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Date: 11/20/2009
Description: Limited Availability of Medica Electronic Transactions This Weekend
Alert: Beginning late Friday, November 20, there will be limited availability of Electronic Transactions on medica.com due to scheduled maintenance related to the Medica Web site. As a result of this scheduled weekend update, Medica online transactions will only provide limited data such as member eligibility. Medica apologizes for any inconvenience.
Action: No action is required.
Date: 11/12/2009
Description: Limited Availability of Medica Electronic Transactions This Weekend
Alert: Beginning Saturday afternoon, November 14, there will be limited availability of Electronic Transactions on medica.com due to scheduled maintenance related to the Medica Web site. As a result of this scheduled weekend update, Medica online transactions will only provide limited data such as member eligibility. Medica apologizes for any inconvenience.
Action: No action is required.
Date: 11/10/2009
Description: CDC Antiviral Guidance and Health Advisory for H1N1
Alert: The Centers for Disease Control and Prevention has recently published information for providers about H1N1 flu, as indicated below. The "Quick Facts" summary includes important information to clear up some common misconceptions about the timing and appropriate use of antiviral medications for H1N1. The CDC Health Alert notes that not all people recommended for antiviral treatment are getting treated, and provides facts for clinicians to consider when deciding whether a patient needs to be treated with antiviral medication.
Action: Refer to recent H1N1 details from the CDC:
Date: 10/30/2009
Description: Cardiac Genetic Test to Require Prior Authorization
Alert: Beginning with December 1, 2009, dates of service, Medica will cover genetic testing for long QT syndrome (LQTS) using the Familion test. Prior authorization will be required. This change will apply to all Medica products including government products unless a particular health plan (whether commercial, Medicare or Medicaid) requires different coverage. Genetic testing for long QT syndrome using any genetic test other than the Familion test is considered investigative and therefore will not be covered. Genetic testing for all other cardiac channelopathies—including but not limited to Brugada syndrome, short QT syndrome and catecholaminergic polymorphic ventricular tachycardia—also is considered investigative and therefore will not be covered.
Action: As of December 1, the complete text of the policy that applies to this determination will be available, under Utilization Management Policies.
Date: 10/29/2009
Description: Reminder on Need for Blood Lead Testing of MHCP Child Patients
Alert: The Minnesota Department of Health continues to emphasize blood lead tests for Minnesota Health Care Programs (MHCP) children, and Medica is doing what it can to promote this important service. As a reminder, blood lead tests are an integral part of a complete Child and Teen Checkups (C&TC) exam—And when a blood lead test is done as part of a complete exam, Medica reimburses providers an additional $102 (for code S0302). Lead testing is recommended at 12 and 24 months of age as part of C&TC exams during office visits, although blood lead tests can be done at 9-15 months of age for the year-one checkup and 16-30 months of age for the year-two checkup. Now that it's flu season, as MHCP children come in for other care, it may be a good opportunity for doctor's offices to test for lead poisoning. Blood lead testing may also be appropriate for older children, and providers are encouraged to do so as needed.

The State of Minnesota has outlined reasons for performing blood lead tests for MHCP children. According to the Minnesota Department of Human Services, "Providers sometimes have questions about the necessity of doing lead testing. Lead testing is a federally required component of C&TC. Research indicates that Medicaid children are at greater risk of lead poisoning. Before any changes might be considered for this component, lead screening data needs to be collected over a period of years. Providers can assist this effort by performing lead testing at the appropriate ages so data which will drive future policy decisions can be gathered."

For more details from the State of Minnesota on blood lead testing, refer to:

Action: Providers are encouraged to conduct blood lead tests for MHCP child patients whenever appropriate.
Date: 10/27/2009
Description: Revised Claim Adjustment and Appeals Forms Posted Online
Alert: Medica has updated two claims forms to reflect community standards in Minnesota for claims submission, as determined by the Minnesota Administrative Uniformity Committee (AUC). The revised forms are:

  • Claim Adjustment Request Form—(for non-Minnesota network providers) To be used when a non-Minnesota network provider has additional data that should have been submitted on the original claim or has a need to correct data that was sent incorrectly on the original claim. (Minnesota providers must follow the AUC guide for electronic submission of voided or replacement claims)
  • Claim Appeal Request Form—(for all network providers) To be used when a network provider is requesting reconsideration of a previously adjudicated claim but there is no additional or corrected data to be submitted. Claim appeals need to be submitted within 180 days of the original claim's disallow date.
Action: Network providers should use these forms, as applicable, after submitting claims to Medica. Click on the names of the forms above to view them.
Date: 10/22/2009
Description: Medica Expands Coverage for VEGF Inhibitor Antibody Treatment
Alert: Effective with October 21, 2009, dates of service, Medica has expanded its coverage of vascular endothelial growth factor (VEGF) inhibitor antibody treatment for age-related macular degeneration to also include coverage for neovascular retinopathies, including diabetic retinopathy. This change applies for all Medica members. To reflect this coverage change, Medica has modified its related coverage policy, "Intravitreal Vascular Endothelial Growth Factor (VEGF) Inhibitor Antibody Treatment for Neovascular Ocular Indications." For all other ocular indications, VEGF antibody treatment continues to be considered investigative and therefore remains not covered.

Action: As of November 1, 2009, providers can see the complete text of the coverage policy that applies to this determination, under Coverage Policies.
Date: 10/08/2009
Description: Conference on Changing Patient Behavior Coming November 4
Alert: Providers are invited to gain new tools and insights to assess change readiness and promote self-care at a conference titled "Creating an Environment for Change: Moving Patients from Thinking to DOING." Learn how to make change the path of least resistance from keynote speaker Stacy Nelson, Ed.D., Vitalsmarts Senior Consultant for the national bestselling books Influencer and Crucial Conversations. This upcoming event is scheduled for November 4 and will be hosted by Fairview Physician Associates in partnership with Medica. The cost for the full-day conference is $45. The registration deadline is October 26.

Healthcare professionals often struggle to influence patients to lose weight, quit smoking, moderate alcohol consumption and get more exercise. But while healthcare professionals work to promote sustainable behavior change, they often lack a model and concrete tools for success. The conference next month will help address such challenges.

Action: Providers can learn more and register online..
Date: 10/07/2009
Description: Medica to Update RSV Prophylaxis Policy Based on Revised AAP Guidelines
Alert: Medica is aware of the recently revised American Academy of Pediatrics (AAP) recommendations for use of palivizumab (Synagis®) for prevention of respiratory syncytial virus (RSV). Medica follows AAP guidelines on RSV prophylaxis for members up to 24 months of age who meet criteria, and will update its coverage policy accordingly. Coverage for eligible RSV prophylaxis is based on a Medica member's immunization benefit.

Action: See more from AAP on revised RSV guidelines. See the current Medica coverage policy, which will be revised by November 1, 2009.
Date: 10/01/2009
Description: Limited Availability of Medica Electronic Transactions This Weekend
Alert: From Friday evening, October 2, to Sunday evening, October 4, there will be limited availability of Electronic Transactions on medica.com due to scheduled maintenance related to the Medica Web site. As a result of this scheduled weekend update, Medica online transactions will only provide limited data such as member eligibility. Medica apologizes for any inconvenience.

Action: No action is required.
Date: 09/04/2009
Description: Limited Availability of Medica Electronic Transactions This Weekend
Alert: From Friday evening, September 4, to Sunday morning, September 6, there will be limited availability of Electronic Transactions on medica.com due to scheduled maintenance related to the Medica Web site. As a result of this scheduled weekend update, Medica online transactions will only provide limited data such as member eligibility. Medica apologizes for any inconvenience.

Action: No action is required.
Date: 09/01/2009
Description: Blood Glucose Monitoring Class to be Modified on Medica Formularies
Alert: Effective January 1, 2010, Medica will remove all Lifescan blood glucose monitoring meters and test strips from both the Medica standard commercial drug formulary and the Medica Choice Care/Medica MinnesotaCare drug formulary (for Minnesota Health Care Programs). The Lifescan meters and test strips that are included in this removal are One Touch Ultramini, One Touch Ultra, One Touch Ultrasmart, One Touch Ultra 2, One Touch Basic, One Touch Ultralink, Fast Take, SureStep, and SureStep Pro.

Effective October 1, 2009, Medica will add Bayer blood glucose monitoring meters and test strips (Breeze 2 and Contour) to the standard commercial and MHCP formularies, which also include the Roche (Accu-Chek) blood glucose monitoring meters and test strips. Medica members currently using Lifescan products will be notified and provided with opportunities to receive an Accu-Chek Aviva, Accu-Chek Compact Plus, Bayer Contour, or Bayer Breeze 2 meter at no charge to assist in this transition.

The above formulary changes will not apply to the Medica Medicare Part D drug formulary.

Action: Prescribers of  Lifescan blood glucose monitoring systems should consider alternative options in light of the above formulary changes. See information on Medica formularies and Medication Request Forms..

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