Select News: May 2017
Maternity online authorizations
Attention OB/GYNs: You can submit prior authorization requests online. Select Health of South Carolina (Select Health) has developed an online authorization submission process through NaviNet to help streamline your administrative processes. Submit requests online to:
- Improve turnaround time for maternity authorizations.
- Streamline data entry to improve data accuracy.
- Improve risk stratification accuracy, which leads to better assessment of needs and program resources.
- Assist in early identification of high-risk pregnancies for care management.
- Create the maternity authorization used for payment of prenatal services within 24 hours.
You can also use the online prior authorization portal to be reimbursed for completion of the pregnancy risk assessment. Register with NaviNet to access the prior authorization portal; a separate sign on is not required. Click on the Pre-Authorization Management link to access the prior authorization system. To learn more about how to use this valuable tool, contact your Provider Network account executive.
Effective May 15, 2017: Generic buprenorphine/naloxone and generic buprenorphine, used in the treatment of opioid withdrawal, no longer require prior authorization and will process at the point-of-sale at participating pharmacies. For branded opioid withdrawal treatment products, such as Suboxone® and Subutex, you must submit a prior authorization request stating the MedWatch form has been completed. The MedWatch form is available online on the Food and Drug Administration website. (PDF) For Zubsolv® (buprenorphine/naloxone without an A-rated generic form), you must submit a non-preferred medication prior authorization request. For details, call PerformRx℠ Pharmacy Services at 1‑866‑610‑2773.
Please visit our website for up to-date pharmacy information, including changes approved by the Pharmacy and Therapeutics Committee, and:
- Preferred drug list (PDL) updates.
- Drug recalls.
- Pharmaceutical management procedure updates.
- New criteria and procedures for submitting a prior authorization.
- Pharmacy benefit restrictions or limitations.
Reminder: Select Health offers two plans
Select Health offers the First Choice health plan, a Medicaid managed care plan that serves more than 330,000 Medicaid members in South Carolina and bordering states. We also offer First Choice VIP Care Plus, a Healthy Connections Prime Medicare-Medicaid plan that provides coverage to seniors age 65 or older who have both Medicare and Healthy Connections Medicaid.
Providers submit claims to Select Health for both plans, but each have specific procedures you must follow. For more information on the First Choice plan, visit www.selecthealthofsc.com. For more on the First Choice VIP Care Plus plan, go to www.firstchoicevipcareplus.com.
We can help: Just "Let Us Know"
If we can help support the care of your patients, our members, who have a chronic disease (such as asthma, diabetes, or coronary artery disease) through education on prevention, lifestyle choices, and adherence to treatment plans, please "Let Us Know"!
Our Let Us Know program helps engage chronically ill members in their health care. We have support teams and tools to help identify, outreach to, and educate our members, as well as clinical resources for care management.
- Contact our Rapid Response and Outreach Team at 1‑866‑899‑5406 to address urgent needs. The Rapid Response and Outreach Team connects with members to verify, schedule or reschedule appointments, and make sure they have transportation.
- Request outreach with the member intervention request form (PDF).
- Use the NaviNet Care Gap worksheet to get pop-up alerts to flag members at risk due to missing or overdue preventive services, or under-utilization or absence of disease-specific controller medications.
Change Health Care (formerly Emdeon) services
Change Health Care (formerly Emdeon) is the clearinghouse for Select Health’s electronic claims transactions. They provide other services in partnership with Select Health, including:
- Electronic funds transfer (EFT) for direct deposit of your claims payments.
- Electronic remittance advice (ERA) for posting of your payments into your practice management or accounting system.
- Direct claims entry for claims submission by small to medium practices that do not submit large volumes of claims.
EFT and direct claims entry are available to Select Health providers at no cost. Contact your Provider Network account executive.
Member rights and responsibilities
As a reminder, please review the rights and responsibilities of our First Choice members. These are also available in our Health Care Professional and Provider Manual. Contact your account executive if you have questions.
Provider Network Management account executives
- Upstate Western Region
- Upstate Greenville Region
- Lowcountry Region
- Midlands Region
- Upper Pee Dee Region
- Lower Pee Dee Region
- Lowcountry Border Region
- Ancillary Services statewide