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Select News: November 2016

Provider champion

Jeff Selman

We’re spotlighting and thanking JSS Behavioral Services, which offers psychological and counseling services to our adolescent and young adult members, including assessments, testing, and therapy.

“Providers spend a lot of time on the mental health component of care,” says Jeff Selman, who has a doctorate in psychology and is Director of Clinical Services for JSS. “We’re a holistic team working with the family. Providers communicate back to us and we pull it all together for the best patient care.”

Using a comprehensive, team approach to identify and diagnose behavioral concerns, including attention-deficit/hyperactivity disorder, autism spectrum disorder, learning disabilities, and behavior regulation problems, JSS provides evidence-based, data-driven treatment to ensure best practice. This includes “gold standard” assessments such as the Autism Diagnostic Observation Schedule, 2nd Edition (ADOS-2).  The company communicates regularly with its referral sources, chiefly physicians and other behavioral health providers. “As soon as we get a referral, we let our providers know,” says Selman. “We send comprehensive reports and updates on treatment and care. We meet with them two or three times a year. Our efforts emphasize collaboration and communication.”

His advice for other behavioral health providers: “Set aside time to talk to physicians, to hear their concerns and what they need, so they can do what they’re trained in and comfortable doing. Communicate what you’re doing to help patients.” Selman stresses the importance of communication among behavioral health providers, too. “It’s good to understand your scope of practice and share experiences as well as take feedback.”

Prescription limit reminders

First Choice members younger than age 21 get unlimited prescriptions or refills. Members ages 21 and older are limited to four prescriptions or refills a month. Medications used to treat the following conditions are exempt from the four-prescription limit:

Acute sickle cell disease Behavioral health disorder Cancer
Cardiac disease Diabetes Hypertension
End-stage lung disease End-stage renal disease HIV/AIDS
Lupus Organ transplant  

If a member, your patient, is denied a medication at the pharmacy, please remind him or her to call Member Services at 1-888-276-2020, or Select Health Pharmacy Services at 1-866-610-2773 before leaving the pharmacy.

A faster, easier way to submit prior authorization requests

Did you know you can submit a prior authorization request form for medications online? Just visit our Pharmacy section and click on “Submit online prior authorization form.”

Help protect our members against the flu

Select Health covers flu vaccinations with no copay for First Choice members. Help us increase the number of our members, your patients, vaccinated this year. You can provide the vaccination during well visits or as part of follow up for high-risk patients, who are more susceptible and should be vaccinated as early as possible. The Centers for Disease Control and Prevention recommendations for the 2016-2017 season are to use the flu shot (inactivated influenza vaccine, or IIV, and the recombinant influenza vaccine, or RIV). Do not use the nasal spray vaccine (live attenuated influenza vaccine, or LAIV).

Clearinghouse name change reminder

Emdeon, our claims clearinghouse, changed its name to Change Healthcare last year. Contact Change Healthcare at 1-877-363-3666, or visit the Change Healthcare website and click on “Resources” for:

  • Enrollment.
  • Product support.
  • Payer lists.
  • EFT/e-payment.
  • Payer ERA.

First Choice versus First Choice VIP Care Plus reminder

Select Health has two health plans: First Choice (Medicaid/Healthy Connections) and First Choice VIP Care Plus (Medicare/Medicaid/Healthy Connections Prime). Please be sure to file claims with the correct health plan. The payer ID for First Choice (Medicaid) is 23285. The payer ID for First Choice VIP Care Plus (Medicare/Medicaid) is 77009.