December 2015

The holiday season is approaching and with this, 2015 is coming to an end. This is the perfect opportunity to review your PAF/HQPAF program, and complete the program successfully in 2015. Please be sure to follow any prior notices you received from Optum about the PAF/HQPAF prioritization guidelines set by our health plan clients. Your Healthcare Advocate can assist your office as you wrap up 2015.

Here are some helpful tips to consider as the 2015 PAF/HQPAF program comes to a close:

• Review the list of your PAF/HQPAF members and determine who still needs to be seen before the end of the year. For those members that have yet to be seen, make sure each patient has an office visit scheduled before December 31, 2015.
• Identify those members that have been seen within the date range listed at top of their form and complete the PAF/HQPAF. Make sure to submit the PAF/HQPAF along with all pages of the progress notes from the patient visit, including results, referrals and any applicable exclusions.
• Reach out to your Optum Healthcare Advocate to make sure all of your PAFs/HQPAFs have been received and not in a rejected status. Your Healthcare Advocate can run a report that lists the current status of every PAF/HQPAF that is generated. Occasionally there are submitted forms that have errors or missing information. Your Healthcare Advocate can identify those forms and let you know what corrections need to be made so you can resubmit and when applicable, receive the administrative reimbursement for your hard work.
• If you have not started on the 2015 PAF/HQPAF program, please reach out to your Healthcare Advocate. They can answer any questions you might have and work with you to incorporate the PAF/HQPAF into your current patient flow. Your Healthcare Advocate is a vital resource that will ensure the PAF/HQPAF program is a success in your practice.

Managing chronic conditions with the PAF/HQPAF

As a reminder, the HQPAF program is a great way to manage Medicare Advantage members and insure they are getting the care they need to manage their chronic conditions and stay on top of their preventive screenings. Your Healthcare Advocate can provide you with useful tools and reports to assist you with these members and their chronic conditions.  Every day, we shape how health care is managed, and how information and technology drives improvements in the system. Optum works with our clients and partners to improve the delivery, quality and cost effectiveness of health care in ways that support and empower more patient-centered, value driven care. For updates on enhancements being made to the 2016 HQPAF programs, please visit the Optum HQPAF Provider Website:

Optum.com/hqpaf

These changes will cover updates for all 2016 program forms and include ICD-10 condition suspects, clinical alerts, and a change to reimbursement rules requiring the timely return.

If you have any questions about the PAF or HQPAF programs, please contact your local Optum Healthcare Advocate or the Optum Provider Support Center between 6:30 a.m.–4:30 p.m. PST, Monday–Friday, at 1-877-751-9207 or email us here.

Thank you again for your participation in the Optum Patient Assessment Form (PAF) and the Healthcare Quality Patient Assessment Form (HQPAF) programs.

As of January 1, 2016, all providers that qualify for HQPAF/PAF administrative reimbursement must receive their reimbursement via direct deposit. In 2016, administrative reimbursement will be completely paperless and checks will no longer be available. To ensure that you do not experience delays in 2016 payments, please visit optum.com/EL or contact Electronic Payments & Statements (EPS) directly at 1-877-620-6194 to enroll.

Remember, all PAF/HQPAF submissions must be sent via traceable carrier (any commercial carrier with traceable delivery) to the following address:

Effective 1/1/2016, mail will no longer be picked up from the old address in Franklin, TN. Any mail delivered to the Franklin, TN address will not be received by Optum. Additionally be sure to note that the address change in 2016 will change to:

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.

For additional information about the Medicare Advantage Five-Star Quality Rating System, please refer to: http://go.cms.gov/partcanddstarratings