Welcome to Provider's Corner! This section of our website is customized to meet your needs and will include useful tips and ideas for practices and procedures you need to complete for NCQA, Buckeye and Ohio Department of Medicaid requirements. The intent is to create an easy-to-use, one-stop shop with helpful specifics around Quality measures, such as HEDIS, CAHPS and clinical processes you can use to meet the criteria for these requirements. Be sure to bookmark this page to make it easy to return when you need to reference content. We hope you find this helpful and are open to topics you’d like discussed on the site.

Provider Appointment Standards for Scheduling

Under Buckeye Health Plan’s contract, providers are to maintain sufficient facilities and personnel to provide covered physician services and ensure that such services are available, as needed, up to 24 hours a day, 365 days a year. Each participating provider will offer hours of operation that are no less than the hours of operation offered to commercial members or comparable to Medicaid fee-for-service if the provider serves only Medicaid members.

To ensure our members receive services for medical and behavioral health appointments in a timely manner, we ask our providers to implement the Appointment Availability Standards for their offices around emergencies, urgent care, routine, sick care and non-life-threatening psychiatric emergencies in accordance with their provider type.

After Hours – (Passing Standards)

• Answering service or system that will page physician. 
• Answering system with option to page physician.
• Advice nurse with access to physician.
• Answering service that will page the provider after a message is left.

You will find additional details in the Provider Manuals located on the website.

Please review the Provider Appointment Standards for Scheduling by line of business.

• Medicaid Appointment Access Standards (PDF)
• Medicare Appointment Access Standards (PDF)
• Marketplace Appointment Access Standards (PDF)

Colorectal Cancer Awareness

Did you know?

According to the American Cancer Society, the lifetime risk of developing colorectal cancer is about 1 in 23 for men and 1 in 25 for women. Early stages of colorectal cancer typically present no symptoms. However, many of these cancers can be prevented through regular screening. When treated at its earliest stage, colorectal cancer can have a 90% survival rate after five years. Adults 45 – 75 should be screened for colorectal cancer.

Key Tips:

• Educate members on the importance of colorectal cancer screenings for early detection and the complete screening options available.
• Talk with patients about using home kits for colorectal cancer screening as an option.
• Educate patients on proper sample collection when distributing testing kits.
• Complete and document all screenings for patients, including date of service.
• Help patients schedule colonoscopy screening appointments.

When ordering home test kits, make Cologuard by Exact Science your preferred test of choice, benefits include:

• Detects 11 biomarkers.
• Recommended testing interval is every 3 years compared to other stool tests.
• Easy testing instructions for patients with a 24/7 patient navigation program.
• Completed test kits can be picked up at member home or taken to UPS store at no cost.

For more information, visit Cologuard.

Colorectal Cancer Screening (COL-E) Measure Flyer

Heart and Nutrition

Do your patients know how to keep their heart healthy? 

February is American Heart Month, and it is dedicated to raise awareness and encourage small heart healthy steps to protect from cardiovascular disease. The heart is a vital organ that keeps the body functioning, and many people may not know that their daily habits and lifestyle can overwork and damage their hearts. Annual Preventative visits are an important aspect of planning for disease management and caring for Buckeye Medicare, Medicaid, and Ambetter members.  These visits are a catalyst to closing gaps in care (i.e., blood pressure, diabetes, cancer screenings), addressing social determinants of health needs, and getting members scheduled and/or referred for required screenings.

PHARMACY CORNER

Did you know?

The ABCDs of Medications for High Blood Pressure

• ACE-Inhibitors or ARBs
• Beta Blockers
• Calcium Channel Blockers
• Diuretics

Medication and Genetics

• ACE-Inhibitors and ARBs may not have clinically significant benefit for African American/Black patients as single drug therapy.
• Use in combination with a Calcium Channel Blocker or a Thiazide Diuretic is clinically effective in black patients with no data showing an increase or decrease in heart health.

First line treatment as single drug therapy for African American/Black patients is Calcium Channel Blockers or Thiazide Diuretics***