Microsoft word - provider newsletter 2nd quarter 2002.doc

2nd Quarter 2002
Published by IUMG Provider Relations Department
IU Health Plan HMO Pharmacy Update
Congratulations to IUPM !!!!
The following information is from Pharmacare, IU Psychiatric Management (IUPM) has been IUHP’s Pharmacy Benefit Manager. These changes awarded a full 3-year accreditation from NCQA!!!! reflect decisions made by the Pharmacare P&T Committee in which IUMG’s Dr. TR Marshall Health/Substance Abuse benefits for IUMG’s participates. IUHP members with prescriptions for members in IU Health Plan HMO, MPlan HMO and drugs that are changing to 3rd tier status receive Advantage Health Plan HMO. This is a tremendous personalized notifications from Pharmacare listing possible less expensive alternatives that they can Health Advantage Expansion Networks
discuss with their PCP. For example, patients on Claritin recently received letters to let them know that Claritin was changing to Non-Preferred drug status (3rd tier) resulting in a higher co-pay for them. The letter mentions that they may want to avoid the higher co-pay by discussing a change to Allegra, Clarinex or Zyrtec. Effective 5/1/2002 the 2nd Tier Drugs Moving to 3rd Tier Status: The Health Advantage Provider Manual is available on the IUMG intranet. Just use the Search Words: * Previous 2nd tier brands that are now available as generic. 3rd Tier Drugs Moving to 2nd Tier Status: Go to the IUMG Intranet and use the Search Word: MEDICAID. You will find a list of topics related Commercial HMOs
IUMG Medical Management Staff Revised June 21, 2002
3901 W 86th Street, Suite 230, Indianapolis, IN 46268
FAX NUMBERS 860-2734 and 860-2735
Asst Medical Director for UM, T.R. Marshall, MD
UM Director, Randy Ott, RN Ph: 860-2731, Pgr: 394-8239

1. Authorization Process: For Commercial HMO Members, MDwise Members and Wishard Advantage
Members:

• Initially, all requests for authorization are faxed or called in to:
a) Precert Coordinators:
Including, but not limited to, all outpatient services, home health, DME, rehab services, colonoscopies, MRIs, CT Scans, and Out of Plan services. b) Inpatient Case Manager:
• Then, follow-up provided , as needed, by: Case Managers:
• Members identified as ‘high risk’ are assigned to a High Risk Case Manager. The High Risk Case Managers will coordinate all required authorizations and services for Members assigned to them.
High Risk Case Managers:

2. Line of Business Specialists: Although the authorization process outlined above covers all lines of business
(Commercial HMO, MDwise and Wishard Advantage), each Case Manager also specializes in a specific line of business when it comes to addressing other issues that arise, attending meetings related to that line of business, and keeping up with that line of business’ policies and procedures. • Commercial HMO
• MDwise
Terry Seung, RN or Linda Straub, RN, CCM • Wishard Advantage

Source: http://www.iumg.com/provider/2nd_Quarter_2002.pdf