Resources

SitePurpose
Aetna Better Health of WVResource for ABH prior authorization submission and status inquires.
Aetna Better Health WV HEDIS Toolkit Downloadable reference guide for HEDIS measures
CMS websiteCMS Website
HCC Coding EducationProvides detailed information on understanding Hierarchical Condition Categories, a risk adjustment model that allows for a more accurate picture of patient health in a chronic disease state. 
Humana Provider Resources For providers: Valuable starting point for claims, preauthorizations, referrals, clinical support, pharmacy resources, dental resources.  
Online portal (Population Health Compass) available with additional reporting features, gap closure attestation.  Please contact your Practice Transformation Specialist to sign up for access to your facility.
 
PEIAProvides fee schedules, provider manuals, enrollment forms and other helpful resources.
The Health PlanFor Providers: Serves as a launching point for information regarding training, patient care programs, claims support, case management referral, clinical support, prior authorizations and referrals.
UnicareStarting point to access Unicare manuals, policies and guidelines (provider and claims), HEDIS reference, prior authorization and eligibility, payor resources available to patients.
United HealthCareResource for physicians, administrators, and healthcare professionals with information including policy/protocols, eligibility and benefits, claims, prior authorization, pharmacy information.
Online portal (Practice Assist) available with additional reporting features, gap closure attestation.  Please contact your Practice Transformation Specialist to sign up for access to you facility.
WV Bureau for Medical Services 

Other Resources

SitePurpose
Find HelpOnline resource to connect with available social services within an area.
United Way 211Online resource center for available services for assistance with finding food, bill payment, mental health services. 

 

Vaccines in a Value-Based World

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Social Determinants of Health in a Value Based Care Approach

Caring for Patients with Chronic Conditions

Diabetes In a Value Based Care World

Cancer Screenings in a Value Based World

2024 HCC Coding Lunch and Learn

United Healthcare STARs Pharmacy Measures FAQ Forum

This forum is designed as a time for provider groups to ask questions related to the medication adherence measures and/or the statin use measures.   Each month the forum will be hosted by the east region clinical quality pharmacists and will begin with a short topic of the month followed by an open Q&A.

You may have questions on measure specifics, such as, inclusion or exclusion criteria, best practices for measure success, or questions related to strategy implementation.  All questions related to the pharmacy adherence measures and the statin use measures are welcomed.  Please note no PHI or PII will be discussed during the forums.

February 8, 2024

2.8.2024 Forum

March 3, 2024

3.14.2024 Forum

April 11, 2024

4.11.2024 Forum 

May 9, 2024

5.9.2024 Forum

June 13, 2024

6.13.2024 Forum

July 11, 2024

7.11.2024 Forum

August 8, 2024

8.8.2024 Forum

September 12, 2024

9.12.2024 Forum

October 10, 2024

10.10.2024 Forum

November 14, 2024

11.14.2024 Forum

December 12, 2024

12.12.2024 Forum