Issue link: https://www.e-digitaleditions.com/i/66539
Tip of the month: how to get a claim paid quickly • Verify the claims mailing address or electronic payor ID# on the members insur- ance card. • Check to ensure all ICD.9 codes have the 4th and 5th digits submitted on the claim form, when applicable. Connecting with: Rosemary Fowler, RN Care Manager Makes a Difference in the Care of R her Patients By Linda Grosser, RN, CNP osemary Fowler, RN, is one of the most caring and expe- rienced care managers that you could meet. She meets the chal- lenges of her job head on, and for her that means going above and beyond the usual expectations, and doing whatever it takes to get her patients the care that they need. This story is one of many examples of why Rosemary is seen as a resource and role model by her co- workers here at CMCS. Rosemary recently received a care management referral for an insured member who is a student and who lives out of state in the college dormitory. This young lady had been hospitalized due to depression; she had bipolar dis- order and was at risk for harming her- self. She had stopped taking her mood stabilizer medication because she could no longer afford it. In a recent article cited in the National Institute of Mental Health it was noted that "inappropriate medication use among people with bi- polar spectrum disorder is a concern," according to Dr. Merikangas. "It is po- tentially dangerous because use of an antidepressant without the benefit of a mood stabilizer may actually worsen the condition." Bipolar disorder affects about 2.6% of the total population, may run in families, and usually starts in late adolescence according to the National Institute of Mental Health. When Rosemary contacted this young member after she was dis- charged from the hospital, she re- viewed the plan of care and the medi- cations that were prescribed. She discovered that the member had not filled her prescription for the mood stabilizer because she could not afford the $100 per month copayment. She was again in a potentially dangerous situation, where her condition could deteriorate and require readmission to the hospital. Rosemary went to work immediately and found that the pro- vider was able to supply samples of the needed medication on that very same day. Then Rosemary found an assis- tance program that would cover the co- pay so that this young lady would not be without medication in the future. In her day-to-day work, Rosemary is an advocate, educator and coach for her patients. She wants her patients to reach • Verify you have the correct date of birth loaded in your system on the patient. • Attach a copy of the primary carriers explanation of pay- ment with the claim. their highest level of personal health and well being. Rosemary called this patient a couple of weeks later to check in to see how she was doing. She shared that she was extremely appreciative of how Rosemary had helped. She said that she had not felt so good or felt so hopeful about the future in a long time. That made Rosemary's day! Working with people who make a difference in the lives others with the dedication and compassion that Rosemary does, makes my day, too. If your family member ever needs a care manager, you will hope that you have someone like Rose- mary to watch over them. CONTACT CMCS 9045 River Road, Suite 250 Indianapolis, IN 46240 Phone: 317.578.4300 Toll Free: 888.504.5556 Fax: 800.747.3693 CMCS connections 7 2nd qu arter 2012