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Iowa

DMCCU Rights & Responsibilities • Iowa

Provider rights and responsibilities

As a participating provider with members enrolled in a disease management program you have additional rights and responsibilities. You have the right to:

  • Have information about DMCCU, including programs, services, our staff and their qualifications and any contractual relationships.
  • Decline to participate in or work with DMCCU’s programs and services for our members, if contractually possible.
  • Be informed of how DMCCU coordinates disease management-related interventions with treatment plans for individual patients.
  • Know how to contact the person responsible for managing and communicating with your patients.
  • Be supported by DMCCU to make decisions interactively with patients regarding their health care.
  • Receive courteous and respectful treatment from DMCCU’s staff.
  • Communicate complaints to DMCCU regarding disease management as outlined in the Provider Complaint and Grievance Procedure.

These rights and responsibilities are available to you in written format upon request to Disease Management Centralized Care Unit.

The Clinical Practice Guidelines (CPGs) for the following chronic conditions are available in the resource area of the secure provider home page. Login is required.

Pulmonary

DMCCU offers asthma and COPD disease management programs for our members. These programs identify and stratify members into risk groups. Based on these risk groups, the program provides specific interventions, such as printed information, durable medical equipment (DME) as needed, home health instruction and/or community asthma and COPD programs and self-management education. In addition, follow-up calls are made to the member/guardian/PCP on a routine basis to determine the need for further intervention. If you would like a complete program description, please contact us.

Cardiac

DMCCU offers a CHF, CAD and hypertension disease management program for our members. These programs identify and stratify members into risk groups. Based on the identified needs, these programs provide specific interventions such as printed information, one-on-one education from a nurse and DME as needed. Follow-up calls are made to the member/PCP on a routine basis to determine the need for further intervention. If you would like a complete program description, please contact us.

Behavioral health

DMCCU offers a disease management program for our members diagnosed with major depressive disorder, bipolar disorder and schizophrenia. The overall goal of the program is to help our members get the most benefit from their healthcare. This can be accomplished by allocating appropriate health plan resources to the care and treatment of members with behavioral health needs and to enhance the capabilities of the network physicians to manage their patients with these disorders. Follow-up calls are made to the member/PCP on a routine basis to determine the need for further intervention. If you would like a complete program description, please contact us.

Diabetes

DMCCU offers a diabetes disease management program for our members. The program identifies and stratifies members into risk groups. Based on the identified needs, the program provides specific interventions such as printed information, one-on-one education from a nurse certified as a diabetes educator, home health instruction and community-based diabetes classes. The diabetes program also facilitates endocrinology referrals for members, as needed. Follow-up calls are made to the member/PCP on a routine basis to determine the need for further intervention. If you would like a complete program description, please contact us.

HIV/AIDS

DMCCU offers an HIV/AIDS disease management program for our members. The program identifies and stratifies members into risk groups. Based on the identified needs, the program provides specific interventions such as printed information, one-on-one education from a nurse and coordination of care. Follow-up calls are made to the member/PCP on a routine basis to determine the need for further intervention. If you would like a complete program description, please contact us.