1. RHODY HEALTH OPTIONS (RHO) IMPLEMENTATION
Nursing Homes Wave 1 and 2
October 18, 2013

2. Rhody Health Options (RHO) Agenda
Implementation Timelines
How to determine eligibility
Case Management
Claims Submission and Payment
Ongoing communication
Q&A
Mack

3. Implementation Timelines
Enrollment Waves 1 and 2
Wave 1 letters sent 9/1 effective 11/1
Wave 2 letters sent 10/1 effective 12/1
NHPRI received 11/1 enrollment file on 10/12
Total 3489 members; 568 in nursing homes
ID cards will be mailed by 10/25

4. Eligibility Several ways to check eligibility:
DHS website=
Navinet =
Call NHPRI Member Services at
CHCs are the core of our network, majority of our board
This gives us great perspective on community concerns
We also have nearly every doctor throughout RI
When we take on new populations, we work with members to get any exceptions into our network

5. Case Management Collaboration
Neighborhood to send each facility a monthly roster of members
Neighborhood to obtain copies of recent MDS forms, review for discharge opportunities, and consult with nursing home staff
Identified Lead Care Manager contacts:
Lea Doiron
Paula Giroud
Utilization Department
20 years of doing this work
Very good at what we do
One of top in country every year
Members love us
A couple years ago we were rated the best in the nation at Customer Service

6. Case Management Role LTSS Waiver application assistance
Develop and monitor individualized Plan of Care
Collaborate to assess for safe discharge plan to the community when appropriate
Participate in discharge planning meetings with members and caregivers
Facilitate referrals to community services to ensure safe transition plan
Follow member, post discharge, to ensure needs continue to be met in the community
20 years of doing this work
Very good at what we do
One of top in country every year
Members love us
A couple years ago we were rated the best in the nation at Customer Service

7. Nursing Home Requirements
Reconcile monthly admissions roster
Provide access for case managers to meet member and review medical record, including MDS
Provide supportive clinical information for those receiving skilled services
Collaborate in identification of those with potential discharge plan
Collaborate in ensuring a safe transition to the community when applicable

8. Claims Submission
If you have not already done so, contact your software vendor to obtain their established clearinghouse connections.
Neighborhood presently trades with these clearinghouses:
Emdeon – Professional & Institutional claims
Navicure – Professional claims
Relay Health – Professional & Institutional claims
SSI Group – Professional & Institutional claims
Viatrack – Professional claims
Contact Mary Harnedy at (401)

9. Claims Submission Patient share Timing of claims payments
Claims testing- to begin 10/25/13; test claims may be forwarded; feed back on results provided to ensure clean claim submission

10. Ongoing Communications
RHO detail on the web by end of month
Provider Manual posted on web by month end
updates-via distribution list
Nursing Home workgroup biweekly meetings
State updates on this Integrated Care Initiative (ICI) project can be found at:
20 years of doing this work
Very good at what we do
One of top in country every year
Members love us
A couple years ago we were rated the best in the nation at Customer Service

11. Contacts at Neighborhood
Medical Management
Michelle Lupoli, Director of Medical Management,
Kathy Ullrich, Manager of Care Management, Duals
Claims Production
Meghan Ruane, Director of Operations,
Provider Engagement and Contracting
Pat Huschle, Director of Provider Engagement and Contracting,
Maureen Brousseau, Manager of Ancillary Network,
Paula Lea, Contract Consultant,
Production Support & EDI
• Mary Harnedy, Specialist,

12. Questions?