[{"id":4,"versionId":34,"chapterNumber":1,"title":"Accessibility Standards","visible":false,"topics":[{"id":14,"chapterId":4,"unitNumber":1,"timestamp":"1/1/0001","title":"Accessibility Standards","description":"\u003cp\u003eHighmark Wholecare\u0026rsquo;s Medicaid and Medicare Accessibility Standards:\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\u003ca href=\"https://content.highmarkprc.com/Files/Wholecare/Forms/Appointment_AfterHoursStandards.pdf\" target=\"_blank\" rel=\"noopener noreferrer\"\u003eAccessibility Standards\u003c/a\u003e\u003c/li\u003e\n\u003cli\u003e\u003ca href=\"https://content.highmarkprc.com/Files/Wholecare/Forms/BehavioralHealthAccessStandardsDetail.pdf\" target=\"_blank\" rel=\"noopener noreferrer\"\u003eBehavioral Health Accessibility Detail\u003c/a\u003e\u003c/li\u003e\n\u003c/ul\u003e","filename":"","visible":false,"liveStatus":2}],"liveStatus":2},{"id":6,"versionId":34,"chapterNumber":2,"title":"Monitoring Compliance with Accessibility Standards","visible":false,"topics":[{"id":37,"chapterId":6,"unitNumber":2,"timestamp":"1/1/0001","title":"Monitoring Compliance with Accessibility Standards","description":"\u003cp\u003eHighmark Wholecare has contracted with Press Ganey, a National Committee for Quality Assurance (NCQA) certified vendor to conduct annual audits to assess our provider network\u0026rsquo;s ability to provide Highmark Wholecare members with timely access to care.\u003cbr /\u003eThe audit addresses:\u003cbr /\u003e■ Appointment availability based on Highmark Wholecare standards\u003cbr /\u003e■ Access to care 24 hours a day/7 days a week\u003cbr /\u003e■ Wait time in the waiting room\u003cbr /\u003e■ Missed appointment protocol\u003c/p\u003e\n\u003cp\u003eThe audit results are utilized to identify plan strengths and barriers to care, and provides Highmark Wholecare with the opportunity to develop initiatives to improve access.\u003c/p\u003e\n\u003ch3\u003eACCESSIBILITY AUDIT\u003c/h3\u003e\n\u003cp\u003eThe Accessibility audit is conducted annually, typically in the 3rd Quarter of the year.\u003cbr /\u003e■ Press Ganey will contact a random sample of our provider network by phone to complete the audit. Call-center agents will ask series of questions to determine compliance with Highmark Wholecare Accessibility Standards.\u003cbr /\u003e■ The call-center agent will request that the office appointment schedule be reviewed (real-time) to obtain a specific date and time of the office\u0026rsquo;s next available appointment.\u003cbr /\u003e■ Identification of office protocol or instructions provided to members by provider offices may also be included as part of the audit.\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eIMPORTANT AUDIT INFORMATION\u003c/h3\u003e\n\u003cp\u003e■ Providers are contractually obligated to participate in the audit.\u003cbr /\u003e■ Highmark Wholecare will announce the upcoming annual audit via fax blast and provider newsletter\u003cbr /\u003e■ Scheduling staff should be educated on the standards and aware of the audit time frame\u003cbr /\u003e■ The audit is conducted telephonically and will take 5 minutes to complete\u003cbr /\u003e■ Provider offices that are non-compliant with one or more standards will receive a report card identifying each non-compliant standard along with required actions\u003cbr /\u003e\u003cbr /\u003e\u003c/p\u003e\n\u003ch3\u003eWHAT YOU CAN DO TO PREPARE FOR THE AUDIT\u003c/h3\u003e\n\u003cp\u003e■ Key office staff that schedule member appointments should review\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003ca href=\"https://content.highmarkprc.com/Files/Wholecare/Forms/Appointment_AfterHoursStandards.pdf\" target=\"_blank\" rel=\"noopener noreferrer\"\u003eHighmark Wholecare\u0026rsquo;s Practitioner Accessibility Standards.\u003c/a\u003e\u003cbr /\u003e\u003cstrong\u003eImportant:\u003c/strong\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003eEducation of staff responding to the accessibility audit questions is a contributing factor to compliance with the standards.\u003cbr /\u003e■ Complete a Practice Self-Assessment to determine if your practice meets Highmark Wholecare\u0026rsquo;s Access to Care Standards.\u003cbr /\u003e\u003ca href=\"https://content.highmarkprc.com/Files/Wholecare/Forms/PracticeSelfAssessmentTool.pdf\" target=\"_blank\" rel=\"noopener noreferrer\"\u003e\u003cstrong\u003ePractice Self-Assessment Tool\u003c/strong\u003e\u003c/a\u003e: The tool contains the accessibility standards monitored by Highmark Wholecare for both Medicaid and Medicare, the criteria a practice must meet to be compliant with the standards, and identifies questions that may be asked by call-center agents during an Accessibility Audit.\u003c/p\u003e","filename":"","visible":false,"liveStatus":2}],"liveStatus":2},{"id":16,"versionId":34,"chapterNumber":3,"title":"Annual Provider Accessibility Audit Process","visible":false,"topics":[{"id":45,"chapterId":16,"unitNumber":3,"timestamp":"1/1/0001","title":"Annual Provider Accessibility Audit Process","description":"\u003cp\u003e\u003cspan\u003eHighmark Wholecare\u0026rsquo;s Annual Provider Accessibility Audit Process:\u003c/span\u003e\u003cbr /\u003e\u003ca href=\"https://content.highmarkprc.com/Files/Wholecare/Forms/AuditProcess.pdf\" target=\"_blank\" rel=\"noopener noreferrer\"\u003eAnnual Provider Accessibility Audit Process\u003c/a\u003e\u003c/p\u003e","filename":"","visible":false,"liveStatus":2}],"liveStatus":2},{"id":12,"versionId":34,"chapterNumber":4,"title":"Provider Non-Compliance with Standards","visible":false,"topics":[{"id":41,"chapterId":12,"unitNumber":4,"timestamp":"1/1/0001","title":"Provider Non-Compliance with Standards","description":"\u003cdiv class=\"collapseArea opened\" id=\"col5\" role=\"region\" aria-labelledby=\"accHeading5\"\u003e\n\u003cp\u003eProvider offices that are non-compliant with one or more standards will receive a report card identifying each non-compliant standard along with required actions to mitigate non-compliance.\u003cbr /\u003e\u003cstrong\u003eNon-compliant: One (1) year\u003c/strong\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003eProviders that are non-compliant with 1 or more standards based on the results of the annual audit will be:\u003cbr /\u003e1. Required to submit an action plan within 45 days\u003cbr /\u003e2. Required to complete staff training within 45 days\u003cbr /\u003e3. Required to complete a practice self-assessment of compliance within 45 days\u003cbr /\u003e4. Required to attest to the completion of staff training and practice self-assessment within 45 days\u003cbr /\u003e*Office Administrator or Corporate Compliance provides signature on action plan template\u003cbr /\u003e5. Resurveyed in the following years annual audit\u003cbr /\u003e\u003ca href=\"https://content.highmarkprc.com/Files/Wholecare/Forms/NonCompliant1yrAuditResultsNotification.pdf\" target=\"_blank\" rel=\"noopener noreferrer\"\u003eExample of Audit Results Notification Noncompliant 1 Year\u003c/a\u003e\u003cbr /\u003e\u003cbr /\u003e\u003cstrong\u003eNon-Compliant: Two (2) consecutive years\u003c/strong\u003e\u003cbr /\u003eProviders that are non-compliant with 1 or more standards for two consecutive years based on the results of the annual audit and the previous year annual audit will be:\u003cbr /\u003e1. Required to submit an action plan within 45 days\u003cbr /\u003e2. Required to complete staff training within 45 days\u003cbr /\u003e3. Required to complete a practice self-assessment of compliance within 45 days\u003cbr /\u003e4. Required to attest to the completion of staff training and practice self-assessment within 45 days\u003cbr /\u003e*Office Administrator or Corporate Compliance provides signature on action plan template\u003cbr /\u003e5. Additional actions may be required.\u003cbr /\u003e6. Resurveyed in the following years annual audit\u003cbr /\u003e\u003ca href=\"https://content.highmarkprc.com/Files/Wholecare/Forms/NonCompliant2yrAuditResultsNotification.pdf\" target=\"_blank\" rel=\"noopener noreferrer\"\u003e\u0026ldquo;Example of Audit Results Notification Non-compliant 2 Year\u0026rdquo;\u003c/a\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"ghpAccordion\"\u003e\n\u003ch3 class=\"accHeading\" role=\"heading\"\u003e\u003c/h3\u003e\n\u003c/div\u003e","filename":"","visible":false,"liveStatus":2}],"liveStatus":2},{"id":13,"versionId":34,"chapterNumber":5,"title":"Accessibility Compliance Tips","visible":false,"topics":[{"id":42,"chapterId":13,"unitNumber":5,"timestamp":"1/1/0001","title":"Accessibility Compliance Tips","description":"\u003cp\u003e\u003cspan\u003e■ Ensure that you have coverage for vacation or an extended absence by another practitioner or you can refer members to another practice or telemedicine provider. Refer to the Medicaid and Medicare Provider Manuals on our provider website for more information regarding telemedicine.\u003cbr /\u003e\u003c/span\u003e\u003cbr /\u003e\u003cspan\u003e■ Share the accessibility standards and Audit questions with key staff that schedule appointments. Education of staff responding to the audit questions is a contributing factor to compliance with the standards.\u003c/span\u003e\u003c/p\u003e","filename":"","visible":false,"liveStatus":2}],"liveStatus":2},{"id":14,"versionId":34,"chapterNumber":6,"title":"Practice Self Assessment Tool","visible":false,"topics":[{"id":43,"chapterId":14,"unitNumber":6,"timestamp":"1/1/0001","title":"Practice Self Assessment Tool","description":"\u003cp\u003e\u003cspan\u003eHighmark Wholecare\u0026rsquo;s Practice Self-Assessment Tool:\u003c/span\u003e\u003cbr /\u003e\u003ca href=\"https://content.highmarkprc.com/Files/Wholecare/Forms/PracticeSelfAssessmentTool.pdf\" target=\"_blank\" rel=\"noopener noreferrer\"\u003ePractice Self-Assessment Tool\u003c/a\u003e\u003c/p\u003e","filename":"","visible":false,"liveStatus":2}],"liveStatus":2},{"id":15,"versionId":34,"chapterNumber":7,"title":"Frequently Asked Questions (FAQs)","visible":false,"topics":[{"id":44,"chapterId":15,"unitNumber":7,"timestamp":"1/1/0001","title":"Frequently Asked Questions (FAQs)","description":"\u003cp\u003e\u003ca href=\"https://content.highmarkprc.com/Files/Wholecare/Forms/AccessFAQ.pdf\" target=\"_blank\" rel=\"noopener noreferrer\"\u003eFrequently Asked Questions (FAQs)\u003c/a\u003e\u003c/p\u003e","filename":"","visible":false,"liveStatus":2}],"liveStatus":2},{"id":21,"versionId":34,"chapterNumber":8,"title":"PROVIDER ACCESS CORRECTIVE ACTION PLAN (CAP) -ONLINE SUBMISSION FORM","visible":false,"topics":[{"id":50,"chapterId":21,"unitNumber":0,"timestamp":"1/1/0001","title":"Corrective Action Plan (CAP)","description":"\u003cp\u003eThank you for choosing to complete your Provider Access Corrective Action Plan (CAP) online. Your practice site should have received a Provider Report Card. This Report Card outlines your Provider Access Audit Results and what standards your site has failed that require a CAP. Please follow the below steps to complete the CAP form.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Click\u0026nbsp;\u003ca href=\"https://content.highmarkprc.com/Files/Wholecare/Forms/CAPSubmissionFormInfo.pdf\" target=\"_blank\" rel=\"noopener noreferrer\"\u003ehere\u003c/a\u003e to see what is needed to complete the online submission form.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Click \u003ca href=\"https://wholecare.highmarkprc.com/Provider-Resources/CAP-Form\"\u003ehere\u003c/a\u003e to complete the CAP form.\u003c/p\u003e","filename":"","visible":false,"liveStatus":2}],"liveStatus":2},{"id":22,"versionId":34,"chapterNumber":9,"title":"Behavioral Health Educational Tools","visible":false,"topics":[{"id":51,"chapterId":22,"unitNumber":0,"timestamp":"1/1/0001","title":"Behavioral Health Educational Tools","description":"\u003cp\u003e\u003ca href=\"https://youtu.be/iR1ePDyt-4M\" target=\"_blank\" rel=\"noopener noreferrer\"\u003eBehavioral Health Provider Access Education Recording\u003c/a\u003e\u0026nbsp;- YouTube Video\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003ca href=\"https://content.highmarkprc.com/Files/Wholecare/docs/BH_ProviderAccessEd.pdf\"\u003eBehavioral Health Provider Access Education\u003c/a\u003e\u0026nbsp;- PDF\u003c/p\u003e","filename":"https://youtu.be/iR1ePDyt-4M","visible":false,"liveStatus":2}],"liveStatus":2}]