August 2022 Provider News
Date: 08/30/22
In this issue:
- General Updates - New Value-Added Benefit for expectant moms (Pacify)
- Quality - Well Child Visits, Immunizations and Return to School Outreach
- Tribal - PaySpan Enrollment and Secure Provider Portal Updates
- Clinical Policy - Reminders and Updates
- Pharmacy Updates - Duplication of Therapy Edits
- Apple Health Core Connections - Child Welfare Virtual Expo, 988 Partner Toolkit, General Reminders
- Training/Education - Clinical Provider Training, Health Equity Conference and Harborview Behavioral Health Institute Conference
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General Updates
Pacify: New Value Added Benefit for Expectant Moms
A convenient way for members to connect with lactation consultants 24/7, birth doulas 24/7 and more.
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Quality
Well-Child Visits
Return to School: Who can Provide EPSDT Well-Child Checkups?
- Physicians and Resident Physicians
- Naturopathic Physicians
- Advanced Registered Nurse Practitioners (ARNPs)
- Physician Assistants (PAs)
- Registered Nurses working under the guidance of a Physician or ARNP may also perform EPSDT well-child checkups.
Immunizations
It has been proven that immunization is the most effective way to control the spread of preventable diseases. The Office of Immunization and Child Profile works for a safer and healthier Washington by:
- Preventing vaccine preventable disease in children, adolescents, and adults.
- Promoting healthy families and increasing use of preventive health care for children and adolescents.
- Providing vaccines at no cost to members under age 19.
Return to School: Well-Child Outreach
Children are returning to in person learning this fall. It is time to reach out and conduct catch up immunizations and well-child care. Coordinated Care can provide a list of kids with critical care gaps. For more information, please contact Eboney Reece-Herrera, our EPSDT Coordinator at: Eboney.A.ReeceHerrera@coordinatedcarehealth.com
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Tribal
Payspan: Sign up to receive Electronic Fund Transfers (EFT) and Electronic Remittance Advices (ERA)
Our Partnership with Payspan offers access to EFT’s and ERA’s allowing you to receive payments and remits quickly, without mail delays or bank deposit preparation. Click the links above for more information or reach out to your Provider Network Specialist for assistance in enrollment.
Provider Portal Updates: Taxonomy updates in Corrected Claims
We recently updated our Secure Provider Portal to allow submission of corrected claims for taxonomy changes through our portal. This update gives you, as one of our partners, an additional option in how to submit corrected claims either via secure provider portal, your clearinghouse, or via paper. Reach out to your Provider Network Specialist for additional training on this new feature or access it in the Provider Portal.
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Clinical Policy
Reminders:
Interventional Pain Management, Left Heart Catheterization, Cardiac Implants
Effective October 1, 2022, interventional pain management, left heart catheterization and cardiac implant services will be reviewed by National Imaging Associates, Inc. (NIA) to determine if the services are medically necessary and covered under Coordinated Care health plans. You will find the policies on the NIA Website. A link is available under “provider resources” on CoordinatedCareHealth.com. Policy names are listed below under Monthly Updates.
CPT codes considered interventional pain management for purposes of this review are: 0213T-0218T, 0228T-0231T, G0260, 27096, 62320-62323, 64479, 64480, 64483, 64484, 64490-64495, 64633-64636. All codes currently require prior authorization, but effective 10/1/22, authorization will be provided by NIA.
CPT codes considered left heart catheterization for purposes of this review are: 93452-93459, 93460-93464, 93565-933568. Prior authorization, issued by NIA, will be required effective 10/1/22.
CPT codes considered cardiac implants for purposes of this review are: 33221, 33224, 33225, 33231, 33230, 33240, 33249, 33206-33208, 33212, 33213. Prior authorization, issued by NIA, will be required effective 10/1/22.
Monthly Updates:
The below clinical policies received updates as part of our regular monthly review in August. These policy changes are effective September 1, 2022. You will find the policies, including a description of the revisions, posted on the policy site.
| Policy Number | Policy Title | Line of Business |
CP.MP.92 | Acupuncture | Ambetter |
WA.CP.MP.37 | Bariatric Surgery | Apple Health |
CP.MP.14 | Cochlear Implant Replacements | Apple Health & Ambetter |
WA.CP.MP.514 | Extra-Corporeal Membrane Oxygenation Therapy (ECMO) | Apple Health |
CP.MP.137 | Fecal Incontinence Treatments | Apple Health & Ambetter |
CP.MP.129 | Fetal Surgery in Utero for Prenatally Diagnosed Malformations | Apple Health & Ambetter |
CP.MP.85 | Neonatal Sepsis Management | Apple Health & Ambetter |
CP.MP.48 | Neuromuscular Electrical Stimulation (NMES) | Ambetter |
CP.MP.128 | Optic Nerve Decompression Surgery | Apple Health & Ambetter |
CP.MP.51 | Reduction Mammoplasty and Gynecomastia Surgery | Apple Health & Ambetter |
The below policies were previously announced as revised on the dates noted. You will find the policies posted on the policy site.
| Policy Number | Policy Title | Effective Date | Line of Business |
CP.MP.243 | Implantable Loop Recorder (Implantable Cardiac Monitor) | 9/1/22 | Apple Health & Ambetter |
CP.MP.244 | Liposuction of Lipedema | 10/1/22 | Apple Health & Ambetter |
New NIA Pain Management and Cardiac policies to be effective 10/1/22:
| Policy Number | Policy Title | Line of Business |
NIA_CG_300 | Epidural Spine Injections | Apple Health & Ambetter |
NIA_CG_301 | Paravertebral Facet Point Injections or Blocks | Apple Health & Ambetter |
NIA_CG_302 | Paravertebral Facet Joint Denervation (Radiofrequency Neurolysis) | Apple Health & Ambetter |
NIA_CG_303 | Sacroiliac Joint Injections | Apple Health & Ambetter |
NIA_CG_065 | Heart Catheterization | Apple Health & Ambetter |
NIA_CG_322 | Pacemaker | Apple Health & Ambetter |
NIA_CG_321 | Implantable Cardioverter Defibrillator (ICD) | Apple Health & Ambetter |
NIA_CG_320 | Cardiac Resynchronization Therapy | Apple Health & Ambetter |
Coordinated Care Pain Management policies to be archived 9/30/22:
| Policy Number | Policy Title | Line of Business |
CP.MP.164 | Caudal or Interlaminar Epidural Steroid Injections for Pain Management | Apple Health & Ambetter |
CP.MP.165 | Selective Nerve Root Blocks and Transforaminal Epidural Injections for Pain Management | Apple Health & Ambetter |
WA.CP.MP.171 | Facet Joint Interventions for Pain Management | Apple Health |
CP.MP.171 | Facet Joint Interventions for Pain Management | Ambetter |
CP.MP.166 | Sacroiliac Joint Interventions for Pain Management | Apple Health & Ambetter |
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Pharmacy Updates
Effective October 1, 2022, additional products will be added to Coordinated Care’s existing duplication of therapy edits to the Benzodiazepine, Antidepressant, and SSRI/SNRI drug classes for members over the age of 18. These edits are implemented to prevent members from receiving excessive medication regimens within the same, or similar medication drug classes. If duplication of therapy occurs, a prior authorization will be required. Below is a list of products that will be added to Coordinated Care’s existing duplication of therapy edits effective October 1, 2022.
Benzodiazepines
- Midazolam (Anticonvulsant)
- Estazolam
- Flurazepam HCl
- Midazolam HCL; Midazolam HCl-Sodium Chloride
- Quazepam
- Temazepam
- Triazolam
Antidepressants
- Vilazodone HCl
- Fluoxetine HCl (PMDD)
- Paroxetine Mesylate (Vasomotor)
Selective Serotonin Reuptake Inhibitors (SSRI)/Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)
- Fluoxetine HCl (PMDD)
- Paroxetine Mesylate (Vasomotor)
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Apple Health Core Connections
Coordinated Care is the only managed care organization administering the Integrated Apple Health Foster Care program in collaboration with the Health Care Authority and Department of Children Youth and Families. Our program, Apple Health Core Connections, serves children and youth in foster care, adoption support, alumni of foster care (ages 18-26), children reunified with their parents, and youth in the Unaccompanied Refugee Minor program. Providers and members can reach us at 1-844-354-9876 or AHCCTeam@coordinatedcarehealth.com.
The Coordinated Care Community Education (CE) 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 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.
Updates/Resources
- Reserve your seat for the 2022 Child Welfare Virtual Expo scheduled for September 28. Sponsored by the Children’s Bureau and the Center for States, this year’s theme is Power in Partnerships: Prioritizing Lived Expertise in Child Welfare.
- As of July 16, 2022, 988 is the new suicide and crisis lifeline. Providers and clinics can help spread the word. SAMHSA has added downloadable print files for wallet cards, magnets, and posters to its 988 Partner Toolkit.
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Training/Education
Visit Centene’s Clinical Provider Training website to find webinars available to all Coordinated Care providers. Webinars are on clinical behavioral health topics and usually offer free continuing education hours. Click on the “National Provider Webinars” button on the right side of the page and scroll to find a complete listing.
HRSA/IEA - Seattle (Region 10) will host a three-day Health Equity Conference to provide a forum whereby attendees can explore health equity through the lens of social determinants of health, and imagine new possibilities for the future of public health and primary care in Region 10. September 14-16, 2022, 8am-5pm virtually and Tacoma, WA. Register here.
Harborview Behavioral Health Institute Conference: Re-Imagining Behavioral Health: Race, Equity and Social Justice. The 2-half day virtual conference will explore the intersectionality of substance use disorders, mental health, and social justice. The event is designed to empower individuals and teams who want to advance health equity and support diversity and inclusion in behavioral health care. September 29-30, 2022. Learn more and register here.
Member Value Added Benefits Overview Please join us on Thursday, September 22, 2022, at 12:00pm (noon) We will be overviewing Member Value Added Benefits for all lines of business: Apple Health (Medicaid), Apple Health Core Connections (Youth in Foster Care), Ambetter by Coordinated Care (Exchange), Washington Wellcare (Medicare Advantage). Register link.