February 2024 Provider News
Date: 02/27/24
In this issue:
- Provider Alert - Change Healthcare Cybersecurity Incident
- General Updates - New CMS Provider Types as of 1/1/2024, NEW FAQ from the HCA – How to Enroll a NPI, Release of ASAM Criteria, 4th edition and public comment on adolescent framework, New Service Encounter Reporting Instructions (SERI) interim guidance available, 6 Degrees Health – New Clean Claim Vendor Effective 1-2-24 (ALL LOBs), Wellcare QRG
- Quality - Health Equity Accreditation (HEA), Annual Wellness Visits (AWV)
- Tribal - Monthly Claims denial outreach change
- Clinical Policy - Monthly Updates
- Apple Health Core Connections - Initial Health Screens: Requirement Change
- Training/Education - March Training Offerings
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Provider Alert
Change Healthcare Cybersecurity Incident and Its Impact to Coordinated Care of Washington
On February 21, Change Healthcare, a software and data analytics subsidiary of UnitedHealth Group’s Optum unit, experienced a cybersecurity incident that has impacted its network and operations. The cybersecurity incident has created a service disruption impacting Coordinated Care’s members and provider network in several ways.
As of now, Change Healthcare has not provided a timeline for resolution. To protect our members and providers we, Coordinated Care, fully disconnected system access to and from Change Healthcare on Feb. 21. We are working on multiple solutions to restore provider functionality and ensure continuity of care for our members. We will continue to provide updates as this situation evolves.
Electronic Claim Submission
The ability to electronically submit claims to Coordinated Care through Change Healthcare is currently down. Providers can easily submit electronic claims to Coordinated Care via many alternative methods including other claims clearinghouses, our secure provider portal or mail. Our preferred clearinghouse for electronic claims submission is Availity. To enroll, please visit the Availity Essentials Portal Registration page and/or call Availity Client Services at 1-800-AVAILITY (1-800-282-4548). For step-by-step instructions for Availity, visit the resource page on our parent company, Centene’s, website. Additional information on claims submission can be found in our Provider Manual located on our website.
Reimbursement via Paper Check and Virtual Credit Card (VCC)
Some paper check and virtual credit card payment processes for Coordinated Care have been disrupted due to this incident. We apologize for any inconvenience this causes. Please know we are working quickly to implement a new process to ensure payments are operational as soon as possible. An alternate way to speed up your payment process is to set up an automated clearing house (ACH) for electronic funds transfer (EFT). Coordinated Care’s preferred ACH/EFT partner, PaySpan (now part of Zelis), has offered to help expedite the sign-up process for providers by calling 1-877-331-7154 or visiting PaySpan.
Chart Retrieval
Change Healthcare performs retrieval of medical records for several of our programs, such as HEDIS® and Risk Adjustment. You may have received a request via phone or fax from Change Healthcare on behalf of Coordinated Care, where you either scheduled appointments or provided medical records. Change Healthcare is unable to honor any fulfillment requests at this time; however, we will be employing two of our existing medical record retrieval vendors, Datavant (formerly Ciox) and Datafied, to satisfy these prior commitments.
These retrievals are required to report on clinical quality measures and diagnosis data to Health and Human Services (HHS), the Centers for Medicare & Medicaid Services (CMS) and the National Committee for Quality Assurance (NCQA). We ask that you please honor the same commitment dates for these vendors, even if you have already committed to providing medical records to Change Healthcare. If you have provided medical records from the time period of Feb. 19, 2023 to current, you may be asked to provide these medical records again.
Thank you for your patience and partnership as we navigate this situation. We apologize for any inconvenience in this matter. If you have any questions, please contact your Provider Engagement representative or our Provider Services team at 1-877-644-4613 or visit Centene's Change Healthcare Outage Overview.
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General Updates
New CMS Provider Types as of 1/1/2024
As of 1/1/2024 CMS implemented 2 new provider types:
- Marriage and Family Therapist (MFT)
- Mental Health Counselor (MHC)
These providers may now enroll as Medicare Providers with CMS and can contract with our Medicare Advantage product Wellcare. Please contact: JoinOurNetwork@Coordinatedcarehealth.com for more information and for contracting.
NEW FAQ from the HCA – How to Enroll a NPI
The Washington State Health Care Authority has published a NEW FAQ – How to enroll a National Provider Identifier (NPI) with Health Care Authority.
Release of ASAM Criteria, 4th edition and public comment on adolescent framework
American Society of Addiction Medicine (ASAM) has recently released the 4th edition of their criteria. This edition, focused on adults, includes substantial changes aimed at improving the guidelines for placement, continued stay, and transfer/discharge of individuals with substance use disorders (SUD) and co-occurring conditions.
Assessment and Treatment Planning considerations for adolescents and transition age youth writing period is scheduled for 2024. The State of Washington will determine the official transition process to the new ASAM criteria with the transition being planned between January and July of 2025. A more definite schedule is forthcoming. As a part of this transition, Health Care Authority (HCA) is actively developing a comprehensive plan that will include training for the updated 4th edition of the ASAM criteria. More information about the transition plan and training sessions will be communicated in the coming months through GovDelivery.
New Service Encounter Reporting Instructions (SERI) interim guidance available
After internal HCA and collaboration with MCO and BH-ASO partners during the December 18, 2023, SERI work group, it was determined there were modifiers which are not appropriate listed in the Crisis Services section (pages 15-18) for specific Crisis Intervention and Crisis Stabilization codes.
Interim Guidance can be found here.
6 Degrees Health – New Clean Claim Vendor Effective 6-1-24 (ALL LOBs)
Coordinated Care is pleased to share that we will be transitioning from Optum to 6 Degrees Health for our clean claim reviews. The Go-Live launch is tentatively set for June 1, 2024.
This transition will be seamless for our provider community and reflects our ongoing efforts to make it easier to do business with Coordinated Care. 6 Degrees Health offers providers the ability to submit records via mail, fax or electronically (by email). You will begin seeing record request correspondence from 6 Degrees Heath and we will provide additional information regarding the transition closer to the go-live date.
Wellcare Quick Reference Guide (QRG)
We have a new Quick Reference Guide (QRG) showing the vendor changes to National Imaging Associates. The new QRG is located on the Wellcare Provider Portal here.
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Quality
Medicaid Quality
Health Equity Accreditation (HEA)
We are excited to announce that Coordinated Care has obtained Health Equity Accreditation (HEA) on both Medicaid and Marketplace lines of business.
What Is Health Equity Accreditation?
The NCQA defines health equity accreditation as “the foundation of health equity work building an internal culture that supports the organization's external health equity work” through programs by:
- Identifying opportunities to reduce health inequities and improve care.
- Improving data collection and analysis of disparities in care to guide actions to address gaps.
- Collecting data that helps the organization create and offer language services.
Coordinated Care understands that health equity can only exist when all people have access to the same opportunities to attain their full physical and behavioral health and well-being, regardless of gender, race, ethnicity, disability, age, cultural characteristics, gender identity, sexual orientation, socioeconomic status, geography, language, or any other social barriers.
Lead Poisoning Screening - EPSDT
All children 12 - 24 months of age should be tested for the risk of lead poisoning. This testing is a Federally mandated preventative health benefit.
For more information, please visit the Department of Health’s website.
Asthma and 90 Day Refills
Moving members with asthma to 90-day refills may increase their medication adherence.
Coordinated Care provides members with 90-day supplies through our preferred mail order pharmacy, CVS Caremark, or any contracted pharmacy.
Wellcare Quality
Annual Wellness Visits
Annual Wellness Visits (AWV) are an opportunity to close clinical HEDIS measure gaps, establish or strengthen your Provider/Patient rapport and most importantly provide quality health care including early detection to save lives. The AWV helps develop or update a Personalized Prevention Plan (PPP) and perform a Health Risk Assessment (HRA).
Helpful resources for Annual Wellness Visits can be found here.
CMS website Medicare Learning Network documents 12 defined components of the First Annual Wellness Visit and subsequent Annual Wellness Visits having 11 components. Preparing eligible Patients for the AWV can include encouraging them to bring to their appointment at a minimum:
- Medical records, including immunization records
- Detailed family health history
- Full list of medications and supplements, including calcium and vitamins, and how often and how much of each they take
- Full list of current providers and suppliers involved in their care, including community-based providers (for example, personal care, adult day care, and home-delivered meals), and behavioral health specialists
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Tribal Updates
Monthly Tribal claims outreach reporting change- Medicaid claims only
There has been a change in the timelines in which IHCP's will receive their monthly report for denial and rejection trends. Due to a change with HCA reporting, the outreach and reports will now be sent via email at the beginning of the month, rather than the end of the month, for the previous month of received claims. For example, the January claims reports will be sent the beginning of February rather than the end.
Please reach out to IndianHealthCareProviderAssistance@coordinatedcarehealth.com with any questions.
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Clinical Policy Updates
There was no regular monthly clinical policy review in January.
The below policy is new effective January 1, 2024. You will find the policy posted on the policy site.
| Policy Number | Policy Title | Line of Business |
|---|---|---|
WA.CP.MP.528 | Intensive Behavioral Supportive Supervision | Apple Health |
The below genetic testing policies received updates as part of our twice-yearly review. Previously announced as effective January 1, these policy changes are now effective April 1, 2024. You will find the policies, including a description of the revisions, posted on the policy site.
| Policy Number | Policy Title | Line of Business |
|---|---|---|
V1.2024 | CG Aortopathies and Connective Tissue Disorders | Apple Health & Ambetter |
V1.2024 | CG Cardiac Disorders | Apple Health & Ambetter |
V1.2024 | CG Dermatologic Conditions | Apple Health & Ambetter |
V1.2024 | CG Epilepsy Neurodegenerative and Neuromuscular Conditions | Apple Health & Ambetter |
V1.2024 | CG Exome and Genome Sequencing for DX of Genetic Disorders | Apple Health & Ambetter |
V1.2024 | CG Eye Disorders | Apple Health & Ambetter |
V1.2024 | CG Gastroenterologic Disorders Non-cancerous | Apple Health & Ambetter |
V1.2024 | CG General Approach to Genetic Testing | Apple Health & Ambetter |
V1.2024 | CG Hearing Loss | Apple Health & Ambetter |
V1.2024 | CG Hematologic Conditions Non-cancerous | Apple Health & Ambetter |
V1.2024 | CG Hereditary Cancer Susceptibility | Apple Health & Ambetter |
V1.2024 | CG Immune Autoimmune and Rheumatoid Disorders | Apple Health & Ambetter |
V1.2024 | CG Kidney Disorders | Apple Health & Ambetter |
V1.2024 | CG Lung Disorders | Apple Health & Ambetter |
V1.2024 | CG Metabolic Endocrine Mitochondrial Disorders | Apple Health & Ambetter |
V1.2024 | CG Multisystem Inherited Disorders, Intellectual Disability and Developmental Delay | Ambetter |
WA.CP.MP.230 | Genetic Testing Multisystem Inherited Disorders, Intellectual Disability and Developmental Delay | Apple Health |
V1.2024 | CG Non-Invasive Prenatal Screening | Ambetter |
WA.CP.MP.231 | Genetic Testing Non-Invasive Prenatal Screening (NIPS) | Apple Health |
V1.2024 | CG Oncology Algorithmic Testing | Apple Health & Ambetter |
V1.2024 | CG Oncology Cancer Screening | Apple Health & Ambetter |
V1.2024 | CG Oncology Circulating Tumor DNA Tumor Cells Liquid Biopsy | Apple Health & Ambetter |
V1.2024 | CG Oncology Cytogenetic Testing | Apple Health & Ambetter |
V1.2024 | CG Oncology Molecular Analysis Solid Tumors & Hematolgic Malignancies | Apple Health & Ambetter |
V1.2024 | CG Pharmacogenetics | Apple Health & Ambetter |
V1.2024 | CG Preimplantation Genetic Testing | Apple Health & Ambetter |
V1.2024 | CG Prenatal and Preconception Carrier Screening | Apple Health & Ambetter |
V1.2024 | CG Prenatal Diagnosis Pregnancy Loss | Apple Health & Ambetter |
V1.2024 | CG Skeletal Dysplasia Rare Bone Disorders | Apple Health & Ambetter |
The below Envolve Vision policies were updated effective January 1. You will find the policies, including a description of the revisions, posted on the Envolve Vision site. A link is available on our policy site.
| Policy Number | Policy Title | Line of Business |
|---|---|---|
CP.VP.01 | Adjacent Tissue Transfer / Grafts involving Eyelid | Apple Health & Ambetter |
CP.VP.02 | Age Related Macular Degeneration | Apple Health & Ambetter |
CP.VP.03 | Amblyopia | Apple Health & Ambetter |
CP.VP.04 | Amniotic Membrane Placement on the Ocular Surface | Apple Health & Ambetter |
CP.VP.05 | Aqueous Shunt | Apple Health & Ambetter |
CP.VP.07 | Blepharoplasty, Ptosis Repair and Canthoplasty | Apple Health & Ambetter |
CP.VP.08 | Cataract Extraction | Apple Health & Ambetter |
CP.VP.10 | Chemodenervation of the Eyelid | Apple Health & Ambetter |
CP.VP.11 | Probing and Closure of the Lacrimal Duct System | Apple Health & Ambetter |
CP.VP.12 | Complex Cataract Extraction | Apple Health & Ambetter |
CP.VP.14 | Scanning Computerized Opthalmic Diagnostic Imaging | Apple Health & Ambetter |
CP.VP.16 | Corneal Pachymetry | Apple Health & Ambetter |
CP.VP 17 | Corneal Hysteresis | Apple Health & Ambetter |
CP.VP 18 | Corneal Topography | Apple Health & Ambetter |
CP.VP 19 | Destruction of Extensive or Progressive Retinopathy | Apple Health & Ambetter |
CP.VP 20 | Destruction of Localized Lesion of Choroid | Apple Health & Ambetter |
CP.VP 21 | Destruction of Localized Lesion of the Retina | Apple Health & Ambetter |
CP.VP 23 | Dark Adaption and Color Vision Examination | Apple Health & Ambetter |
CP.VP 25 | Ectropion_Entropion Repair | Apple Health & Ambetter |
CP.VP 26 | Extended Ophthalmoscopy | Apple Health & Ambetter |
CP.VP 28 | Fluorescein Angiography | Apple Health & Ambetter |
CP.VP 29 | Fundus Photography | Apple Health & Ambetter |
CP.VP 31 | Gonioscopy | Apple Health & Ambetter |
CP.VP 32 | Indocyanine Green (ICG) Angiography | Apple Health & Ambetter |
CP.VP 33 | Infracture of the Inferior Turbinate | Apple Health & Ambetter |
CP.VP 34 | Iris Coloboma | Apple Health & Ambetter |
CP.VP 35 | Refraction | Apple Health & Ambetter |
CP.VP 36 | Keratoplasty | Apple Health & Ambetter |
CP.VP 37 | Laser Iridotomy and Inferior Turbinate | Apple Health & Ambetter |
CP.VP 38 | Laser Trabeculoplasty | Apple Health & Ambetter |
CP.VP 40 | Photdynamic and Intravitreal Therapies | Apple Health & Ambetter |
CP.VP 43 | External Ocular Photography | Apple Health & Ambetter |
CP.VP 44 | Ocular Prosthesis | Apple Health & Ambetter |
CP.VP 45 | Ophthalmic Biometry | Apple Health & Ambetter |
CP.VP 46 | Visual Therapy | Apple Health & Ambetter |
CP.VP 48 | Secondary Intraocular Lens | Apple Health & Ambetter |
CP.VP 49 | Recurrent Corneal Erosion, Photo Keratectomy | Apple Health & Ambetter |
CP.VP 52 | Refractive Surgery | Apple Health & Ambetter |
CP.VP 53 | Prophylaxis of Retinal Detachment | Apple Health & Ambetter |
CP.VP 54 | Repair of Retinal Detachment | Apple Health & Ambetter |
CP.VP 55 | Sensorimotor Examination | Apple Health & Ambetter |
CP.VP 57 | Surgical Strabismus Repair | Apple Health & Ambetter |
CP.VP 61 | Trabeculectomy Ab Externo | Apple Health & Ambetter |
CP.VP 63 | Visual Field Testing | Apple Health & Ambetter |
CP.VP 64 | Vitrectomy | Apple Health & Ambetter |
CP.VP 65 | Yttrium Aluminium Garnet (YAG) Laser Capsulotomy | Apple Health & Ambetter |
CP.VP 66 | Specular Microscopy | Apple Health & Ambetter |
CP.VP 67 | Ant Segment Photography, Fluorescein Angio | Apple Health & Ambetter |
CP.VP 68 | Ophthalmic B-Scans | Apple Health & Ambetter |
CP.VP 71 | Low Vision Evaluations and Aids | Apple Health & Ambetter |
CP.VP 74 | Serial Tonometry | Apple Health & Ambetter |
CP.VP 75 | Surgical Excison of Eyelid Lesions | Apple Health & Ambetter |
CP.VP 76 | Canthotomy | Apple Health & Ambetter |
CP.VP 77 | Glaucoma Screening | Apple Health & Ambetter |
CP.VP 78 | Eyelid Reanimation | Apple Health & Ambetter |
CP.VP 80 | Ocular Surface Reconstruction | Apple Health & Ambetter |
CP.VP 86 | Electroretinography | Apple Health & Ambetter |
CP.VP 88 | Teleretinal Screening for Diabetic Retinopathy | Apple Health & Ambetter |
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.107 | Durable Medical Equipment (DME) and Orthotics and Prosthetics Guidelines | 3/1/24 | Apple Health & Ambetter |
| CP.MP.186 | Burn Surgery | 5/1/24 | Apple Health & Ambetter |
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Apple Health Core Connections (AHCC)
Prior to the passage of HB 1227 that went into effect on July 1, 2023, all youth in foster care were required to receive an Initial Health Screen within the first five days of entering foster care. With the new legislation, Initial Health Screens are no longer required for all children entering foster care.
New Requirements: Caseworkers are instructed to identify whether children and youth have any health care needs.
- If children/youth have an emergent health care need, they must be taken to urgent care or the emergency department immediately to be evaluated.
- If they have a non-emergent illness, chronic health issue, injury, or health concern, the child/youth must receive an Initial Health Screen within the first five days of enter out-of-home care.
- If there are no known medical needs, an Initial Health Screen does not need to occur.
All children in foster care must still have an EPSDT completed within the first 30 days of entering out-of-home care. As a reminder, providers should use the TJ Modifier to receive a higher payment for conducting the EPSDT for youth in foster care.
For questions, please contact AHCCTeam@coordindatedcarehealth.com.
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Training/Education
Deep dive into prevention ethics: Integrity and the SPF: Six interactive virtual sessions, focusing on taking a deep dive into the principles of the Code of Ethics for Prevention Specialists and 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. Thursday March 7th 7:30 AM - 9 AM Register here.
Substance Use and Other Risk Factors for Gun Violence: Prevention and Intervention Strategies This presentation focuses on the intersection of adolescent substance use and gun violence in metropolitan, suburban, and rural communities. Along with substance use, 15 additional risk factors for gun violence will be discussed. Emphasis will be placed upon protective factors which help buffer the impact of risk factors. Tuesday March 12th 8 AM - 9:30AM Register here.
Catalyst for Change Webinar Series: Centering Health Equity in Value-based Care Join the Foundation for Health Care Quality in collaboration with Washington Health Alliance and Comagine Health to kick off the first webinar of a three-part series on Catalyst for Change, focused on health equity in a value-based era! Wednesday March 6th 12 PM - 1:30 PM Register here.
Supporting LGBTQ+ Immigrants This webinar will provide an overview of the lived experiences of LGBTQ+ immigrant communities in the United States. Historically, the United States has been a beacon for immigrants. The untold narratives of LGBTQ+ immigrants are least known about. There are an estimated 904,000 LGBTQ+ immigrants in the United States, which means that more than one in ten LGBTQ adults are immigrants. Using an Indigenized framework this webinar will share knowledge to assist providers think through culturally responsive best practices when providing services to LGBTQ+ immigrants. This webinar will also share information on how to support LGBTQ+ immigrants in their own communities, as well as ways to address the barriers they face in accessing and receiving care. Tuesday March 5th 11 AM - 12 Register here.
TALK: Toolkit for Adolescent Care This toolkit supports primary care clinicians in provider their adolescent patients with high-quality preventive care that addresses psychosocial and sexual health topics, including three components: 1) Training for clinicians in communication strategies for addressing sensitive topics; 2) Resources for clinicians such as 1-page conversation starters on 12 different topics; 3) Standardizing adolescent-friendly clinic practices. Learn more here.