.An email will be sent to the EPSDT/PreventiveHealth and Education Department andproviders will receive a reply within three to fivebusiness days.

To register for UnitedHealthcare CommunityPlan provider portal, go toUHCCommunityPlan.com/health-professionals/TN/members-information >UnitedHealthcare Community Plan for Families> “Access secure provider website.” Follow linksto register.

To access the non-secured portion of thewebsite, go to UHCCommunityPlan.com >Health Professionals > Tennessee under AlreadyPart of Our Network > Claims and MemberInformation > UnitedHealthcare Community

Plan for Families. This page brings you to theformer AmeriChoice Online webpage. Here youcan access our policies, Provider AdministrationManual, handouts, forms and recent newslettersand e-Alert notices sent to providers.

Pharmacy

Pharmacy Updates

Just a reminder: Pharmacy Updates areavailable at UHCCommunityPlan.com.The pharmacy hotline is 800-922-1557.

UnitedHealthcare Community PlanPreferred Drug List Updates

The UnitedHealthcare Community PlanPreferred Drug Lists (PDL) are available oneach plan's website atUHCCommunityPlan.com. For the most up-to-date information please visit our site, which alsoincludes recent Pharmacy and TherapeuticsCommittee decisions related to PDL additions,PDL deletions and PDL modifications.

Complete PDL information is also accessiblethrough the Epocrates Formulary tool atwww.epocrates.com

Provider Service Center: 800-690-1606

Practice Matters is a periodic publication for physicians and other health care professionals and facilitiesin the UnitedHealthcare network.

UnitedHealthcare Plan of the River Valley, Inc.

M47507TN 11/11

8 Cadillac Dr., Ste. 100Brentwood, TN 37027