illuma Care Connections Quality Improvement Programs
Frequently Asked Questions — Health Plans
Who is Illuma?
How does illuma close gaps in care?
Are all providers eligible to participate?
How does a PCP get the results of the exam into their electronic medical record system?
What if the patient has a pre-existing relationship with a provider that is not part of their network?
illuma Care will make every effort to facilitate uninterrupted relationships between patients and providers, even if the imaging center is not participating in the program. illuma Care promotes the continued relationship by means of two separate initiatives.
- First Priority Scheduling to Existing Relationships: illuma Care maintains historical relationships between patients and providers. As part of the initial patient setup process, illuma Care accepts special data fields which identify existing relationships between patients and providers. That relationship is available to our care coordination team, so they can offer scheduling to those practices first.
- Care Coordinator Scripting: The scripts used by our care coordination team include asking patients if they would like to be scheduled with a practice that they have used before. Priority is given to those practices before a geographically convenient practice is suggested.
How does illuma ensure the claims and codes are captured properly?
illuma trains their providers on proper billing and coding. Further, illuma captures clinical documentation after the patient visit to catch mis-coded claims quickly so they can be amended and share the clinical data with clients to support ‘supplemental data” for HEDIS audits.
illuma is the only end to end solution that enables real-time scheduling with community-based providers, while collecting supplemental (clinical) data for reporting. With illuma, there is no need to purchase expensive equipment which PCP practices are hesitant to incorporate or send costly mobile units into a community that still require a qualified professional to review images from the screening. illuma eliminates the need for additional readings and equipment by leveraging our expertise and relationship with conveniently located community providers.