R E D I V O PR
N I T E L L U B 21 0 2 NE JU
A Message From
Kathryn Chaney, VHP Provider Relations Manager Kathryn Chaney Provider Relations Manager Kathryn.Chaney@vhp.sccgov.org
Dear VHP Providers, The COVID-19 pandemic made 2020 an exceptionally challenging year for our Provider community. The pandemic has required significant changes in how you treat our Members, engage with the public, and run your day-to-day operations. VHP has also undergone significant changes, as we transitioned to a remote working environment, learned to engage through teleconference calls, and still stayed focused on our number one priority, the well-being of our Members. This period has allowed VHP to improve operations, processes, and communications to enhance services to both our Providers and Members. We are excited to share some of our 2020 achievements as well as our goals for 2021.
2020 Achievements: 1. Updated and posted the 2021 Provider Manual for our Commercial lines of businesses; which includes Commercial Classic, Commercial Preferred, Covered California, and the Individual & Family Plan. Please visit www.valleyhealthplan.org/providers/provider-manual. 2. Expanded the scope and frequency of standing Joint Operating Committees (JOCs) with many of our provider groups and hospitals. More JOCs are currently being scheduled for 2021, so please reach out to your Provider Relations Representative if you have not heard from us yet. 3. Refreshed and enhanced the new provider orientation packet. We have also scheduled monthly web-based orientations for all new providers, as well as those existing Providers who would like a refresher on VHP processes and operations. Please reach out to your Provider Relations Representative for more information. 4. Since the Fall of 2020, developed quarterly Provider Bulletins to keep our providers informed of health plan and regulatory changes, billing and/or process changes, where you can direct Members to receive COVID-19 testing and vaccines, and about other useful information. This is our third consecutive Provider Bulletin; if you have feedback, please let us know how we can improve to better meet your needs!
3. Increase the Provider Relations team so that each one of our providers has a dedicated Provider Relations Representative. VHP is highly focused on expanding access in its networks; in doing so, we are adding additional staff with the necessary experience to support these new areas of growth. One of these areas of focus is Behavioral Health Services, which now has dedicated staff specialized in serving this Provider community.
VHP CHIEF EXECUTIVE OFFICER Laura E. Rosas, JD, MPH
4. Working with Provider Credentialing Data Management Teams Development of an inbound/outbound Provider roster process. This process will be based on a roster template that houses a standard set of data elements to be received at the end of each month. Provider Relations will verify for completeness cross-reference for accuracy and then validate with the provider for the confirmation of data accuracy. We will share more on this improvement in future communications.
VHP CHIEF FINANCIAL OFFICER Paul Antigua
While we continue to build on our successes, VHP is still largely remote and unable to visit you directly at your office setting. Please continue to work with your assigned Provider Relations Representative, or contact us at ProviderRelations@vhp.sccgov.org or 408.885.2221. We can also set up an ad hoc video conference meeting to discuss your questions face to face. Please remember that we miss interacting with you in person and look forward to the time when we can be back in the field again while we serve and support you in caring for our Members! Thank you, Kat Chaney, VHP Provider Relations Manager
VHP CHIEF MEDICAL OFFICER Ghislaine Guez, MD VHP CHIEF OPERATIONS OFFICER Debra Halladay
ACTING VHP CHIEF BUSINESS DEVELOPMENT OFFICER David Hurst VHP ASSISTANT DIRECTOR, PROVIDER NETWORK OPERATIONS Justin Keller VHP ASSISTANT DIRECTOR, BEHAVIORAL HEALTH SERVICES Chris Jaquis VHP MEDICAL DIRECTOR Elizabeth Murphy, MD VHP MEDICAL ADVISORS Stephen Harris, MD COUNTY OF SANTA CLARA BOARD OF SUPERVISORS Mike Wasserman, District 1 Cindy Chavez, District 2 Otto Lee, District 3 Susan Ellenberg, District 4 Joe Simitian, District 5 COUNTY EXECUTIVE Jeffrey V. Smith, MD, JD
5. Expanded our Provider Relations Team to meet the needs of our Providers and ensure that we respond quickly to your questions. I am one of these new staff members!
2021 Goals: 1. Development of a dedicated Provider Relations call center to ensure that providers can easily connect with the Provider Relations team and have their questions triaged appropriately for quick resolution. 2. Create Provider Portal to allow providers to communicate with members via the portal, as well as review Member’s personnel information, deductibles, co-pay amounts, accumulators, benefits, eligibility history, claims history and status, and review historical referrals and authorizations. Pg. 2 | June 2021 Provider Bulletin
Meet the Providers Relations Team!
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Provider Relations Team! Kathryn Chaney Provider Relations Manager 408.885.5780 Kathryn.Chaney@vhp.sccgov.org
Chet Mababa Provider Relations Specialist 408.885.2631 Chet.Mababa@vhp.sccgov.org Occupational Therapy Speech Therapy Mental Health Fremont Hospital Radiology Centers Durable Medical Equipment (DME) Prosthetics/Orthotics
Veronica Valdivia Provider Relations Specialist 408.885.4151 Veronica.Valdivia@vhp.sccgov.org
Phuong Au Provider Relations Specialist 408.885.2599 Phuong.Au02@vhp.sccgov.org
Vivian Than Provider Relations Specialist 408.885.3676 Vivian.Than@vhp.sccgov.org
O'Connor Hospital St. Louise Regional Hospital Valley Medical Center (VMC) Santa Clara Valley Medical Center (SCVMC) Asian Americans for Community Involvement (AACI) Foothill/Tri Cities/BACH Gardner Health Center Indian Health Centers North East Medica Services (NEMS) Planned Parenthood Ravenswood/MayView/Roots School Health Centers Clinica de Salud Physical Therapy
Advanced Surgery Center Advanced Surgicare, LLC Forest Surgery Center Montpelier Surgery Center Buncke Clinic Plastic Surgery Institute (PSI) Natividad Medical Center (NMC) NMC - Physicians Group Home Health Agencies Hospice Skilled Nursing Facilities
Acupuncture Anesthesiology Audiology Chiropractors Individual Contracted Providers BASS Medical Group NCPN (aka NCAMG) Physicians Medical Group of San Jose (PMGSJ) San Benito Medical Associates
Gregg Fondacabe Provider Relations Specialist
Regene Ross Provider Relations Specialist
Gregg.Fondacabe@vhp.sccgov.org
Regene.Ross@vhp.sccgov.org
Patricia McHarris Office Specialist III 408.793.6076 Patricia.McHarris@vhp.sccgov.org
Non-Contracted Community Clinics
Sutter (PAMF & SGMF) Santa Clara County Individual Practice Association (SCCIPA) SVMD (formerly Verity Medical Foundation) El Camino - Los Gatos El Camino - Mountain View HCA - Regional Center of San Jose HCA - Good Samaritan Hospital Dialysis - Satellite; DaVita Lucille Packard Stanford Hospital Labs Pathology
Non-Contracted Facilities Non-Contracted Hospitalists/ Hospitals Non-Contracted Providers/Physician Groups/Transport Non-Contracted Surgery Center Emergency Transportation Ambulance (AMR) Urgent Care
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Currently working as a Disaster Service Worker
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COVID-19 Updates VHP COVID-19 Vaccine Scheduling Assistance Program VHP Member Services, Case Management, and Health Education are currently contacting our Members who may be eligible for the COVID-19 vaccine. VHP staff is reviewing Santa Clara County eligibility criteria for these Members while assisting with the scheduling of vaccine appointments upon request (and availability). Members also receive informational links to FAQs from the Centers for Disease Control and Johns Hopkins University. If Members have additional questions or concerns about possible allergic reactions based on their health history or conditions, our staff will direct them to their primary care physician for further guidance. As part of this program, VHP staff will encourage our Members to complete their routine preventive screenings and receive any outstanding vaccinations that may have become past due during the pandemic. As their Provider, we value the vital role that you play in ensuring the health of our Members and appreciate your support in this effort.
“The beginning of the end of the COVID-19 pandemic happens when our populations are vaccinated. Still, as we get back to real life, we need to be certain
Vaccination Update from the SCC Public Health As of this publication, Santa Clara County has greatly increased its availability of COVID-19 vaccines. Please see the link below to access information on vaccine availability and other information. As this situation is evolving, VHP would like to ensure tthat our Providers are aware of the items which are billable by line of business (Commercial Classis, Commercial Preferred, Covered California, Individual & Family Plan, and MediCal)(Please find these resources on Page 8) that they can find the most up to date information from Federal, State, and County resources. Santa Clara County’s Public Health Department routinely provides updates to all residents on COVID-related activities such as testing sites, vaccinations sites, vaccination priorities, dashboard reports, etc.
that we aren’t setting ourselves up for the spread of other infectious diseases – so we also need to make sure that kids are current with routine vaccination schedules and that flu vaccination rates next year stay as high as they were this year.” Ghislaine Guez, MD, MBA Chief Medical Officer
For the most current information and updates, please visit the Santa Clara County Public Health Department COVID-19 Vaccine Resource Page at www.sccgov.org/sites/covid19/Pages/home.aspx.
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Billing Guidelines for the Administration of the COVID-19 Vaccination The American Medical Association has announced vaccine-specific CPT codes for coronavirus (COVID-19) immunizations. Additional information is available at https://www.ama-assn.org/ search?search=coronavirus+cpt+codes.
Please refer to the list of COVID-19 vaccine administration codes below when submitting claims:
Health Education Corner!* We know their journey is tough, so we are here to help. Let VHP help get your patient’s wellness journey started today! Free Nutritional Workshops for VHP Members: As a Provider, you know there is a vast array of information related to healthy eating and that it can sometimes be difficult for people to identify facts from fiction. VHP has designed free nutrition workshops for your patients, which are designed to: • Explain why diets may or may not work, and why they can be confusing.
Code
CPT Short Descriptor
COVID-19 Vaccine/Procedure Name
91300
SARSCOV2 VAC 30MCG/0.3ML IM
Pfizer/BioNTech - Vaccine
0001A
ADM SARSCOV2 30MCG/0.3ML 1ST
0002A
ADM SARSCOV2 30MCG/0.3ML 2ND
91301
SARSCOV2 VAC 100MCG/0.5ML IM
Moderna - Vaccine
0011A
ADM SARSCOV2 100MCG/0.5ML1ST
Moderna - 1st Dose Administration
0012A
ADM SARSCOV2 100MCG/0.5ML2ND
Moderna – 2nd Dose Administration
91303
SARSCOV2 VACCINE AD26 5X1010 VP/0.5ML IM USE
Janssen (J&J) - Vaccine
0031A
IMM ADMN SARSCOV2 AD26 5X1010 VP/0.5 ML 1 DOSE
Pfizer/BioNTech - 1st Dose
• Learn how to make eating healthy and well-balanced diets fun and energizing.
Administration Pfizer/BioNTech – 2nd Dose
• Have access to healthy and satisfying recipes that they can try each day.
Administration
Janssen (J&J) - Single dose Administration
COVID-19 vaccine immunization billing codes for provider administration: VHP Provider Update - “COVID-19 Vaccine Update for VHP’s Covered California, Individual & Family Plans and Commercial Employer Group”: www.valleyhealthplan.org/providers/bulletin-and-updates/ updates Medi-Cal COVID-19 Guidance: https://files.medi-cal.ca.gov/pubsdoco/COVID19_response.aspx Additional COVID-19 resource links: California COVID-19 Response: https://covid19.ca.gov/ CDPH COVID-19 Updates: www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/ncov2019.aspx DMHC COVID 19 Response: www.dmhc.ca.gov/COVID-19.aspx DHCS COVID 19 Response: www.dhcs.ca.gov/Pages/DHCS-COVID%E2%80%9119-Response.aspx VHP COVID-19 Updates: www.valleyhealthplan.org/sites/p/Bulletin-and-Updates/Pages/ProviderBulletin-and-Updates.aspx If you have any questions, please contact your assigned Provider Relations Representative at ProviderRelations@vhp.sccgov.org or 1.408.885.2221.
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• Discuss and learn simple tips on how they can improve their overall health through proper management of their diet.
Free Virtual Fitness Classes for VHP Members: Get your patients’ hearts pumping and healthy by having them join VHP’s FREE virtual fitness classes! We have classes that can be done safely in the convenience of their own homes or mobile device via Zoom. From Zumba classes and sports conditioning to yoga and Pilates, we are sure to have something that your patients will find interesting! As a reminder, these classes and programs are available to all VHP Members. Classes are offered each quarter to all VHP members, and registration is simple. Your patients can register for available nutrition classes by visiting the VHP website at www.valleyhealthplan.org and searching for “Classes and Programs”, or using the direct link for VHP - Classes & Programs at www.valleyhealthplan. org/members/health-and-wellness/class-listings. For further information, you or your patients can email Health Education at Healtheducation@vhp.sccgov.org or call 408.885.3490. Additional information related to healthy eating can also be found at VHP - Healthy Eating at www.valleyhealthplan.org/members/ healthy-eating.
Weight Watchers – Discounted Weight Loss Programs for VHP Members: VHP has partnered with Weight Watchers (WW) to provide a valuable resource for our Providers caring for our Members who may be struggling to achieve or maintain a healthy weight. VHP Members can receive more than 50% off their WW program costs! When it comes to programs designed to help improve patient health by losing weight and eating healthy, WW has the experience and expertise to develop plans tailored for each person’s specific needs. WW is now offering individually developed programs through the myWW+™ app, which gives participating Members the support they need to achieve their goals; including food and activity tracking, access to 8,000+ delicious and healthy recipes, a Member-only social network, and access to 24/7 support from WW coaches. Please see our program options on the next page. Digital Program Only = Less than $9.00/Month * Programs are only open to commercial lines of business. (VHP -Employer groups, Covered CA, Individual Family Plan) Santa Clara Family Health Plan enrollees are not eligible.
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Digital Program access includes the ability to track and monitor food intake, document daily activities, and weight-loss progress, and access all tools and resources on the myWW+™ app. It also provides access to WW’s database of restaurants; 8,000+ recipes; 24/7 coaching; Members-only digital community; on-demand workouts; ;and so much more. Digital Program + Unlimited Workshops = Less than $20.00/Month The Digital Program + Unlimited Workshops includes all of the benefits of the Digital Program, plus weekly inperson or virtual meetings with a WW coach and weekly weight-loss education curriculum rooted in decades of research combined with the latest in science-backed techniques to help patients lose weight and build healthy habits. Registration is easy; simply direct your patients to the VHP website at www.valleyhealthplan.org and have them search for “Health and Wellness”, or share the VHP - Health & Wellness link at www.valleyhealthplan. org/members/health-and-wellness/class-listings. In addition, patients can email Health Education at Healtheducation@vhp.sccgov.org or 408.885.3490.
Preparing for Provider Surveys - Guidelines & Standards Preparing for Provider Surveys - Guidelines and Standards VHP conducts three Provider Surveys on an annual basis.
1. Provider Satisfaction Survey (PSS)
2. Provider Appointment and Availability Survey (PAAS)
3. Provider After-Hours Survey (AH)
These regulatory surveys required by the California Department of Managed Health Care (DMHC) allow VHP to receive feedback on your satisfaction with the services provided by VHP and information on where we can improveas well as, whether your practice is adhering to the regulatory standards set forth by DMHC. For those practices not meeting the standards, a Provider Relations Representative will follow up to provide education on how to meet the DMHC standard(s) and ensure that we have the correct contact information for use in the survey process. As a reminder, all VHP contracted Providers are obligated to adhere to standards and to participate in these surveys.
Medi-Cal Rx Transition – Delayed Until Further Notice from DHCS In the Winter 2020 Provider Bulletin, VHP informed you that the Medi-Cal Pharmacy (Medi-Cal Rx) transition to Magellan, a potential vendor to serve as the State of California’s Pharmacy Benefits Manager, was scheduled to be implemented on 4.1.21. Since that publication, the State has provided to the Plans notice that the implementation of Medi-Cal Rx will be further delayed. At this time, no new guidance or dates have been provided. VHP will provide further guidance and details on the implementation date of this pharmacy change when we learn more from DHCS. To stay up to date with current information provided by DHCS, please refer to the following link: www.dhcs.ca.gov/provgovpart/pharmacy/Pages/Medi-CalRX.aspx. The Medi-Cal Rx initiative is part of CalAIM and for more information, please visit the Department’s website at www.dhcs.ca.gov/provgovpart/Pages/CalAIM.aspx. Pg. 10 | June 2021 Provider Bulletin
Provider Satisfaction Survey (PSS) As a Provider-oriented managed care partner, VHP is committed to maintaining and improving practitioner satisfaction with the health plan and to ensure that we are meeting your needs, VHP conducts a Provider Satisfaction Survey (PSS) on an annual basis to ellicit feedback from you on our operations and your interactions with some of our key departments. This survey provides VHP with critical feedback which is analyzed to identify the plan strengths and develop strategies to address opportunities for improvement to better serve you. A Comparison of the Overall % of Providers who are Very Satisfied or Satisfied with VHP Services from 2019 to 2020 Overall Provider Satisfaction with VHP Services
Goal
Goal Met (Y/N)
MY 2020 Results
MY 2019 Results
Primary Care Physicians
80%
N
79.5%
81.4%
Specialists
80%
Y
90.9%
91.9%
Psychiatrists
80%
Y
100.0%
100.0%
Non-Physician Mental Health Provider (NPMH) Practitioners
80%
N
73.5%
81.3 %
Total
80%
N
79.9%
83.9%
Provider Appointment and Availability Survey (PAAS) The California Department of Managed Health Care (DMHC) requires health plan members to be seen in a timely manner. The primary intent of these regulations, and underlying legislation, is to ensure that VHP’s provider network has the capacity and availability to provide care to our Members within the established regulatory timeframes. Sometimes, the wait time for a member appointment will need to exceed the standard time frames established by DMHC. This may be allowed if it is the provider’s professional judgment that the longer wait time would not be harmful to the member’s health. If you do have an appointment wait time that exceeds the timely access standards set forth below, you must document in the member’s medical record that the longer wait time will not be harmful to the member’s health. To see how VHP’s contracted Providers are meeting these Timely Access Standards, you may review and/or download a copy of the report at www.valleyhealthplan.org/providers/bulletin-and-updates/updates Primary Care Physicians Appointment Availability Compliance for Primary Care Physicians
Goal
Goal Met (Y/N)
MY 2020 Results
MY 2019 Results
Availability of Urgent Care Appointments Within 48 Hours - No Prior Authorization
90%
N
66%
52%
Availability of Non - Urgent Care Appointments - Within 10 Days
90%
Y
92%
86%
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Specialist Physicians Appointment Availability Compliance for Primary Care Physicians Availability of Urgent Care Appointments - Within 48 Hours - No Prior Authorization
Goal
Goal Met (Y/N)
MY 2020 Results
MY 2019 Results
90%
N
49%
39%
90%
N
79%
59%
Access and Availability Standards The California Department of Managed Health Care (DMHC) requires health plan members to be seen in a timely manner. The primary intent of these regulations and the underlying legislation is to ensure that the VHP network of Providers has the capacity and availability to provide care to you within certain timeframes for the various levels of care. However, sometimes waiting longer for care is not a problem. Your physician may give you a longer wait time. It must be noted in your record that a longer wait time will not be harmful to your health. Appointment Scheduling Maximum Waiting Times
Availability of Non-Urgent Care Appointments - Within 10 Days
Appointment Type
Timely Access Standard
Emergency services
Immediately
Urgent care appointments not requiring prior authorization
Offer appointment within 48 hours of request
Urgent care appointments requiring prior authorization
Offer appointment within 96 hours of request
Non-urgent appointments for Primary Care Services
Offer appointment within 10 business days of request
Non-urgent appointments for Specialist Care Services
Offer appointment within 15 business days of request
Non-urgent appointments for Ancillary Services
Offer appointment within 15 business days of request
Office/clinic wait time (from appointment registration time to when seen by the practitioner/physician)
30 minutes (VHP Standard)
Psychiatry Specialty Appointment Availability Compliance for Primary Care Physicians
Goal
Availability of Urgent Care Appointments
Goal Met (Y/N)
90%
- Within 48 Hours - No Prior Authorization Availability of Non-Urgent Care Appointments - Within 10 Days
N
90%
N
MY 2020 Results 49% 79%
MY 2019 Results 39% 59%
After Hours Standards Every provider in VHP’s network must provide an outgoing message to members calling after hours instructing them to hang up and call 911 in the event of an emergency. In addition, 100% of all primary care physicians and behavioral health provider offices must provide an outgoing message to members calling after hours indicating that the practitioner will respond in 30 minutes or less. Compliance with Out-Going Messaging - Include Instructions to Call 911 for Emergency Compliance with Out-Going Messaging - Include Instructions to Call 911 for Emergency
Goal
Primary Care Physicians
100%
N
95%
92%
Appointment Type
Timely Access Standard
Behavioral Health Practitioners
100%
N
90%
81%
Life-threatening emergency
Immediately
Non-life-threatening emergency
Offer appointment within 6 hours of request
Urgent Care appointments
Offer appointment within 48 hours of request
Non-urgent appointments with a non-physician Behavioral Health Care Practitioner (Psychologist, MFT, LCSW) and Psychiatrist
Offer appointment within 10 business days of request
Office/clinic wait time (from appointment registration time to when seen by physician/practitioner)
30 minutes (VHP standard)
Compliance with Out-Going Messaging - Include Instructions to Call 911 for Emergency Primary Care Physicians Behavioral Health Practitioners
Goal Met (Y/N)
MY 2020 Results
MY 2019 Results Accessibility to Behavioral Health Care
Goal
Goal Met (Y/N)
MY 2020 Results
MY 2019 Results
100%
N
62%
35%
100%
N
54%
27%
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BELIEVE YOU MAY BE ABLE TO SAVE EVEN MORE ON ALREADY LOW-COST VHP COVERED CALIFORNIA PLANS
2020 HEDIS for All Providers
Open Enrollment – CoCA & the American Rescue Plan
VHP, like most health plans, uses the annual submission of clinical data for the Healthcare Effectiveness Data and Information Set (HEDIS) from the National Committee for Quality Assurance (NCQA) to develop Provider performance ratings on the quality of service and population health outcomes. These scores are important because they:
The COVID-19 pandemic has led to a loss of employment for many Americans. Now, there is a new and exciting opportunity for your patients to enroll and save more than ever before with VHP! Now is the time to encourage your patients to enroll in a plan they can afford and and access comprehensive care.
1. Provide an overview of the quality of care our Members are receiving and potential opportunities for improvement. 2. Are part of the scoring used to develop VHP’s Star Rating, which is posted publicly for potential consumers to view when they are considering which health plan to choose for their care. 3. Are used as part of VHP’s scoring for NCQA Health Plan Accreditation. Your active participation as a VHP Provider is an important part of this process because these scores represent the quality of care that you provide to our Members. To ensure that you are capturing all your HEDIS-related services for the calculation of your performance rating, please submit claims in a timely manner, use correct billing codes, and provide medical records as requested. For this year’s (2021) HEDIS activities, VHP Quality Team is asking that you partner with us to focus care on prevention/screening measures. It has been identified that the COVID-19 pandemic, has led to a reduction in patient utilization, leading to gaps in care. For example, 15% fewer children under the age of three (3) years have received the first dose of MMR1, and 28% fewer adolescents ages 11 – 13 years have received the Tdap booster1. Reports also show that national colorectal cancer screening rates had initially dropped 86% during the COVID-19 pandemic and have remained at a rate that is 36% lower than in previous years. In addition, there has been a decrease of 45% in the detection of new colorectal cancer cases2. In response to these findings, and recognizing our community has seen an exacerbation of disparities in the health care system, the VHP Quality Team will focus on childhood and adolescent immunizations, as well as colorectal cancer screening and other preventive services for the 2021 HEDIS performance year. The VHP Quality Team will work with you, our Provider partners, to close the gaps in care for our Member’s essential preventive services through targeted interventions and the implementation of value-based payment programs. We look forward to working with you on these initiatives and thank you for all you do to serve the community and serve our Members. References: 1. “Fill the Gaps. Keep Immunizing Your Patients!” Drop in Immunizations During COVID-19 – California Vaccines for Children (VFC), http://eziz.org/home/immunization-drop/ 2. Patel, S., Issaka, R. B., Chen, E., & Somsouk, M. (2021). Colorectal Cancer Screening and COVID-19. The American journal of gastroenterology, 116(2), 433–434. https://doi.org/10.14309/ ajg.0000000000000970.
During Special Enrollment Period (SEP) those shopping for health insurance are normally required to have a Qualifying Life Event (QLE) such as getting married, having a baby, moving to a new service area, or losing coverage in order to enroll in a new plan. Covered California has implemented two ways that your uninsured or underinsured patients can enroll in a VHP plan without needing a QLE. The American Rescue Plan (ARP) enrollment period is from April 12th through December 31, 2021. More money is now available to help lower the monthly cost of health coverage. The ARP increases the premium assistance provided to eligible Covered California Members, raises income limits for eligibility, and allows enrollment in a Covered California Plan without a QLE. This is a unique opportunity for your patients to save more than ever. Even those already enrolled in a VHP Covered California plan will enjoy lower premiums automatically starting with their June 2021 premium bill, no action required. VHP’s off-exchange Individual & Family Plan (IFP) Members are encouraged to check whether they are newly eligible for premium assistance and to switch to a VHP Covered California plan. VHP IFP Members who take advantage of the ARP, and switch to a VHP Covered California plan, will carry over any payments made toward their deduction with them. Existing VHP Members can expect to see details regarding the ARP and potential benefits of changing their plan on their June 2021 premium billing. For your patients who are not eligible for Covered California, there is another way to enroll with VHP. VHP’s IFP is the only Qualified Health Plan that does not require citizenship and is the perfect plan for those who do not qualify for Covered California. No social security number is needed – all who live in the VHP service area are welcome! There has never been a more critical time to have coverage; let your uninsured patients know VHP IFP is an option available to them. Encourage your patients to review their subsidy eligibility, enroll in VHP, and save with the lowest cost plans for the most popular metal tiers. Coverage can start as soon as the 1st of the month following plan selection. The new benefits provided by the ARP make health coverage more affordable than ever, which can both reduce the number of uninsured or self-pay patients, as well as improve coverage retention for those facing economic challenges. For enrollment assistance your patients can contact a VHP Broker at BrokerRelations@vhp.sccgov.org or 408.885.3560.
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VHP’s Website Presence – New & Improved for You!
Also New & Improved…VHP’s Provider Manual!
VHP is excited to announce the launch of our new website! With a focus on improving communication with Providers, Members, and other partners and stakeholders, VHP is making it easier than ever to access information, tools, forms, and other resources online. Significant effort has gone into the redesign, including:
One of the first areas of the new VHP website that we encourage Providers to visit is our 2021 Provider Manual, where our new Provider Manual is available to view online or to download in PDF format for printing or distribution. To see the new 2021 Provider Manual please visit, www.valleyhealthplan.org/providers/ provider-manual.
• Simplifying the navigation and reducing the number of “clicks” to access frequently visited pages. • Developing easy access to contact information. • Displaying of “related topics” to improve and increase website flow. • Improving the website’s search functionality. • Updating or reformatting forms to be digitally fillable, so printing is not necessary.
VHP’s Provider Manual has been updated based on feedback provided by VHP’s community of Providers. The Provider Manual has been enhanced to assist you in responding to questions from our Members, includes a Quick Reference Guide (QRG), and contains VHP resource information on VHP’s policies, procedures, operating practices, and provider-related regulatory requirements. The new Provider Manual, covering VHP’s Employer Group, Covered California, and Individual & Family Plan products, was effective February 1, 2021, following an online review period for Providers to share feedback.
VHP’s web team continues to improve the site, content, and user experience, and welcomes your input. If you have ideas for how our website can be improved to help you deliver care and service to our Members, please email your suggestions to ProviderRelations@vhp.sccgov.org.
For those Providers contracted to serve VHPs Medi-Cal Members, please continue to refer to VHP’s 2020 Provider Manual. VHP’s is developing a new Medi-Cal Provider Manual. Look for updates in the next issues of the Provider Bulletin.
Important: VHP’s relaunched site includes new URLs as well as links to frequently visited pages and forms that you may already have bookmarked for easy access. For an interim period, users will be redirected automatically to the new site location for these resources. Once you have been redirected to the new location, please remember to bookmark it so that you can continue to easily find the information in the future.
For information not found in the Provider Manual, or questions you may have, please contact Provider Relations at ProviderRelations@vhp.sccgov.org or at 408.885.2221. You can also request laminated QRGs that your office staff can post at convenient locations at your office.
We Want to Hear from You! Share with Us! Do you have a patient success story? A favorite recipe? A health care related joke, pun, or comic strip? An idea on how to improve the patient/doctor relationship? Or an idea or thought another provider may benefit from hearing? We want to give you a chance to engage with your fellow VHP Providers; if you have an idea, a topic, or an experience you would like to share, please submit a written summary to ProviderRelations@vhp.sccgov.org
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