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PEIA Weight Management Provider Training

PEIA Weight Management Provider Training. April 29, 2011, Morgantown May 5, 2011, Lewisburg. Goals for today. Familiarize providers with new fee schedule Familiarize providers with new eligibility guidelines Ensure clarity regarding process for claims submission

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PEIA Weight Management Provider Training

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  1. PEIA Weight Management Provider Training April 29, 2011, Morgantown May 5, 2011, Lewisburg

  2. Goals for today Familiarize providers with new fee schedule Familiarize providers with new eligibility guidelines Ensure clarity regarding process for claims submission Ensure provider awareness of program resources, outcomes and best practices Provide forum for feedback among providers and to PEIA

  3. Eligibility is changing! THE OLD: BMI of 30 or greater; or BMI of 25 or greater with related condition (hypertension, diabetes, heart disease, metabolic syndrome or sleep apnea)

  4. New guidelines, July 1, 2011 THE NEW: Body mass index of 25 or greater (no cormorbid condition required) OR Waist circumference of 35 inches or greater for woman OR Waist circumference of 40 inches or greater for a man

  5. WHY? Outcomes research provides sufficient validation of improved health Averted bariatric surgeries Cost beneficial Member requests Provides “engagement” for members to make lifestyle changes

  6. Marketing New program brochures available Good time to market to PEIA policyholders and their families Historically enrollment picks up in the Fall PEIA now has web enrollment: go to www.wvpeia.gov/healthandwellness programs/weight management

  7. Why the new fee schedule? IRS regulations regarding “fitness memberships” PEIA can only pay for professional services Member copayment will serve as the “membership fee” Simplify copayments Better distribution of services over time

  8. New schedule of services EP visits alternate with RD visits Personal training more consistent New code for personal training (S 9451) EP payment increased from $12.50 per 15 minutes to $15.00 Providers to all use CHERI to cut down on confusion and errors given the change

  9. Member copayments All will go to $20 monthly effective July 1, 2011 For new participants, it is a win For current participants, they will view as fee increase although they will gain also in regards to personal training For those about to begin, we need full disclosure, so they can make an informed choice as to when to begin Anticipate increase in participants starting in July

  10. Nidia.I.Henderson@wv.gov QUESTIONS?

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