Covid-19 Vaccine
When do we code the UAS Covid-19 Vaccine item Yes?
If your Member has been “Fully Vaccinated” between December 1st, 2020, and Now: “Yes” is the correct UAS response. Return
When do we code the UAS Dental Exam item- Yes?
If your Member has had an In-person or Telehealth Dental Exam within 365 days, then “Yes” is the correct UAS response.
Is Potentially Avoidable Hospitalization (PAH)* a Quality Incentive Measure?
Yes, the 2023 MLTC Quality Incentive includes 1 efficiency measure: Potentially Avoidable Hospitalization (PAH).
Which Preventative Care Items are included in the 2023 Quality Incentive Measures?
1. Dental Exam 2. Covid-19 Vaccination 3. influenza Vaccination 4. Pneumococcal Vaccination.
What is Claims Data?
A bill submitted for payment, sent to the health insurer (Fidelis care) from a medical provider for services rendered to our Members.
What does Fully Vaccinated Mean?
“Fully Vaccinated” refers to our Members who have completed their Covid-19 Vaccine Primary Series
What is a Dental Exam and why is it important?
A Dental exam is a checkup of your teeth and gums. These exams are important for protecting oral health. Oral health problems can become serious and painful if not treated promptly.
What is a Potentially Avoidable Hospitalization (PAH)?
An inpatient hospitalization that might have been avoided if proper outpatient care was received in a timely fashion.
What are Yes/No Inconsistencies in our Preventative Care Items(2023 QIM)?
The Yes/No Inconsistencies occur when we select “No” but the response is “Yes” as indicated by our UAS comments containing the date(s) the Preventative Care was received and the date(s) is within the look-back period.
What is the correct response to the Preventative Care Items when Claims Data is available in Lenavi?
When Claims Data is available, the correct response to the UAS Preventative Care item is “YES”.
What is Covid-19 Vaccine “Up to date”?
If your Member is “Up to date” That means that he/she has completed their Covid-19 Vaccine Primary Series. 1 dose of the Janssen COVID-19 Vaccine= (Fully Vaccinated) or 2 doses of the Moderna, Pfizer, AstraZeneca, or Novavax COVID-19 Vaccine= (Fully Vaccinated)
And 1 or 2 Covid-19 boosters *If Member has completed their primary series—but is not yet eligible for a booster—he/she is also considered up to date. *
Who should get a Dental exam?
Most children and adults should get a dental exam. This includes individuals who are denture wearers/edentulous as receiving a routine Dental exam can address ill-fitting dentures as well as detect Oropharyngeal cancers and/or other diseases.
Which six conditions are classified as a Potentially Avoidable Hospitalization (PAH)?
The hospitalization is identified as potentially avoidable if the primary diagnosis is any one of the following conditions: 1. Anemia 2. Electrolyte imbalance 3. Heart failure 4. Respiratory infection 5. Sepsis 6. Urinary tract infection
What are the consequences of the Yes/No Inconsistencies identified in our UAS Assessments -Section L Prevention (linked to the 2023 Quality Incentive Measures)?
Answer 1: The Yes/No Inconsistencies constitute missed opportunities to accurately reflect how well we are caring for our Members. Answer 2: We as a plan, will not receive the economic incentives linked to the Quality Incentive Measures which constitutes another missed opportunity. The economic incentives allow Fidelis to implement/expand programs and services designed to promote improved health outcomes for our Members.
Where can I locate the Claims Data in Lenavi?
On the Prevention tab within the Progress Report and in the Lenavi Preventative Measure History Report.
Why is the UAS Answer to the Covid-19 question Yes, if Member up to date?
In-order for your Member to receive a booster he/she must first be “Fully Vaccinated”. This means that our Boosted Members (up to date) are to be coded as “Yes” for the UAS Covid-19 Vaccine item.
What are the two ways our Members can get their Dental Exam?
In-person at a Dental office or Dental Telehealth.
What is the lookback period for Hospitalizations, (Inpatient Acute Hospital with Overnight Stay)?
In the last 90 days (or since the last assessment, if the person was assessed less than 90 days ago).
Question: What are the other Preventative Care Measures that are not included in the 2023 QIM, but are as important to our Members’ health and well-being?
1.Colonoscopy test in LAST 5 YEARS 2. Eye exam in LAST YEAR 3. Hearing exam in LAST 2 YEARS 4.Mammogram or breast exam in LAST 2 YEARS(for women ages 50 - 74)
Where can I view the Claims Data?
Within the Prevention tab in the Lenavi Progress Report and in the Lenavi Preventative Measure History Report.
Does 1 dose of the Janssen COVID-19 Vaccine mean Member is Fully Vaccinated?
Yes, 1 dose of the Janssen COVID-19 Vaccine means Member is Fully Vaccinated.
How to contact Dentaquest to find a Dentist and set up an appointment
Contact DentaQuest via Member Services- Phone Number 1-800-516-9615 or Contact Dentaquest via Link: https://dentaquest.com/contact-us/
What are the main components to consider when completing the UAS PAH & Inpatient Acute Hospital with Overnight Stay item?
1.Confirming the hospitalization occurred within the Last 90 Days(or since Last Assessment if Less Than 90 Days Ago) 2.Confirming that the hospitalization was not already captured in a previous UAS 3.Confirming and selecting the correct Diagnosis(es). Up to 4 may be selected
How can we promote greater accuracy when completing Preventative Care in UAS Section L: Treatments and Procedures?
Click “Update Comments” Tab for a side-by-side view of UAS selections and comments to promote accuracy and consistency.
What is the NPI # (National Provider Identifier)?
The NPI is a unique identification number for covered health care providers.