Health Management

CareSource nurses and outreach workers are available to assist your CareSource patients in coordinating appropriate medical and support services. Our focus is on helping our members acquire and maintain effective management of their condition through assessment, coordination of care, education and support. CareSource offers case management support for a variety of conditions including asthma and high-risk pregnancy. 

Health education

CareSource members receive health information through a variety of communication vehicles including easy-to-read newsletters, brochures, fliers, phone calls and personal interaction.

Healthchek exams

Healthchek is Ohio's name for Early Periodic Screening, Diagnosis and Treatment (EPSDT) services. This is a federally required series of exams for Medicaid consumers through age 20. 

All children of these ages who are CareSource members should receive Healthchek exams. The program is designed to provide comprehensive preventive health care services at regular intervals. Healthchek stresses health education to children and their caretakers in the areas of health maintenance, early intervention, and systematic treatment of problems. 

Healthchek components

The Healthchek exam is a general health assessment and includes the following components:

• Comprehensive health and development history
• Comprehensive unclothed physical examination
• Nutritional assessment
• Developmental assessment
• Vision and eye assessment at each exam and referral to optometrist or ophthalmologist if needed
• Hearing assessment at each exam
• Dental assessment and referral to a dentist, as indicated
• Laboratory tests including lead screening appropriate for age and risk factors
• Assessment of immunization status and administration of required vaccines
• Health education, including anticipatory guidance

To assist with documentation of all exam components, CareSource offers a Healthchek Checklist to complete and include in the member's medical record.

Exam frequency

The recommended schedule for Healthchek exams is as follows:

• Birth
• 1 month
• 2 months
• 4 months
• 6 months
• 9 months
• 12 months
• 15 months
• 18 months
• 24 months
• Annually from ages 3 through 20

Healthchek codes

Exams should be coded on claim forms using CPT codes 99381 through 99395, whichever is applicable, as indicated in the following chart. Correct codes are required for timely and accurate claims payment and documentation of services provided.

New Patient/Initial Exam

Established Patient/Periodic Exam

Please use these codes along with appropriate ICD-9 diagnosis codes (V20.2, V70.0, V70.3, V70.5, V70.6, V70.8, V70.9). We encourage you to conduct Healthchek exams at the time of acute-care visits. When doing so, please submit the next-higher level E&M CPT code and the appropriate Healthchek ICD-9 code as the secondary diagnosis.

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CareSource Disease Management Program

CareSource members with chronic conditions, including asthma and diabetes, will be automatically enrolled into CareSource’s enhanced disease management program.

Benefits to Members

Members enrolled in the program will receive free information to help them better manage their asthma or diabetes. Information sent to members will include care options for them to discuss with their provider.

Members identified as high risk will have a nurse assigned to their case to help educate, coordinate and provide resources and tools to help the member reach their health care goals.

How to Refer Members

If you have a CareSource patient with asthma or diabetes who you believe would benefit from this program and is not already enrolled, phone 1-888-882-3614.

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Lead screening

The Ohio Medicaid program requires that children receive a blood lead level test at 1 and 2 years of age. This is a required part of the Healthchek exam provided at these ages. Filter-paper testing is an accepted method for obtaining blood lead levels and is approved by the Ohio Department of Health (ODH). It is available to you at no cost.

Both lead levels and hemoglobin can be tested with one blood sample. The filter-paper method offers fast, quantitative results from three drops of blood obtained through a finger stick capillary puncture. It is a less invasive method of sample collection that can be performed conveniently in a physician's office. Please bill CareSource for the capillary stick with CPT code 36416.

Supplies and instructions are provided by MedTox, the lab that processes the results. Supplies are provided at no charge and lab results are delivered within 24-48 hours of receipt. Lead levels that exceed 10 ug/dL with this sampling method are recommended for retesting by a follow-up capillary or venous puncture according to ODH guidelines.

For more information, please call MedTox at 1-877-628-7274 or contact your local CareSource Provider Relations Representative.

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Immunizations

Immunizations are an important part of preventive care for children and should be administered during Healthchek exams, as needed. 

CareSource endorses the same recommended Childhood Immunization Schedule that is approved by the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP). This schedule is updated annually. 

Vaccines for children

The federal Vaccines for Children (VFC) program makes designated vaccines available at no cost to health care providers to administer to children 18 and younger who are enrolled in Medicaid. CareSource members are eligible for these vaccines. 

VFC vaccines are available through the Ohio Department of Health (ODH). Please bill CareSource with the appropriate CPT and ICD-9 vaccination codes for the immunization being administered. CareSource will pay for administration of the vaccine only. Billing with the vaccine codes will help ensure that you are reimbursed properly for administration of the correct vaccine. 

For more information about the VFC program and how to obtain vaccines in Ohio, please contact:

Immunization Program
Ohio Department of Health
246 N. High St.
PO Box 118
Columbus, OH 43213-0118
Phone: 1-800-282-0546 or (614) 466-4643
Ask to speak with the VFC representative for your county
E-mail: Immunize@gw.odh.state.oh.us

Immunization codes

Please bill CareSource with the following CPT and ICD-9 vaccination codes to receive reimbursement for administration of the vaccine.

*Indicates evidence of disease. A member who has evidence of disease during the numerator event time is compliant for the antigen.
**The two-dose hepatitis B antigen Recombivax is recommended for children between 11 and 14 years of age only.

Statewide web-based immunization registry

CareSource encourages all participating health care providers to take advantage of the statewide web-based immunization registry called IMPACT SIIS. The registry consolidates immunizations from multiple Providers into one central record and provides reliable immunization history that is electronically accessible from multiple health care practice sites. It also facilitates the introduction of new vaccine protocols and sends immunization reminder/recall notices automatically.

The system is designed to save time and money, reduce paperwork, and provide quick and efficient tracking of immunizations. It also streamlines inventory reporting required by the VFC program.

If you are located in Franklin County, please contact Project LOVE for more information at (614) 645-1478. In other areas of the state, please call the Ohio Department of Health (ODH) at 1-800-282-0546.

Asthma

CareSource has a comprehensive asthma management program for members, and we offer a variety of tools to help health care providers coordinate care. Our program includes the following elements:

• The National Asthma Education and Prevention Program (NAEPP) practice guidelines. CareSource endorses these standards. The full manual of guidelines is available from the National Heart, Lung and Blood Institute.
• Asthma Patient Action Plan forms for members and their physicians to complete together. These help ensure patients understand your recommended treatment plan and promote patient self-care management.
• Case management services focused on member health assessment, coordination of care, education and support.  

Please contact us if you have asthmatic CareSource patients who could benefit from these services. Just call 1-800-488-0134 and follow the menu prompts to speak to someone in case management. We appreciate your active participation in the development of treatment plans.

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Care Transitions Programs

Our Care Transitions programs are designed to positively impact health outcomes by:

• Contacting patients discharged from inpatient admissions, helping them with their care treatment plan
• Decreasing inappropriate emergency department utilization and unnecessary admissions/readmissions
• Helping members with medication adherence
• Assisting with establishing a medical home between patients and providers

Visit our Network Notification for program description and additional member benefits.

Refer a Member

For questions or to refer a member, please call 1-866-867-0421.

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Smoking cessation

The Ohio Tobacco Quitline is a free phone service that can help Ohioans quit smoking. CareSource has teamed up with the Quitline to offer eligible members a stop-smoking patch that can be mailed to their home without a prescription when they call the quitline at 1-800-QUIT-NOW (1-800-784-8669).

When Members call, they receive:

• Free support and service from an experienced quit specialist
• A personalized quit plan and self-help materials
• Information about medicines that can help them quit

A free four-week supply of a stop-smoking patch is available. If members continue counseling through the line, they can get a four-week refill. Members are asked to have their CareSource member ID number available when they call.

Quitline callers are five times more likely to succeed than those who try to quit on their own. If you have CareSource patients who use tobacco, please let them know about the Quitline and encourage them to call. We appreciate your support.

Smoking intervention includes the 5 A's strategy

There is solid evidence that physician intervention has a positive impact on a patient's efforts to stop smoking. There are several intervention strategies designed to help health care providers cover the bases when talking to patients about smoking habits.

The following 5 A's strategy is adapted from the U.S. Public Health Service clinical practice guideline, "Treating Tobacco Use and Dependence."

1. Ask
2. Advise
3. Assess
4. Assist
5. Arrange

This approach is endorsed by the American College of Obstetricians and Gynecologists (ACOG) for use with pregnant patients during routine prenatal office visits as well. Please discuss smoking cessation with all of your CareSource patients. If you don't have a comprehensive intervention tool, please consider this easy-to-remember approach.