Resources
| Site | Purpose |
| Aetna Better Health of WV | Resource for ABH prior authorization submission and status inquiries. |
| Aetna Better Health WV HEDIS Toolkit | Downloadable reference guide for HEDIS measures |
| CMS website | CMS Website |
| CMS HCC V38 - Condensed | The condensed version of the CMS Hierarchical Condition Categories (CMS-HCC) |
| HCC Coding Education | Provides 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, and dental resources. An online portal (Population Health Compass) is available with additional reporting features and gap closure attestation. Please contact your Practice Transformation Specialist to sign up for access to your facility. |
| PEIA | Provides fee schedules, provider manuals, enrollment forms and other helpful resources. |
| The Health Plan | For Providers: Serves as a launching point for information regarding training, patient care programs, cland aims support, case management referral, clinical support, prior authorizations and referrals. |
| Unicare | Starting point to access Unicare manuals, policies and guidelines (provider and claims), HEDIS reference, prior authorization and eligibility, payor resources available to patients. |
| United HealthCare | Resource 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. |
| VHN Quality Measure Crosswalk Codes 2024 | |
| WV Bureau for Medical Services |
Other Resources
| Site | Purpose |
| Find Help | Online resource to connect with available social services within an area. |
| United Way 211 | Online 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
Medicare AWV - Utilizing a Team-Based Approach for Higher Quality Care
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 | |
March 3, 2024 | |
April 11, 2024 | |
May 9, 2024 | |
June 13, 2024 | |
July 11, 2024 | |
August 8, 2024 | |
September 12, 2024 | |
October 10, 2024 | |
November 14, 2024 | |
December 12, 2024 |