Select News: December 2015 / January 2016
Reaching Out to Wish You a Happy New Year!
Select Health of South Carolina wishes you a happy and safe holiday season full of peace, joy and happiness. Thank you for being a part of our Select Health family and for all you do for our members and the community throughout the year.
HEDIS® Spotlight: Your Office May be Contacted
Select Health is preparing for our annual Healthcare Effectiveness Data and Information Set (HEDIS) medical record audit, with final results reported to National Committee for Quality Assurance for accreditation purposes and as required to the state of South Carolina. Results identify opportunities for improvement and monitor the success of related quality, member education and outreach efforts. To determine if a member received the recommended services, we look at our claims encounter data; if we’re unable to identify if a service was provided (such as a prenatal care visit, immunization or diabetes retinal eye exam), we review the member’s medical record. We may contact your office to arrange an onsite visit or possibly request this information by fax/mail.
You can help. Please schedule site visits promptly and provide records as requested. HIPAA allows the release of medical record information to health plans without authorization from an individual for the purposes of health plan operations and quality improvement initiatives. We’ll distribute HEDIS results to primary care providers in June 2016. For details, call Heather Simmons at 1-843-569-4825 or 1-800-741-6605.
(include Quit Smoking flyer)
Since it’s time for New Year’s resolutions, please note that several tobacco cessation products are available without prior authorization for a 90-day consecutive period per rolling 12 months to help members stop smoking. Preferred products are:
- Zyban – 60 tablets/month
- Chantix – 60 tablets/month
- Nicotine gum – 450 pieces/month
- Nicotine patches – 28 patches/month
Call Pharmacy Services at 1-866-610-2773 for more information.
Please visit our website for up to-date pharmacy information including changes approved by the Pharmacy and Therapeutics Committee as well as:
- Preferred Drug List (PDL) updates
- New prior authorization criteria and procedures for submitting a prior authorization
- Pharmacy benefit restrictions or limitations
Reach Out and Read Is Available
Supported by the American Academy of Pediatrics, Reach Out and Read Carolinas is an evidence-based literacy intervention program provided by a network of medical providers for children from birth through age 5. A best practice in pediatric primary care, the program focuses on language, literacy and early brain development. If 35 percent or more of your patients are children with South Carolina Healthy Connections (Medicaid), Reach Out and Read is available to you. Call 1-828-290-9049 or contact Callee.Boulware@reachoutandread.org.
New and Current Subscribers: Win $50
We continue to celebrate Select News’ new look and name with a monthly drawing for a $50 Amazon.com e-certificate. Subscribe here for a chance to win. Current subscribers will automatically be included. Recent winners include Nicholas Schisler of Aging With Flair. We’ll notify December/January’s winner in February, so sign up now!