April 2024 Provider News
Date: 04/30/24
In this issue:
- General Updates - ABA Provider Credentialing
- Quality - CMS Blood Lead Testing Mandate - Lead Screening, Chlamydia Screening Best Practice, Telehealth, National Minority Health Month (NMHM)
- Pharmacy Update - Hyaluronic Acid, Opioid Reminder, Evolent Update, New Biopharmacy/Buy-bill Prior Authorization Fax Number
- Tribal - Resource for IHCP assistance
- Clinical Policy - Monthly Clinical Policy Updates
- Wellcare - Rawlings (external vendor) Review of Medicare claims for Coordination of Benefits (COB)
- Apple Health Core Connections - No-Cost TF-CBT Training
- Training/Education - Deep dive into prevention ethics: Confidentiality and the SPF, Adverse Childhood Experiences, Supporting LGBTQIA+ Youth in Foster Care, The Lost Boys – The forgotten Victims of the Child Abuse Material Industry
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General Updates
ABA Provider Credentialing
For provider awareness please reference the updated (4/1/2024) ABA billing guide here. Reminder and clarification about provider type enrollment on page 20 of this billing guide.
Please contact HCA Provider Enrollment with questions:
HCA Provider Enrollment
Phone: 1-800-562-3022, ext. 16137
Phones are open: Tuesdays and Thursdays from 7:30 a.m. to 4:30 p.m.
(Closed from noon to 1 p.m.)
Phones are closed: Mondays, Wednesdays, and Fridays.
Email: providerenrollment@hca.wa.gov
Website
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Quality
Medicaid Quality
CMS Blood Lead Testing Mandate - Lead Screening
Federal law mandates testing for all children covered by Medicaid. The completion of the risk assessment questionnaire does not meet the Medicaid requirement and all children enrolled in Medicaid are required to receive blood lead screening test at ages 12 months and 24 months.
Chlamydia Screening Best Practice
- Perform chlamydia screening every year on every 16 to 24-year-old female identified as being sexually active.
- Inform patients that chlamydia screening can be performed through a urine test. Offer this as an option for patients.
- Add Chlamydia screening as a standard lab for women 16‒24 years old. Use well-child exams and well-women exams for this purpose.
- Place chlamydia swab next to Pap test or pregnancy detection materials.
- Meet with teens and young adults separately from their parents to allow open conversation.
- Advise members during wellness visits or when they are seen for birth control to get screened for chlamydia.
Telehealth
Increased access to physicians and specialists via telehealth helps ensure patients receive the right care, at the right place, at the right time. CMS provides this guidance and toolkit for providers:
Wellcare Quality
National Minority Health Month (NMHM)
April is a time to raise awareness about the importance of improving the health of racial and ethnic minority communities and reducing health disparities.
Minority and underserved communities often face limited access to care, higher rates of chronic conditions, and worse health outcomes, as well as stigma and discrimination in health care settings. For example, Black people are 30 percent more likely to die from heart disease, 50 percent more likely to have a stroke, and 30 percent more likely to have asthma. Additionally, compared to non-Hispanic White persons, Hispanic individuals are 70 percent more likely to be diagnosed with diabetes and 1.2 times more likely to be obese.
Build awareness about the disproportionate burden of premature death and illness in people from racial and ethnic minority groups by talking with patients about the importance of preventive care and recommend appropriate Medicare-covered preventive services.
View updated 2024 changes to AWV.
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Pharmacy Updates
Hyaluronic Acid
Effective 7/1/2024, as instructed by the Washington State Health Care Authority, Coordinated Care will no longer cover hyaluronic acid products. This is based upon the review of evidence performed by the Health Technology Clinical Committee.
| Code | Description of Codes |
|---|---|
| J7320 | Hyaluronan or derivitive, GenVisc 850, for intra-articular injection, 1 mg |
| J7321 | Hyaluronan or derivative, hyalgan, Supartz or VISCO-3, for intra-articular injection, per dose |
| J7322 | Hyaluronan or derivative, Hymovis, for intra-articular injection, 1 mg |
| J7323 | Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose |
| J7324 | Hyaluronan or derivative, Orthovisc, for intra-articular injection, per dose |
| J7325 | Hyaluronan or derivative, synvisc or Synvisc-One, for intra-articular injection, 1 mg |
| J7326 | Hyaluronan or derivative, Gel-One, for intra-articular injection, per dose |
| J7327 | Hyaluronan or derivative, Monovisc, for intra-articular injection, per dose |
| J7328 | Hyaluronan or derivative, gelsyn-3, for intra-articular injection, 0.1 mg |
| J7332 | Hyaluronan or derivative, Synojoynt, for intra-articular injection, 1 mg |
| J7332 | Hyaluronan or derivative, TRILURON, for intra-articular injection, 1 mg |
Opioid Reminder
Reminder, an Opioid Attestation Form is required when:
- Beginning chronic (non-cancer) use of opioids, or
- Daily opioid doses exceed 120 morphine milligram equivalents (MME).
Health Care Authority MME conversion factors for methadone use a sliding scale as follows:
| Methadone | Factor |
|---|---|
| up to 20mg per day | 4 |
| 21 to 40mg per day | 8 |
| 41 to 60mg per day | 10 |
| More than 60mg per day | 12 |
Evolent Update - Ambetter Only
Effective for dates of service on or after 4/1/2024, prior authorization requests for the following April 2024 new HCPCS codes need to be verified by Evolent.
| HCPCS | Generic Name | Brand Name | PA Required |
|---|---|---|---|
| J0209 | SODIUM THIOSULFATE (HOPE) INJECTION | SODIUM THIOSULFATE | Yes |
| J1010 | METHYLPREDNISOLONE ACETATE INJECTION | METHYLPREDNISOLONE ACETATE | No |
| J1323 | ELRANATAMAB-BCMM INJECTION | ELREXFIO | Yes |
| J1434 | FOSAPREPITANT INJECTION | FOCINVEZ | Yes |
| J2277 | MOTIXAFORTIDE INJECTION | APHEXDA | Yes |
| J2919 | METHYLPREDNISOLONE SODIUM SUCCINATE INJECTION | METHYLPREDNISOLONE SODIUM SUCCINATE | No |
| J3055 | TALQUETAMAB-TGVS INJECTION | TALVEY | Yes |
| J9073 | CYCLOPHOSPHAMIDE (INGENUS) INJECTION | CYCLOPHOSPHAMIDE | Yes |
| J9074 | CYCLOPHOSPHAMIDE (SANDOZ) INJECTION | CYCLOPHOSPHAMIDE | Yes |
| J9075 | CYCLOPHOSPHAMIDE INJECTION | CYCLOPHOSPHAMIDE | Yes |
| J9248 | MELPHALAN INJECTION | HEPZATO | Yes |
| J9249 | MELPHALAN (APOTEX) INJECTION | MELPHALAN | Yes |
| J9999 | TISLELIZUMAB-JSGR INJECTION | TEVIMBRA | Yes |
Participating providers should submit oncology/supportive drug authorizations for members through Evolent.
NEW FAX NUMBER Effective 5/28/24: Biopharmacy/Buy-bill Prior Authorization- Ambetter only
Effective 05/28/24, Biopharmacy/Buy-bill Prior Authorization requests for Ambetter will have a new fax number: 833-364-2511.
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Tribal
Resource for Assistance - all lines of business
IHCPs have access to a dedicated email inbox for inquires regarding all lines of business here at Coordinated Care (Medicaid, Marketplace/Exchange, and Medicare Advantage). Please don’t hesitate to reach out to IndianHealthCareProviderAssistance@coordinatedcarehealth.com and the team monitoring the inbox will assist or connect you with the appropriate contacts to resolve your questions.
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Clinical Policy Updates
There was no regular monthly clinical policy review in March.
The below policies were reviewed and updated to match new state benefits. These policy changes are effective on the dates noted. You will find the policies, including a description of the revisions, posted on the policy site.
Policy Number | Policy Title | Effective Date | Line of Business |
WA.CP.MP.502 | Cochlear | 1/1/24 | Apple Health |
| Transcranial Magnetic Stimulation for Treatment Resistant Major Depression | 4/1/24 | Apple Health |
The below policy will be archived effective May 1, 2024.
Policy Number | Policy Title | Line of Business |
WA.CP.BH.506 | Psychological Testing | Apple Health |
The below policies were previously announced as revised on the date noted. You will find the policies posted on the policy site.
Policy Number | Policy Title | Effective Date | Line of Business |
CP.MP.186 | Burn Surgery | 5/1/24 | Apple Health & Ambetter |
CP.MP.22 | Stereotactic Body Radiation Therapy | 7/1/24 | Apple Health & Ambetter |
| CP.MP.62 | Hyperhidrosis Treatments | 7/1/24 | Apple Health & Ambetter |
CP.MP.82 | NICU Apnea Bradycardia Guidelines | 7/1/24 | Apple Health & Ambetter |
CP.MP.173 | Implantable Intrathecal or Epidural Pain Pump | 7/1/24 | Apple Health & Ambetter |
CP.MP.190 | Oxygen Use and Concentrators | 7/1/24 | Ambetter |
CP.MP.243 | Implantable Loop Recorder (Implantable Cardiac Monitor) | 7/1/24 | Apple Health & Ambetter |
CP.MP.248 | Facility Based Sleep Studies for Obstructive Sleep Apnea | 7/1/24 | Apple Health & Ambetter |
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Wellcare
Rawlings (external vendor) Review of Medicare claims for Coordination of Benefits (COB)
As you know, we are committed to continuously evaluating and improving overall Payment Integrity solutions as required by State and Federal governing entities. We are writing today to inform you of an additional review that will go into place on or after 8/1/2024.
| Description of Changes | Lines of Business |
|---|---|
| Wellcare claims will be reviewed for coordination of benefits by Rawlings, an external vendor. In accordance to policy CC.PI.09 (Coordination of Benefits/Third Party Liability/Subrogation), providers will begin seeing correspondence from Rawlings when these claims are identified as being incorrectly paid for members with other primary coverage. Instructions for next steps and how to outreach for additional information will be included in the letters that Rawlings will send to the providers. | Medicare |
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Apple Health Core Connections (AHCC)
Coordinated Care is the single managed care organization to administer the Integrated Managed Care Apple Health Foster Care program in collaboration with the Health Care Authority and Department of Children Youth and Families. This program serves children and youth in foster care, adoption support, alumni of foster care (ages 18-26), and children reunified with their parents. Coordinated Care’s program is named “Apple Health Core Connections.” You can reach us at 1-844-354-9876 or AHCCTeam@coordinatedcarehealth.com.
The Coordinated Care Community Education Team serves providers and their staff with training to support the needs of the Medicaid population. The CE Team can offer training on topics such as SBIRT, Adoption Success, Trauma Informed Care, ACEs, Resilience, and Secondary Trauma and Self Care. To request more information or to schedule no-cost training please email: communityeducation@coordinatedcarehealth.com.
No-Cost TF-CBT Training
Coordinated Care is providing a no-cost Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) Training for contracted, in-network Coordinated Care providers. This training will be held on Wednesday May 1 and Thursday May 2, 2024 from 8:30 a.m. to 5:00 p.m. each day at: Northwest Indian College, Bellingham, WA. For more information reach out to Katherine.Ferguson@coordinatedcareheatlh.com.
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Training/Education
Deep dive into prevention ethics: Confidentiality and the SPF This series will address the need for ongoing prevention ethics training. In six interactive virtual sessions, participants will focus on taking a deep dive into the principles of the Code of Ethics for Prevention Specialists with special focus on how these principles apply when implementing the Strategic Prevention Framework (SPF). Each session will focus on a different principle. After a short presentation, participants will work together in small groups to look at how that principle can be applied by our prevention workforce while implementing the SPF.
Date: Thursday, May 2, 7:30-9:00AM Register here.
Adverse Childhood Experiences This training explains the Adverse Childhood Experiences (ACEs) study and identifies all 10 ACEs. All childhood experiences have an impact on people as they mature. This training explores the long-term effects that adverse childhood experiences have on physical and mental health. Preventative measures, resiliency, and how to address the needs of children with a high ACEs score are all discussed.
Date: Wednesday, May 8, 1:00PM Register here.
Supporting LGBTQIA+ Youth in Foster Care This course will focus on learning and creating an understanding of Sexual Orientation, Gender Identity & Expression (SOGIE), how to create an accepting and affirming spaces for LGBTQIA+ youth, and work on increasing cultural awareness of issues specifically facing LGBTQIA+ youth in Foster Care.
Date: Tuesday, May 28, 10:00AM Register here.
The Lost Boys – The forgotten Victims of the Child Abuse Material Industry The Lost Boys training is designed as an advanced level training for direct care staff and field staff working with Commercial Sexually Exploited Children (CSEC) and trafficking survivors. We will be discussing aspects of the child abuse material industry that are too often overlooked… boys: The Forgotten Victims. We will hear the stories and voices of male youth survivors in this training on the commercialized aspects of the child abuse material industry, enhance your knowledge base on trafficking, discuss myths & facts, current trends, and step inside the experiences of the forgotten victims themselves.
Date: Wednesday, May 29, 10:00AM - 1:00PM Register here.