May 2024

If you have patients who reside in a nursing home or assisted living/adult care facility, Independent Health’s Medicare Family Choice® HMO I-SNP plan* may be able to provide them with an extra level of support to meet their special needs while working closely with you to improve their health outcomes and quality of care.

How the plan works

Upon enrollment, each Family Choice member is assigned an Interdisciplinary Care Team consisting of the member’s Primary Care Provider (PCP), a Family Choice Nurse Practitioner (NP) or Physician Assistant (PA), and a Family Choice Social Worker/Care Manager. The specially-trained NP or PA is on call 24 hours a day, seven days a week to provide care and support any time it’s needed. Their responsibilities include:

• Working in collaboration with the member’s PCP and the facility’s staff to identify potential problems before they become serious.
• Providing as many clinical services as possible in the member’s residence.
  
• Minimizing unnecessary and disruptive emergency room visits and hospital stays whenever it’s safe and appropriate.
  
• Keeping in close contact with the member’s PCP and family, updating them about the member’s condition and making sure that they are involved in the care-planning process. 

Other key features of Family Choice 

• Low or no out-of-pocket costs
• Year-round enrollment open to all eligible Medicare beneficiaries
• Monthly on-site medical assessments and visits
• Individualized care plan that addresses the member’s needs and health care preferences  
• Single point of contact nurse or coordinator for benefit authorizations and care transitions
• Transportation to and from off-site doctor appointments

Impressive survey results

Over the years, the Family Choice plan has consistently received high satisfaction marks from families and caregivers. A recent survey** of people whose loved ones are enrolled in the program showed:

• 99% would recommend Family Choice to others.
• 98% feel their NP or PA provides their loved ones with the quality of care they expected them to receive.
• 97% are satisfied with Family Choice.

To learn more

Nearly 40 facilities nursing homes and assisted living/adult care facilities in Western New York currently participate with the Family Choice plan. For additional information, you and your patients may visit our website.

Independent Health is a Medicare Advantage organization with a Medicare contract offering HMO, HMO-SNP, HMO-POS and PPO plans. Enrollment in Independent Health depends on contract renewal. *This plan is available to all Medicare eligibles that are entitled to Medicare Part A and enrolled in Part B. Members must reside in a participating facility in Western New York. Members must receive all routine care from participating providers. **Survey conducted by Independent Health in July 2023 with 707 families surveyed and 178 families (25%) responding.

Independent Health uses claim editing to align claim payment more closely to clinical best practices and industry standard coverage and coding guidelines. For claims processed on or after May 26, 2024, Independent Health will be deploying additional edits to our automated front end editing system.

For details on these new and future edits, please refer to the Coding section of the provider portal; here you will find a detailed spreadsheet that includes the edit criteria, effective date, and applicable lines of business. This chart is updated monthly to include new and updated edits. Please be sure your practice routinely reviews this grid to ensure accurate claim submission for Independent Health.

We believe this process will enable you and your billing staff to more readily understand our payment of claims given the widespread use of these policies, because it will also bring our processes in line with other local health plans.

As a reminder from previous communications, the goals of this claims editing process are to:

• Increase claim submission accuracy;
• Bring us to closer adherence to Local and National Coverage Determinations by Medicare;
• Align more closely with clinical guidelines.  

Independent Health uses the Centers for Medicare and Medicaid Services as a basis for many of these edits, along with specialty society recommendations and clinical best practice guidelines.

Helpful Tips

• Check the chart regularly to make sure your medical documentation and claim submission align with Independent Health’s requirements. This will help with timely claim processing and payment. 
  
• Keep your office staff updated to ensure that you have processes in place to support your decision-making when delivering care to our members.
  
• Continue to follow current Independent Health policies, as well as the Notice of Denial of Medical Coverage (NDMC) processes when applicable.
• Please share this information with all health care providers, office staff and billing staff.

Independent Health has contracted with symplrCVO, to help address the credentialing processing in an effort to improve the credentialing timeline.

If symplrCVO needs information during the credentialing process, a representative will contact the individual identified in CAQH as the credentialing contact for the provider.

SymplrCVO will request documents by email and will provide a secure link to the provider’s office upon request if the provider needs to send sensitive or confidential information. 

We will begin working with SymplrCVO the week of April 29.

Beginning in May, Independent Health will conduct the following member engagement/outreach campaigns:

Falls Prevention Campaign

This campaign targets Medicare members who have been identified as having a high likelihood of falls. 

This campaign includes telephone calls to members around falls and ways to prevent falling; it will also include emails to our Medicare population, providing education about fall prevention, and encouraging members to speak to their doctor about ways to prevent falls.

• Targeted Cohort: Medicare members who have a high likelihood of falling or a history of falls.
• Launch Date: telephonic outreach will begin in late April.  The email campaign will occur in May through July.

Physical Activity Campaign

This campaign targets Medicare members who have been identified as having low physical activity levels.

This campaign includes telephone calls to members about their physical activity and ways to increase their activity level. It will also include emails to our Medicare population, providing education about benefits of physical activity, encouraging members to speak to their doctor about ways to be more active.

• Targeted Cohort: Medicare members who have low physical activity levels.
• Launch Date: telephonic outreach will begin in late April, the email campaign will occur in May through July

• Medicare Advantage formulary deletions for individual and group plan members, effective May 1, 2024.
• Pharmacy Benefit Dimensions 3-Tier formulary deletions, effective May 1, 2024.
• Pharmacy Benefit Dimensions 5-Tier formulary deletions, effective May 1, 2024.

Magellan Rx, administered by Magellan Rx Management, reviews select specialty drug prior authorization requests on Independent Health’s behalf. To view Magellan Rx policies for the drugs that they review, click here.

Independent Health's drug formularies
Access Independent Health's drug formularies here.

To obtain a hard copy, please contact Independent Health Provider Relations by calling (716) 631-3282 or 1-800-736-5771, Monday through Friday from 8 a.m. to 6 p.m.

Reddy Bikeshare launches ninth season - IH news, Mar. 29, 2024

The Reddy Team turned on the bikeshare network in late March. It is not only the system’s largest season launch to date, but it is also its first to include Reddy+, the name of the new pedal-assist e-bikes, as well as East Side Forward Pass, a discounted bikeshare pass targeting residents who live on Buffalo’s east side.