Welcome
Welcome to the Provider Information area at CUP. We take pride in developing effective
communication to support you in taking care of our members.
PHARMACY PRIOR AUTHORIZATION CHANGES: Effective August 1, 2008,
the Southwest Washington Medical Center (SWMC) Pharmacy staff will administer CUP's
pharmacy prior authorization process. For prescriptions that require PA's during
normal business hours, please call SWMC Pharmacy Benefits at (360) 514-7077 to initiate
the prescription request. You do not need to fax the CUP Medication Request Form.
If you have questions or would like to discuss alternatives, please contact SWMC
Pharmacy Benefits at (360) 514-7077. For additional information, go to http://www.cuphealth.com/docs/provider/pharmacy_pa_changes.doc.
CHANGES TO PRIOR AUTHORIZATION PROCESS AND REQUIREMENTS EFFECTIVE SEPT. 1, 2008
FOR BASIC HEALTH SUBSIDIZED MEMBERS:
In order to manage the pre-existing condition
waiting period and coverage of benefits for newly enrolled Basic Health Subsidized
members, effective Sept. 1, 2008 CUP will start requiring a PCP referral and approved
authorization by CUP for all Specialist visits, all imaging (except flat film x-rays),
and all outpatient procedures for our Basic Health Subsidized members. We will continue
to require authorizations for services such as inpatient procedures that are currently required. The Referral Guidelines matrix on CUP's website will be updated with these
new requirements by the Sept. 1st implementation date. For more information, go
to
http://www.cuphealth.com/docs/provider/.
MID-YEAR BENEFIT CHANGES FOR HEALTHY
OPTIONS, SCHIP, BASIC HEALTH PLUS, AND BASIC HEALTH MATERNITY BENEFITS PROGRAM:
1) MENTAL HEALTH BENEFITS FOR CUP PATIENTS WHO DO NOT MEET THE RSN ACCESS TO
CARE STANDARDS: Starting July 1, 2008, the mental health benefit for
children age 18 and younger is increased from 12 to 20 hours of treatment (including
evaluation) per calendar year. For children under age 5, all prescriptions for psychotropic
drugs must be reviewed and have a Second Opinion by a pediatric psychiatrist. For
more information about mental health coverage, go to the HRSA website at
http://fortress.wa.gov/dshs/maa/download/Numberedmemos.html for their 2008
numbered memorandums #08-17 and #08-18.
2) SMOKING CESSATION PROGRAM: Starting in July 2008, all CUP members
age 18 and older are eligible for the Free and Clear Quit for Life Program. For
pregnant members, there is no age requirement to participate in the program. CUP
patient may enroll by calling the Free and Clear Quit for Life Program toll free
at (866) QUIT-4-LIFE or (866) 784-8454.
ID Number Change
Each month CUP still receives a significant number of claims submitted with the
old CUP member ID numbers. We understand the difficulty many providers and billing
offices have in transitioning to the new member ID numbers. However, CUP will start
rejecting claims with dates of service that start 7/1/08 if those claims are submitted
without the new 10-digit member identifier shown on the CUP member ID card. On January
1, 2008, CUP’s Healthy Options, SCHIP, Basic Health Plus, and Basic Health Maternity
Benefits Program member ID numbers changed from a 10-14 digit pic to a new system-generated
10-digit number preceded with the letter “C”. This new identifier is shown on the
member’s CUP ID card and meets HIPAA privacy requirements. CUP’s Basic Health Subsidized
member ID numbers changed January 1, 2007 from a 9-digit SSN to the new system generated
10-digit number preceded with the letter “C”. These changes may require providers
or billing offices changing their system set-up to use the new ID numbers. If you
have questions, please contact CUP’s Claims Manager, Hope Murray, at
hmurray@cuphealth.com, phone 360-449-8895.
ProviderOne
CUP's Chronic Disease Self-Management Program (CDSMP)
-information to refer your patients
to the workshop and get brochures and prescription referral pads for your practice.
CUP's Chronic Disease Self-Management Program
(CDSMP) -information to have your staff
members trained as Leaders who may offer the program at your clinic or organization.Looking
for Self-Management Resources for People with Chronic Conditions?
CUP Online Services
Search Member Eligibility along with a host of other features that are available.
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MaternaLink is a pregnancy wellness
program offered at no charge to CUP members. It includes two confidential pregnancy
screens, educational information, and the BabyLine, a 24-hour free information line
where questions are answered by an experienced maternity nurse, from enrollment
up to six weeks postpartum. For more information, call 1-877-589-BABY (1-877-589-2229).
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