Part D Claims Processing Made Easier

Humana is making it easier for physicians to get reimbursed for vaccines administered in their offices.

Earlier this year, Humana contracted with Dispensing Solutions, Inc. (DSI) eDispense Vaccine Manager to give Humana participating physicians access to a Web portal to process claims for vaccines administered to Part D members, including ZOSTAVAX® (Zoster Vaccine Live). ZOSTAVAX® is a frozen Part D covered vaccine used for adults 60 years old or older to help prevent shingles.

The advent of vaccines like Zostavax, which are covered under Part D, have been problematic for physicians seeking reimbursement because many physicians are unable to bill for Part D drugs due to software limitations, and most physicians are not traditionally contracted with Humana as Part D providers.

However, physicians who are contracted with DSI through eDispense can submit a Part D claim in real time for drug reimbursement, based on the member's Part D benefit coverage.

Also, physicians who are contracted with DSI through eDispense can submit Humana member information through the Web portal and receive eligibility status, as well as member cost share information.

Humana is pleased to work with DSI and believes a relationship with Dispensing Solutions' eDispense Vaccine Manager will:

• Improve member access to Part D drugs
• Provide faster reimbursement for physicians
• Reduce paper claims submissions by members
• Promote healthy outcomes for members

Physicians who elect not to enroll through eDispense will need to collect full payment from the member at the time of the office visit, and the member will need to submit a paper claim to Humana for processing. Humana will reimburse the member for the vaccine, minus the appropriate member cost-share.

Humana participating physicians who want information about enrolling in eDispense should visit http:\\enroll.edispense.com. For questions about eDispensing Solutions, please call (866) 522-EDVM (866-522-3386).

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Connection Between Oral,
Overall Health Continues to Grow

Research shows that oral health – preventive care and regular visits to the dentist – is integral to overall health. For example, according to the Mayo Clinic, the following is true:

• Periodontal disease may contribute to heart disease, the nation's leading cause of death.
• People with diabetes are more likely to develop oral infections and periodontal disease. The reverse also seems to be true.
• Periodontal disease may increase the risk of premature, underweight babies.
• The lower respiratory tract can draw bacteria in from the mouth and throat, causing infections and worsening lung problems.

In general, oral infections can cause or aggravate overall health problems and ultimately lead to higher health care costs. These facts are especially troubling in light of the 2000 report of the U.S. Surgeon General, Oral Health in America, which found that most adults over the age of 25 have some form of periodontal disease, with the severity increasing with age.

In addition to preventing periodontal disease, regular dental care can help detect health problems not directly related to oral health. According to an Academy of General Dentistry study, more than 90 percent of all systemic diseases have oral symptoms, meaning the dentist could be the first health care provider to diagnose a health problem. Routine dental exams and X-rays may detect osteoporosis, for example, by showing the amount of bone loss from year to year. Dentists are also instrumental in diagnosing oral cancer, which can be successfully treated if caught early through dental exams.

Physicians are encouraged to talk with patients about their oral health, and urge them to visit a dentist regularly. Humana-insured patients who are enrolled in HumanaDental receive coverage for four cleanings, two periodontal exams and two regular exams each year.

All patients – whether or not they are insured by Humana – can take advantage of www.mydentalIQ.com, a new online tool provided by HumanaDental. The site provides a dental health risk assessment, which immediately rates dental health knowledge and delivers a personalized scorecard with health tips. Users can learn more about the link between oral and overall health, steps to maintain oral health, how family history may impact oral health, healthy eating habits and much more. In addition, they can print copies of their scorecards to give to their dentists during their next visit. There's also a calendar that makes tracking daily brushing and flossing fun for children.

Educating patients about the links between oral and physical health can help provide better outcomes while reducing health care costs. Providing the tools available at www.mydentalIQ.com for free is another way Humana fulfills its mission to help consumers make informed health and benefits decisions.

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