Direct Care Pro

What is Direct Care Pro (DCPro)

DCPro is part of Missouri’s MO HealthNet program intended to improve health status and decrease complications for patients with chronic illnesses including: Asthma, Chronic Obstructive Pulmonary Disease (COPD), Diabetes, Gastroesophageal Reflux Disease (GERD), Heart Failure, Hypertension, Falls in the Elderly, Hyperlipidemia, Osteoporosis, and Muscular Sclerosis. The program increases involvement of a pharmacist with their primary health care provider, empowers patients to perform self-management, and utilizes existing community resources and health infrastructures through the coordination of care.

The State of Missouri supports the important role pharmacists play in improving the health status and the education of MO HealthNet participants. This includes an integrated Medication Therapy Management (MTM) program for pharmacist participation.

 

Who has oversight of DCPro?

The State of Missouri, Department of Social Services, MO HealthNet Division (MHD) (formerly Division of Medical Services or DMS) oversees DCPro.  Xerox (formerly ACS) is the subcontractor for Cyber Access™ which includes DCPro, a feature of the overall web-based Cyber Access™ tool.

 

How is DCPro implemented by a pharmacist?

Cyber Access is currently in use by many MO HealthNet providers and is the primary clinical provider portal for MHD.  Providers use it for electronic prior authorization requests and to access individual patient paid claim histories (patient profiles).  It’s also used to approve DME services, as well as many other clinical services.

Through DCPro, pharmacists are messaged when filling a prescription for a patient who meets certain disease-based criteria included in their health profile. The message to the pharmacist is received in the DUR message field, along with the other relevant DUR messages being populated.

An example of the message is: AVL DIAB INTVN (Available Diabetic Intervention). This indicates the MTM patient intervention opportunity exists.

Pharmacists can bill in 15-minute increments using CPT codes, with payment ranging from $10-$20 per 15-minute increments.  All interventions are face-to-face encounters with the patient.

 

Do I have to be a provider to participate?

Before an MTM intervention can be performed, the pharmacist must first enroll as a MO HealthNet provider (provider type 35) through Missouri Medicaid Audit & Compliance (MMAC).

 

What training is required?

Pharmacists must:

1) Hold a certificate of medication therapeutic authority (MT certificate) issued by  the Missouri Board of Pharmacy. Note: If you are not a PharmD, you will need to take a Missouri Board of Pharmacy approved Medication Therapy Services (MTS) training course in order to apply for the MT certificate.

2) Be enrolled as a MO HealthNet provider with an active provider status.

 

Can a pharmacist complete a patient intervention from any site?

The program requires that the pharmacist perform the intervention face-to-face, in a space that is not the pharmacy prescription intake or delivery area. Thus, the intervention may take place in a variety of settings, such as but not limited to, a clinic, patient home or pharmacy. The actual intervention must take place in a private area which is HIPAA compliant.

If the pharmacist is practicing in a retail pharmacy, the pharmacist will receive an alert through the pharmacy dispensing system, providing notification that the patient qualifies for an intervention. Then, the pharmacist logs into the CyberAccess system to reserve and complete the intervention.

If the pharmacist is not practicing in community pharmacy they may log onto CyberAccess to see which patients in their panel may have eligible interventions.

Note: The pharmacist has 30 days to complete the intervention once reserved. If not completed, it will be returned to the “pool” of interventions, allowing another pharmacist provider the opportunity to reserve.

 

How are pharmacists paid for a DCPro intervention?

Payment is contingent upon the provider logging onto the CyberAccess web site to view, reserve and complete interventions. Once an intervention is completed, DCPro will automatically submit an electronic 837 claim generated by the tool to MO HealthNet on behalf of the pharmacist. The claim status is reflected on the provider’s remittance advice. The payment may be “paid to” another provider if so designated.


What documentation is required for DCPro?

Appropriate documentation includes a log of all clinical interventions, including patient name, patient signature, date, beginning and ending time of intervention and any other desired information relating to the intervention. When audited, a copy of the patient’s chart must be reproducible.


How do I obtain more information regarding CyberAccess, DCPro and training?

1)     To become a CyberAccess user, or for more information about DCPro and the training, contact the Xerox help desk via e-mail at cyberaccesshelpdesk@xerox.com or call 1-888-581-9797 or 573-632-9797.

2)     For questions about applying for a MO HealthNet Provider ID, contact the Provider Enrollment Unit via e-mail at mmac.providerenrollment@dss.mo.gov.

3)     To apply for an NPI #, visit https://nppes.cms.hhs.gov/

How do I stay current on notifications?

Subscribe to MO HealthNet News. Providers should go to the MHD Website to subscribe to the electronic mailing list to receive automatic notifications of provider bulletins, provider manual updates and other official MO HealthNet communications via e-mail.

 

Next Steps:

  1. Apply for and receive the MTcertificate from the Missouri Board of Pharmacy. Apply for an NPI.

  2. Become a CyberAccess user by contacting the Xerox help desk via e-mail at cyberaccesshelpdesk@xerox.com or call 1-888-581-9797 or 573-632-9797.

  3. Apply for and receive your MO HealthNet status from MMAC. The application form must be completed online.  After completion, you can print a copy for your records. You MUST fax your supporting documents (including the signature sheet) to the Provider Enrollment Unit as part of the application process. Please contact Xerox for additional details.

  4. Attend a CyberAccess web-based training session to learn how to use the CyberAccess tool and how to reserve, perform and bill for DirectCare Pro encounters.  Call the CyberAccess Help Desk for details.

  5. Subscribe to MO HealthNet News.

  6. Begin completing interventions for eligible patients.