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You are about to leave a GSK website. By clicking this link, you will be taken to a website that is independent from GSK. The site you are linking to is not controlled or endorsed by GSK, and GSK is not responsible for the content provided on that site.

Some features of this site may not function properly. For optimal user experience, please view this site in Chrome, Firefox, Safari, or Edge. Reimbursement decisions are made by individual insurance plans. The GSK Vaccines Reimbursement Support Center is a resource for physicians, physician office staff, and pharmacists to help address questions about billing, coding, and reimbursement for GSK vaccines. Phone: Fax: References: 1.

Data on file, GSK. Kirchhoff SM. Congressional Research Service Your plan coordinates physical health, mental health, and substance use disorder treatment services to provide whole-person care under one health plan. Most Apple Health clients have managed care, which means Apple Health pays a health plan a monthly premium for your coverage, which include preventive, primary, specialty, and other health services.

Clients enrolled in managed care must see providers who are in their plan's provider network, unless prior authorized or to treat urgent or emergent care. Newly eligible and renewing Apple Health clients choose or are auto-assigned into a managed care organization MCO the day they become eligible. Their managed care enrollment is backdated to the beginning of the current month.

Clients can change their managed care plan at any time. Changes usually take effect the following month that the change was made, depending on when you request the change. These plans are for clients who are eligible for Apple Health, but not eligible for managed care enrollment, such as:.

Upon becoming eligible for Apple Health coverage without a managed care plan also known as fee-for-service , clients may select a Behavioral Health Services Only plan. A BHSO fact sheet is available online. Within available funding, a BH-ASO also has the discretion to provide outpatient behavioral health services or voluntary psychiatric inpatient hospitalizations for individuals who are not eligible for or enrolled in Apple Health.

The Apple Health Foster Care AHFC program provides statewide physical and behavioral health coverage mental health and substance use disorder treatment services. You can choose any one of the five available plans that serve your area when you enroll in Apple Health. Not all plans are available in all areas. All Apple Health plans cover the same basic services , but they have some differences in the way they provide services. Each health plan has its own network of providers, hospitals, and pharmacies.

Please verify with the health plan that the providers you prefer are in the plan's network. Before you can be in a managed care program, you must apply for coverage. To choose or change your health plan, most clients may visit Washington Healthplanfinder. See more information about how to change your health plan. All Apple Health plans offer the same basic services.

Some services are paid for by Apple Health without a managed care plan, also called fee-for-service FFS. That's what we call it when Apple Health pays providers directly for each service they do, using your ProviderOne services card.

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Kaiser permanente montclair You may also be interested in:. Integrared services are paid for by Apple Health without a managed care plan, also called fee-for-service FFS. Clients enrolled in managed care must see providers who are in their plan's provider network, unless prior authorized or to treat urgent or emergent care. Fax: How do I defer? Changes usually effect the following month that the change was made, depending on when you request the change.
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Highmark bcbs payment Patient Populations 50 years and older Immunocompromised, 18 years and older Prescribing Info. Clients can change their managed care plan at any time. Visit www. Fax: Your plan coordinates physical health, mental health, and substance use disorder treatment services to provide whole-person care under one health
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Utilization review jobs highmark health Phone: Please verify with the health plan that the providers you prefer are in the integraated network. These plans are for clients who are eligible for Apple Health, but not eligible for managed care enrollment, such as:. Your plan coordinates physical health, mental health, and substance use disorder treatment services to provide whole-person care under one health plan. Manage benefits Working accenture is special open enrollment? Patient Counseling. Kirchhoff Https://

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This might span six weeks in a patient with severe hypertension whose medication is being aggressively titrated or six years in a healthy patient getting yearly mammograms. When the right side becomes full, you can overlay a blank copy of the template, cutting off the three panels on the left and binding the new page to the chart.

The summary is integrated in that it includes data on one page from multiple and now unnecessary parts of a traditionally organized chart. More importantly, however, it is integrated in that the relationships between problems, medications and measured flowsheet parameter results are evident on a single page, and their changes compensated or decompensated, improving or progressing are readily apparent over time.

This allows the physician to follow, for example, the response of the glycohemoglobin HbA 1c or blood pressure as a function of the number of drugs and their dosages. At each visit, the physician enters dynamic data into the integrated summary as follows: First, newly available outside test results for tests drawn at the previous visit are entered into the previous visit column. Finally, new medications or dosage changes and newly ordered lab or imaging tests are entered into the column for the next visit again, with colons to indicate that results are pending.

The clinical example on page 36 describes the case of a hypothetical middle-aged female patient with a fairly complicated set of problems and shows how the integrated summary would be completed over several visits. The sample progress note on page 38 shows how references to the integrated summary can shorten documentation. Patient demographics. Patient demographic data is recorded across the top of the integrated summary.

Relatively static data e. The middle panel on the left is the problem list, where problems are organized by disease or organ system following some sensible order see the box. Listing problems in the temporal order of their diagnosis requires more mental integration of the data than ordering problems by disease or organ system.

Problems are entered on the problem list leaving room above and below for subsequent or future entries. For example, as I conduct a new patient history, if the patient tells me about chronic hepatitis first, I may enter this problem about one third of the way down the list. When she subsequently reports congestive heart failure, I can add this to the list above. Six months later, when she develops endometriosis, I can add this to the list below.

Physicians may find it useful to expand upon each element of the problem list, adding date of onset, diagnostic criteria, extenuating circumstances at the time of diagnosis and dates of major quantifying test results e. To understand how a physician would use the integrated summary in practice, consult the text in this box and the example below, both of which are color coded to facilitate understanding.

This example details the care of a hypothetical middle-aged female patient. The patient presents for an initial visit. She gives a history of hypertension HTN , familial risk for coronary artery disease CAD and smoking all of which are added to the problem list , and her exam shows wheezing leading to a new diagnosis of chronic obstructive pulmonary disease COPD.

Her problem of smoking is expanded to document the intervention of cessation counseling. The past medical history PMH section is filled in from her history, and the immunizations heading helps to remind me that now that she has been diagnosed with COPD she is a candidate for pneumococcal polysaccharide PPS , which is given.

The atenolol she reports taking is entered into the initial column of the medication list. Integrating the problem and medication lists to the flow sheet, I choose the parameters of blood pressure BP , basic metabolic panel BMP and heart rate as appropriate to monitor, and the new diagnosis of COPD suggests adding metered dose inhaler MDI frequency and peak flow.

Integrated flowsheet values documenting bradycardia and restricted peak flow assist me in recognizing that atenolol is now contraindicated, for which I substitute hydroclorothiazide HCTZ , and that albuterol is needed, as shown in the next column of the medication list.

The patient follows up. The problem list is further expanded to show that the patient heeded my recommendation to quit smoking. The abbreviated plan section also shows that a one-time oral steroid burst prednisone was prescribed.

The lab results that have returned are entered into the preceding column, including the preceding elevated fasting glucose unbeknownst at the time steroids were prescribed. The problem list adds that diabetes mellitus DM has been diagnosed. It also shows that prophylactic aspirin has been recommended now that the patient has other CAD risk factors with DM.

Flowsheet parameters of glucose, glycohemoglobin HbA 1c , urine dipsticks, ophthalmic and podiatric screens, as well as liver function tests LFTs to monitor statin therapy are added and ordered as indicated by the colons. The plan section shows a dietician referral was made, and the patient will follow up in one month.

The integrated flow sheet shows the home glucometer readings are suboptimal in response to the glyburide dose recorded above, and an augmented twice-daily dose is recorded in the next column. The increase in her age shown in the demographic section reminds me in my review of the screening section that she is now a candidate to begin annual fecal occult blood testing and cards are given, with results later appended.

The patient presents with hemiparesis and is found to be in atrial fibrillation a-fib with a rapid ventricular rate and is admitted to the hospital. Problem list is updated accordingly. The patient returns to the office for follow-up after discharge from a stroke-rehabilitation center.

Unfortunately, her paresis has not improved. The problem list is expanded to annotate the results of major quantifying hospital tests including head computed tomography scan CT , echocardiogram ECHO and adenosine thallium cardiac perfusion scan AdThal. I update her medication list to reflect that digoxin was started in the hospital for rate control, warfarin was substituted for aspirin for anticoagulation, and that metformin was added for her yet suboptimal glucometer readings.

Her flow sheet is modified by adding new monitoring parameters for rhythm, digoxin level and International Normalized Ratio INR.

Hospital admission lab results are added to the preceding column, and colons mark the pending results of tests ordered today. The screening section shows a flexible sigmoidoscopy is scheduled, and the plan section documents a one-week follow-up. Past medical history.

The lower left panel of the integrated summary contains a summary of pertinent past medical history. Immunization IZ status for infrequently repeated vaccinations, such as tetanus-diphtheria and pneumococcal polysaccharide, is also included where appropriate. The top panel on the right leaves room for chronic medications to be entered.

Its organized structure allows drugs to be grouped vertically by organ system and horizontally by temporal order of initiation. Grouping like agents and leaving blanks above and below to add future agents for other systems makes it easier to associate groups of drugs to a corresponding problem and choose when to titrate existing drugs or add a new agent.

New medications and dosage changes are entered in the next visit column. This includes using similar structures for datasets, such as CDISC standards, and standard formats for tables, figures and listings. The requirements laid out by regulatory authorities for Integrated Summaries make the collaboration between statisticians, programmers and medical writers inevitable. The challenge is understanding what roles they play in the planning and preparation of Integrated Summaries and the best way of collaborating.

While the biostatistician sets out an analysis plan and the programmers are pooling data, the medical writer should have a summary of analysis considerations.

A dedicated Integrated Summaries team follows the project from conception to submission, deploys the same programming macros, uses the same writing style and creates an Integrated Summaries document template in line with company branding to be used for future summaries. They will present their tips for Sponsors on successful preparation. Caroline started her career as a statistician in University departments heavily involved in clinical trials.

Caroline worked for 1. Mark has served in progressive management positions in the clinical trials industry for over 25 years. He began his clinical research career in the CRO environment as a programmer and project manager and served in project management, business development, and information technology functions. Mark was Project Director for several NDA submissions and global clinical trials, and he has served as department head of data management, clinical operations, and business development groups as well as Director, eClinical Technologies for a major CRO.

This webinar will particularly benefit mid to large size pharmaceutical and biotechnology companies with Late Phase Studies in the pipeline. All services are underpinned by strong clinical and biometrics project management.

We offer our customers a very experienced, attentive, adaptable and flexible study team that works much like an extension of their own team. PharmaCompass is the one-stop, pharmaceutical information platform developed for professionals to make your strategic business decisions. Already have an account? You have just entered the contest with submissions and point s spent. Skip to content.

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WebWhen a veteran gets emergency services at a VA hospital and the VA cost sharing is more than the cost sharing under our plan, we will reimburse the veteran for the difference. . WebFeb 28, The FDA requires Integrated Summaries, both ISS and ISE submissions, for NDAs which includes an overview and summary of clinical efficacy and safety within . WebOur locally-based integrated Provider Solutions teams employ a high-touch approach, focusing on our common goals of improving member access to care, promoting healthy .