OFFICE VISIT

Portal Administrators: It’s important to us that our members’ protected health information (PHI) is always safe. Here are some good habits to adopt in protecting our members’ information:

• Schedule time to periodically audit your portal users.


• Inactivate portal accounts for staff* who have left your organization.
• Make sure your staff is assigned to the Tax IDs, providers, and roles that match their job’s required access to conform with HIPAA’s “minimally necessary” standards.

*When a provider leaves our network, the provider portal account is automatically updated to a special inactive user status. They will be able to view information, but not submit new transactions. This means portal administrators only need to actively update non-provider staff user accounts for those who should not have portal access.

High Blood Pressure Awareness Month in May is a good time to remind our members of the importance of controlling their blood pressure to help prevent heart disease and stroke.

To help you support your patients with hypertension control, the Centers for Disease Control and Prevention (CDC) offers the following resources and materials: Resources for Health Care Professionals toolkit, a Healthy Lifestyle Goals Calendar that provides healthy recipes and fun options to get patients moving, and implementing a Self-Measured Blood Pressure Monitoring With Clinical Support Program. This program is a cost-effective way to help increase medication adherence and lower blood pressure. To help close gaps in care, we ask you to:

• Consider modifying the treatment plan if the patient is hypertensive during the visit.
• Review diet, medications, exercise regimen, and treatment adherence with the patient at each visit.
• Partner with patients to help identify any barriers to effective blood pressure management.
• Connect patients with care coordinators or other practice staff.
• Encourage patients to use mail-order pharmacy services to save on the cost of medications.

If a member needs coaching on self-care, consider referring them to our Complex Case Management program. For more information and/or for your referrals, call our Care Management department at 800-447-0768, Monday through Friday, 9 a.m. to 5 p.m.

During National Osteoporosis Awareness and Prevention Month in May, be sure to assess women 67 to 85 years of age who suffered a fracture and who had either a bone mineral density (BMD) test or a prescription for a drug to treat osteoporosis in the six months after the fracture. Osteoporosis Management in Women who had a Fracture (OMW) is a HEDIS^® star measure. Here are some tips to help close gaps in care:

• Ask all female patients 67 to 85 years of age if they’ve had a fracture since their last visit.
• Consider writing a prescription for osteoporosis medication at time of fracture.
• If patients are unable or unwilling to have a BMD test, prescribe osteoporosis medications, if appropriate.
• Place a reminder in the patient’s chart for a BMD test.
• Partner with your EmblemHealth or ConnectiCare relationship manager to offer in-home BMD screening assessments.
• Use telehealth visits to review, document, and prescribe medication, when appropriate.
• Educate patients on safety and fall prevention.

EmblemHealth and our partner Pulse8™ look to our primary care providers to maintain accurate medical record documentation and claims coding to capture the complete health status of each New York State of Health (NYSOH) Marketplace, Medicare HMO, and Medicaid member. EmblemHealth’s risk adjustment program is designed to help our PCPs identify members with chronic conditions who require an annual evaluation. The program also supports correct coding and documentation of the condition’s determined severity. EmblemHealth needs evidence of ongoing care to support accurate reimbursement from government programs. As a bonus, PCPs who also complete a compliant Provider Alert and provide the supportive progress note(s) in Pulse8’s Collabor8 Provider Portal can receive additional reimbursement.

The 2022 EmblemHealth Risk Adjustment Program for Primary Care Practitioners (PCPs) runs from Jan. 1, 2022 through Dec. 31, 2022.

Pulse8 offers a series of free, 60-minute monthly webinars. Each session is followed by a question-and answer period. We encourage you and your staff to take advantage of this educational opportunity. You may register for Pulse8’s monthly webinars through the secure provider portal or on our website’s Learning Online Pulse8 page.

These Pulse8 webinars are generally held on Tuesdays and Thursdays at 8:30 a.m. and 12:30 p.m. Here are the April and May topics:

• April 26 & 28 – Breaking Down the Specifics of Coding for Orthopedic Conditions
• May 24 & 26 – Transmitting Updates for Coding Related to Neurologic Conditions, Chronic Pain, and Mental Health

Collabor8™ Provider Portal

PCPs can access Pulse8’s Collabor8 Provider Portal via the EmblemHealth provider portal. Collabor8 is a web-based tool that supports improvements in documentation, quality, and risk score accuracy. Here is what one of our valued network providers says about the Pulse8/Collabor8 program:

“The Collabor8 portal is super easy to use. Its simple and straightforward functionality requires very little time to train staff. The diagnosis codes and conditions for consideration are clear. Providing both the ICD-10 code and description of the condition category allows for quick review of patient records and query to provider, if needed. The PDF format for submission of supporting documents is convenient and simple. The interface uploads each PDF in a snap and without fail. It is very impressive as many other portals struggle with this functionality.”

If you are interested in learning more about how you can access Pulse8’s provider resources and webinars, contact Pulse8’s Customer Support team Monday through Friday, 8 a.m. to 8 p.m. at 844-8PULSE8 (844-878-5738) or email to support@pulse8.com.