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The San Juan IPA was founded in 1986 by a group of 21 community physicians to partner with

insurance companies with the goal of improving the quality of care to patients while simultaneously

decreasing the cost of care to those payers. Originally formed with a “Quality Assurance Committee”,

the San Juan IPA has grown to over 450 members representing 39 specialties and sub-specialties

in 70+ offices across New Mexico, a HEDIS quality review function, a Credentialing Committee,

and a care management committee component.

As an NCQA-accredited organization, San Juan IPA’s core services of contracting and

credentialing are complemented by an array of expanding resources for the physician office,

helping keep practice costs low and quality of care high.  We continually look for ways to

promote new quality initiatives both within and outside the practice walls for patients and employers.

  1. To ensure that a heath care delivery system is in place, which provides available, accessible and adequate numbers of facilities, locations, and personnel for the provision of health care services.
  2. To ensure that a health plan members are provided covered services without regard to race, color, creed, sex, religion, age, national origin, ancestry, marital status, sexual preference or physical or mental handicap.
  3. To ensure that the SJIPA has in place the organizational and administrative systems capable of messaging medical services contracts between providers and third party vendors
  4. To ensure that the quality of care to all patients continues at the highest level of  care possible.  
  5. Provide support for community health education and wellness.

Santa Fe Providers Gallup Providers Wound Care JOIN US! Behavorial Health Employment Opportunities Pay Membership Dues/Invoices Las Cruces Providers More News!

San Juan IPA SPECIAL Alert!

ALL Providers:  Health and Human Services (HHS) Office of Inspector General (OIG) Scam

The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently confirmed that the HHS OIG Hotline telephone number is being used as part of a telephone spoofing scam targeting individuals throughout the country. These scammers represent themselves as HHS OIG Hotline employees and can alter the appearance of the caller ID to make it seem as if the call is coming from the HHS OIG Hotline 1-800-HHS-TIPS (1-800-447-8477). The perpetrator may use various tactics to obtain or verify the victim’s personal information, which can then be used to steal money from an individual’s bank account or for other fraudulent activity. HHS OIG takes this matter seriously. We are actively investigating this matter and intend to have the perpetrators prosecuted.

It is important to know that HHS OIG will not use the HHS OIG Hotline telephone number to make outgoing calls and individuals should not answer calls from 1-800-HHS-TIPS (1-800-447-8477). We encourage the public to remain vigilant, protect their personal information, and guard against providing personal information during calls that purport to be from the HHS OIG Hotline telephone number. We also remind the public that it is still safe to call into the HHS OIG Hotline to report fraud.  We particularly encourage those who believe they may have been a victim of the telephone spoofing scam to report that information to us through the HHS OIG Hotline 1-800-HHS-TIPS (1-800-447-8477) or spoof@oig.hhs.gov. Individuals may also file a complaint with the Federal Trade Commission 1-877-FTC-HELP (1-877-382-4357).

More information is available on the OIG Consumer Alerts webpage.




GRT Repeal Tax Deduction for Doctors: 

The legislature has a bill that will have what we think a huge impact on the financial profit of private practice doctors.  The bill repeals the GRT deduction for Medicare and Manage Care Contracts.   We have sent out a number of requests for members for data so we can fight this bill in the senate.  HB 202 passed the house on party lines and has a tax increase for doctors and hospitals.  This is an example of the impact:

A practice with Medicaid, Medicare, Managed Care, Private Pay, Co-pay and deductibles, including other revenues is $5,000,000.  The new formula under HB 202 the doctor would take 40% and then pay local GRT rate, which would be the total tax bill.

$5,000,000 x .40 = 2,000,000 x .078 = 156,000 would owe the state of New Mexico

WE have heard from one radiology group, the tax would be $700,000 greater than they currently pay, orthopedic $100,000, but we need many practice examples.  The bill will fund the general appropriation act.

We need to hear if this has a positive or negative impact and data from your practice.  We will redact the information so individual practices are not named but we need examples ASAP.  Thank you so much, really appreciate getting as many practices to participate.

Please submit your responses to:

Annie Jung via email at:  ajung@nmms.org

Randy Marshall via email at:  rmarshall@nmms.org

Action Request - Removal of GRT Deduction Fast-Tracked 

HB 202 - which amends Gross Receipts Tax collections, deductions, and computations - particularly on health care services -  is being fast-tracked through the Senate.

SB 202 will be the funding bill for the general appropriation act and will repeal the Managed Care and Medicare tax deduction for all health care providers.  The bill allows 60% deduction and then apply your local GRT rate to the remaining 40% to arrive at tax owed.

Contact Senators and ask that they OPPOSE CS/HB 202.
Senator Phone List
Senate Emails with pre-populated note
Senate Emails to cut and paste as a block of addresses
All Senators need to be contacted as the bill will be heard on the Senate floor in no time.   It is harmful to Medicine, business, and patients.  There are constructive ways to fix budget woes and this bill is not one of them. 

NMMS Brief is available to download.

If you have any questions, please contact me directly, NMMS Executive Director Randy Marshall at
rmarshall@nmms.org,  or reply to this email.

With best regards always,

William Ritchie MD
NMMS President 2016-2017

ALL Presbyterian Health Plan Providers:  2017 Annual Education Conferences & Webinar Series:

The next Provider Education Conference webinar will be on March 28 and 30.

Webinar Topics will cover:

1) Recent changes in the health plan.

2) Current policies and procedures.

3) The Centennial Care program.

4) Requirements from the New Mexico Human Services Department, Center for Medicare & Medicaid Services, and the National Committee for Quality Assurance.

You may register to attend at:  http://phs.swoogo.com/PHP17

ALL United Healthcare Providers:  New 2017 Cumulative Opioid Quantity Limitations

If you are unable to read this message or see the images, view it online.

New for 2017:
Cumulative Opioid Quantity Limitations


We wanted to share with you our new safety limit on opioid medications for UnitedHealthcare Medicare Advantage and Prescription Drug plan members. As you may know, the Centers for Medicare & Medicaid Services (CMS) now requires Part D plans to limit the cumulative morphine equivalent dose (MED) of opioid medication(s) that a patient receives over a period of time. Our new cumulative MED limit is 360 mg for members who may be taking more than one opioid drug for pain management from one or more prescribers.

High doses of opioids, even when used as directed, can contribute to overdose or lead to opioid abuse in some people. That's why we ask for your help in following this new limit - so your patients who are our members receive the lowest effective dose of opioid medication(s) that's medically necessary for their condition. Please keep these tips in mind when prescribing:

1. Review your patient's cumulative opioid regimen and consider tapering opioid doses as appropriate.

2. Calculate your patient's cumulative MED, keeping in mind that prescriptions from other prescribers may be contributing. For help calculating a drug's MED, please review the information in the following list of resources. If you prescribe more than the allowed limit of 360 mg MED, your patient's prescription will be rejected at the pharmacy. The rejection can only be resolved by an OptumRx coverage review. To reach the OptumRx prior authorization department, please call 800-711-4555.

3. If your patient needs a higher dosage than the limit, please complete our prior authorization form. The form will be faxed to your office once your prior authorization request is initiated. Please submit the form along with chart documentation and an attestation that a cumulative opioid dose greater than 360 mg MED is medically necessary.

4. Encourage your patient to only see one prescriber for their opioid medication and to use the same pharmacy when filling their prescription.

Below is some helpful information about opioid management, including online tools and resources. We truly appreciate your attention to this important matter and for the care you provide our plan members. If you have questions, please contact OptumRx at 800-711-4555.

Opioid Medication - Additional Resources & Tools for Prescribers
The Centers for Disease Control and Prevention (CDC) issued their opioid guidelines in the
March 2016 Morbidity and Mortality Weekly Report (MMWR). Here are key takeaways from that report:

Use non-opioid therapies. Instead of opioids, please recommend non-pharmacologic therapies such as exercise and cognitive behavioral therapy and non-opioid pharmacologic therapies for chronic pain. Don't use opioids routinely for chronic pain. When opioids are used, combine them with non-pharmacologic or non-opioid pharmacologic therapy, as appropriate.

Start low and go slow. Prescribe the lowest possible effective dosage and start with immediate-release opioids instead of extended-release/long-acting opioids. Only provide the quantity needed for the expected duration of pain. Avoid increasing total daily opioid dosages greater than 90 mg of morphine equivalents.

Follow up. Regularly monitor patients to make sure opioids are improving pain and function without causing harm. If you have a patient with continually increasing dosing or who isn't receiving much benefit from continued opioid use, please consider tapering and discontinuing the medication. Monitor patients for opioid dependence disorder and comorbid mental health conditions.

Review PDMP Data. Review a patient's history of controlled substance prescriptions using state prescription monitoring program (PDMP) data. This can help you determine whether your patient is receiving opioid dosages or dangerous combinations that place them at risk.

For more information on these CDC guidelines and how to calculate the total daily dose of opioids, please visit the CDC Guideline for Prescribing Opioids for Chronic Pain.

Online Tools & Resources

Interagency Guideline on Prescribing Opioids for Pain

National Center for Biotechnology Information: "The Role of Psychological Interventions in the Management of Patients with Chronic Pain"

Patient Substance Use Treatment Helpline
If you have a patient who is our member and may be struggling with opioid abuse, please ask them to contact our free and confidential treatment service.

Specialized licensed clinicians provide treatment advocate services 24 hours a day, 7 days a week.

Phone: 855-780-5955

Website: liveandworkwell.com

Insurance coverage provided by or through UnitedHealthcare Insurance Company, All Savers Insurance Company or its affiliates. Health plan coverage provided by UnitedHealthcare of Arizona, Inc., UHC of California DBA UnitedHealthcare of California, UnitedHealthcare of Colorado, Inc., UnitedHealthcare of Oklahoma, Inc., UnitedHealthcare of Oregon, Inc., UnitedHealthcare of Texas, Inc., UnitedHealthcare Benefits of Texas, Inc., UnitedHealthcare of Utah, Inc. and UnitedHealthcare of Washington, Inc. or other affiliates. Administrative services provided by United HealthCare Services, Inc.

Doc #: PCA-1-005020-02032017_02162017

© 2016 UnitedHealthcare

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