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Receiving your 2015 PAFs/HQPAFs
 

May 2015

 

Welcome to the Patient Assessment Form (PAF) and the Healthcare Quality Patient Assessment Form (HQPAF) Programs for 2015. We thank and appreciate all returning provider offices - and welcome all new provider offices - to the program.

A comprehensive health assessment is one of the best ways for older adults to manage their health. Seeing a physician or certified health care practitioner on an annual basis helps close gaps in care and promotes early detection and management of chronic illnesses. Claims data indicates that only a small percentage of Medicare Advantage members currently receive this type of visit.

An annual wellness visit and the recommended preventative services can close up to 25 HEDIS/Star Ratings measures. The annual wellness visit and recommended preventive services can often catch health problems early when they may be easier and less expensive to treat. All Medicare Advantage members should receive a free annual wellness visit, with no out-of-pocket costs, that includes a schedule of recommended preventive services.

Twenty five clinical and medication adherence quality measures can be addressed when a member completes an annual wellness visit and the recommended preventative services. Targeted HEDIS/Star Ratings Measures*

C01 – Breast Cancer Screening C16 – Diabetes, Kidney Disease
C02 – Colorectal Cancer Screening C17 – Diabetes, Blood Sugar
C03 – Cardiovascular, Cholesterol Screen C18 – Diabetes, Cholesterol
C04 – Diabetes, Cholesterol Screen C19 – Controlling Blood Pressure
C05 – Glaucoma Testing C20 – Rheumatoid Arthritis
C07 – Physical Health C21 – Improving Bladder Control
C08 – Mental Health C22 – Reducing the Risk of Falling
C09 – Monitoring Physical Activity C24 – Getting Needed Care
C10 – Adult BMI Assessment C25 – Getting Appointments and Care Quickly
C11 – Special Needs Plan, Medication Review D15 – Diabetes Treatment
C12 – Special Needs Plan, Functional Assessment D16 – Medication Adherence, Diabetes
12 – Special Needs Plan, Functional Assessment D16 – Medication Adherence, Diabetes
C13 – Special Needs Plan, Pain Screening D17 – Medication Adherence, Hypertension
  D18 – Medication Adherence, Cholesterol

* The Centers of Medicare & Medicaid Services (CMS) can change the measures and methodology as part of the Star Ratings program. The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by health plans to measure performance on important dimensions of care and services. For additional information as well as publications and products available for HEDIS, please visit the National Committee for Quality Assurance (NCQA) website at ncqa.org.

Optum wants to encourage and support your success with the HQPAF/PAF program. Talk to your local Optum Healthcare Advocate for additional tools on the PAF and HQPAF program. This includes the HQPAF Provider Instructions and the HQPAF Provider brochure.

For questions, please contact the Optum Provider Support Center at 1-877-751-9207, or contact your local Healthcare Advocate.

 

 

Did you know...

Your Healthcare Advocate can provide you with tools that may help you accurately complete and submit your PAFs/HQPAFs. Ask for your copies today.

SFTP Submission Instructions

HQPAF Provider Instructions

Preventive Medicine Assessment with Personalized Health Plan and Screening Schedule

Annual Screening and Evaluation of Chronic Conditions

Understanding & Coding Medicare Preventive Services

PAF Provider Instructions - Medicaid version

For more information, please contact your local Optum Healthcare Advocate.

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