Missouri WISEMAN Program Manual

WISEWOMAN ALERT Values

WISEWOMAN ALERT Values are clinical measures or laboratory results that require medical follow-up immediately or within 7 days of the WISEWOMAN office visit. Follow-up can be completed the same day, if possible, with a WISEWOMAN Diagnostic Visit. The provider should document the date of the medical work-up on the screening form and note follow-up details. If a woman does not receive a work-up or intends to follow-up with another provider, the WISEWOMAN Education Coordinator should be notified and the follow-up information should be coded appropriately in MOHSAIC. Providers must also enter a claim for any visit including an ALERT Value within 7 days of the date of service (DOS).

WISEWOMAN ALERT Values

• Blood Pressure (BP): SBP >180mmHg and/or DBP >120mmHg
• Blood Glucose (fasting or non-fasting): <50mg/dL or >250mg/dL

*Note: There are no ALERT values for cholesterol or A1C*

ALERT Value Reporting Guidelines

• Record the participant’s BP and lab values on the WISEWOMAN Screening or Diagnostic Form, as appropriate (entering any ALERT value in MOHSAIC will automatically trigger the ALERT box to be completed)
• Record the date of the medical evaluation with a qualified practitioner on the WISEWOMAN Screening or Diagnostic Form
• Code the status of the ALERT value work-up with numerical coding system on the paper form and in MOHSAIC
• The numerical coding system for the status of a work-up is as follows:
  1. 1. Work-Up Complete: Participant has been seen and diagnosed by a medical provider either the day of the screening visit or within seven (7) days of the screening visit
  2. 2. Follow-Up/Work-Up by Alternate Provider: Participant intends to see alternate provider within 7 days
  3. 3. Participant Refused Work-Up: Participant has an ALERT value, but refused work-up
  4. 4. Work-up Not Completed, Participant Lost to Follow-Up: Participant had an ALERT value, but was lost to follow-up and work-up was not completed
• A participant who did not attend her scheduled work-up within THREE (3) months after a screening visit and could not be reached to reschedule another appointment is considered “lost to follow-up”

Lost To Follow-Up Guidelines

CDC requires specific documentation on ALERT value participants, which is submitted on the WISEWOMAN Screening or Diagnostic Form for the participant. There is a section on the Screening Form and the Diagnostic Form titled “ALERT Value Notes,” where information regarding the participant’s treatment plan and follow-up will be documented.

If a participant is referred to an outside clinician for ALERT value follow-up, the referring WISEWOMAN clinic is responsible for following up with the outside clinic to see if participant attended her appointment and obtain records to report back to the WISEWOMAN Program. Providers should notify the WISEWOMAN Education Coordinator if any participant is “lost to follow-up” and document the information on the appropriate form, including contact attempts.

WISEWOMAN Participant Is Considered “Lost To Follow-Up” When:

• Participant is referred to a medical provider in-house for the ALERT value follow-up and the clinic has three documented phone calls or attempts to reach participant to have ALERT value addressed with the medical provider with no response
• Participant is referred to an outside clinician and the referring WISEWOMAN clinic attempts to make the appointment within seven (7) days and are unable to

Blood Pressure Management

Improving control of hypertension is a major focus of the WISEWOMAN Program. Providers are expected to conduct additional preventive services for participants who have disease level hypertension, which is defined as a woman with an average BP of ≥130/80.

It is required that a WISEWOMAN participant receive follow-up services if they present to the provider with an abnormal or disease level blood pressure. This follow-up can be completed with a Blood Pressure Medical Follow-up, Diagnostic Office Visit or a Health Coaching session to discuss blood pressure management.

Blood Pressure Medical Follow-Up

Blood Pressure Medical Follow-Ups (yellow) are recommended for participants with abnormal disease level hypertension (Stage 2 ≥140/≥90 and ALERT Level ≥180/≥120) identified during a WISEWOMAN screening visit. The WISEWOMAN Program will reimburse up to three 25-minute, face-to-face, in-office Blood Pressure Medical Follow-Ups within 12 months of the participants Initial RRC or Annual screening visit. Two complete blood pressure measurements are required and BP Medical Follow-Ups can be completed by any trained medical staff who has the ability to contact a practitioner, if necessary. BP Medical Follow-Ups should be submitted as a WISEWOMAN First/Second/Third Blood Pressure Medical Follow-Up claim in MOHSAIC.

Diagnostic Office Visit

A Diagnostic Office Visit (gray) is utilized when a participant has an abnormal WISEWOMAN screening. WISEWOMAN will reimburse providers for one 30 minute, face-to-face Diagnostic Office Visit per grant year.

Qualifying Reasons for a Diagnostic Office Visit

• Hypertension (≥130/80)
• Elevated cholesterol
• Elevated blood glucose
• Smoking cessation medication
• Mental health follow-up

Diagnostic Office Visit Guidelines

• Must be a face-to-face visit with a qualified clinician (e.g. physician, physician assistant or nurse practitioner)
• If the screening clinic does not have a qualified clinician on-site, the participant should be referred to an outside provider and it is the responsibility of the referring WISEWOMAN provider to obtain follow-up information for the Diagnostic Office Visit to reimburse the provider
• Must be completed to confirm a diagnosis of hypertension (≥130/80), high cholesterol or diabetes, assess and prescribe medication for smoking cessation or follow-up on mental health concerns
• A participant can still receive a Diagnostic Office Visit if they have a history of any of the qualifying conditions
• Documentation of the reason(s) for the Diagnostic Office Visit must be completed on the WISEWOMAN Diagnostic Form (gray)
• Diagnostic Office Visits should be scheduled within 7 days for any ALERT value
• Diagnostic Office Visits can be completed on the same day as the screening visit, if possible, and do not require additional BP or lab values (the provider can input the values from the screening visit)
• If a Diagnostic Office Visit is completed at a later date, two new complete BP measurements are required
• Document any ALERT values on the WISEWOMAN Diagnostic Form (gray)
• Screening providers must be able to link participants to medical services for medical evaluation and assist participants with access to low-cost or free medication
• Submit a WISEWOMAN Diagnostic claim in MOHSAIC for the participant’s Diagnostic Office Visit for reimbursement of services with all required components

*Note: WISEWOMAN is unable to reimburse for the cost of any medications*