May 2022 Provider News
Date: 05/27/22
In this issue:
- Billing Updates - Inactive NPIs: Requirement for Revalidation
- Quality - Postpartum/Newborn Visits, PPC HEDIS Measure
- Apple Health Core Connections - May Update
- Clinical Policy - Reminders, Monthly Policy Updates, New Prior Authorization Requirements
- General Updates - One Health Port Single Sign On, Hepatitis C Policy Changes, On.Demand Program, Extended Postpartum coverage, HCA Primary Care Transformation Model Survey
- Training/Education - Centene’s Clinical Provider Training, Caring for Russian and Ukrainian Families in Washington State, Pediatric Mental Health CME Event, 2022 Washington Behavioral Healthcare Conference
- Pharmacy Update - July 1, 2022, Preferred Drug List Changes
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Billing Updates
Inactive NPIs: Requirement for Revalidation
Beginning January 1, 2022, Coordinated Care denies all claims submitted with an inactive NPI.
The Affordable Care Act (ACA) requires state Medicaid agencies to revalidate the enrollment of all Medicaid providers once every five years. To avoid any potential denials for an inactive NPI, providers must respond to HCA’s notices to complete revalidation. Upon receiving a revalidation notification, providers should gather and submit all documents requested on their Revalidation Checklist, complete the online revalidation process, and complete any other documents that may be required specific to their provider type. More information on the revalidation process can be found here.
If providers did not respond to their revalidation notification and therefore became inactive in ProviderOne, Coordinated Care began denying their claims on January 1, 2022. Please note that on Professional HCFA Claims, both the Rendering (box 24j) & Billing (box 33a) NPIs need to be active for payment. For Facility UB Claims, both Billing (box 56) & Attending (box 76) NPIs need to be active for payment. If either the individual or group NPI is inactive, the entire claim is denied EXnZ (denial will show as: NPI NOT REGISTERED. COMPLETE NPI ENROLLMENT/REVALIDATION PROCESS W/ HCA).
If a provider’s enrollment with HCA lapsed or they never enrolled with HCA, providers should complete the enrollment process specific to their provider type. More information about enrolling as a Medicaid Provider can be found on HCA’s site.
Please note: HCA will review requests for retro-active registration of providers if a provider’s registration has lapsed. A provider needs to complete the Effective Date Change form and other required documentation to be considered for retro-active registration.
As of March 2022: HCA is experiencing an extraordinarily high volume of applications and there is no automated way to track the status of pending applications. Coordinated Care and the HCA ask all providers to confirm on the application, the provider’s desired effective date they need their enrollment to start. Please do not call HCA to confirm receipt of your application, unless you did not receive the following message when you submitted your application:
Claims denied EXnZ will be reprocessed for providers whose retro-active registration is approved. This eliminates the need for providers to resubmit their claims or request reprocessing.
Please reach out to your Provider Network Specialist if you have any questions about the revalidation process.
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Quality
Postpartum/Newborn Visits
When scheduling Postpartum and Newborn visits, it's helpful to combine or make concurrent visits. This can be beneficial in making sure mom is taking care of herself as well as her newborn. Taking every opportunity to ensure mom's recovery outcome is healthy will benefit both mom and baby.
PPC Prenatal and Postpartum Care (NCQA)
Timeliness of Prenatal Care: The percentage of deliveries in which women had a prenatal care visit in the first trimester, on or before the enrollment start date or within 42 days of enrollment.
Postpartum Care: The percentage of deliveries in which women had a postpartum visit on or between 7 and 84 days after delivery.
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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), and 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.
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Clinical Policy
Reminders
Genetic Testing: Twenty-seven new genetic testing policies will be implemented on July 1, 2022, and are listed below. The policies can be found on our provider website under the “Genetic Testing” lists. Previously posted genetic testing policies will be archived as of June 30.
Cell-free Fetal DNA: The Health Care Authority does not fund testing for all pregnancies. Consequently, Coordinated Care requires prior authorization for cell-free fetal DNA testing. The current policy (WA.CP.MP.84) will be archived 6/30/22 and replaced with WA.CP.MP.231 – Genetic Testing Non-Invasive Prenatal Screening (NIPS) as part of the genetic testing policy update, but the prior authorization requirements will not change.
Clinical Policy Monthly Updates
The below clinical policies received updates as part of our regular monthly review in May. These policy changes are effective June 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 |
WA.CP.MP.519 | Administrative Days | Apple Health |
CP.BH.201 | Deep Transcranial Magnetic Stimulation for the Treatment of Obsessive Compulsive Disorder | Ambetter |
WA.CP.MP.504 | Elective Delivery Prior to 39 Weeks | Apple Health |
CP.MP.106 | Endometrial Ablation | Apple Health & Ambetter |
WA.CP.MP.27 | Hyperbaric Oxygen Therapy | Apple Health |
CP.MP.160 | Implantable Wireless Pulmonary Artery Pressure Monitoring | Ambetter |
CP.MP.87 | Inhaled Nitric Oxide | Apple Health & Ambetter |
CP.MP.24 | Multiple Sleep Latency Testing | Apple Health & Ambetter |
WA.CP.MP.507 | Oral Enteral Nutrition | Apple Health |
WA.CP.MP.506 | Psychological Testing | Apple Health |
CP.MP.146 | Sclerotherapy for Varicose Veins | Ambetter |
WA.CP.MP.185 | Skin Substitutes | Apple Health |
CP.MP.185 | Skin Substitutes for Chronic Wounds | Ambetter |
CP.MP.163 | Total Parenteral Nutrition and Intradialytic Parenteral Nutrition | Apple Health & Ambetter |
CP.BH.200 | Transcranial Magnetic Stimulation for Treatment Resistant Major Depression | Apple Health & Ambetter |
WA.CP.MP.522 | Varicose Vein Treatment | Apple Health |
WA.CP.MP.527 | Vitamin D Testing | Apple Health & Ambetter |
The below new policy was approved as part of our regular monthly review in May. This policy will be effective September 1, 2022. You will find the policy posted on the policy site.
| Policy Number | Policy Title | Line of Business |
CP.MP.243 | Implantable Loop Recorder (Implantable Cardiac Monitor) | Apple Health & Ambetter |
The below policy will be archived effective June 1, 2022. If prior authorization is required, review will be based on InterQual criteria.
| Policy Number | Policy Title | Line of Business |
WA.CP.MP.207 | Home Prothrombin Time Monitoring | Apple Health |
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.173 | Implantable Intrathecal or Epidural Pain Pump | 6/1/22 | Apple Health & Ambetter |
| CP.MP.86 | Neonatal Abstinence Syndrome Guidelines | 7/1/22 | Apple Health & Ambetter |
New Genetic Testing Policies effective 7/1/22:
| Policy Number | Policy Title | Line of Business |
CP.MP.215 | Genetic Testing Aortopathies & Connective Tissue Disorder | Apple Health & Ambetter |
CP.MP.216 | Genetic Testing Cardiac Disorder | Apple Health & Ambetter |
CP.MP.217 | Genetic Testing Dermatologic Conditions | Apple Health & Ambetter |
CP.MP.218 | Genetic Testing Epilepsy, Neurodegenerative and Neuromuscular Disorders | Apple Health & Ambetter |
WA.CP.MP.219 | Genetic Testing Exome and Genome Sequencing (addresses previous policy WA.CP.MP.524 - Whole Exome Sequencing) | Apple Health |
CP.MP.219 | Genetic Testing Exome and Genome Sequencing | Ambetter |
CP.MP.220 | Genetic Testing Eye Disorders | Apple Health & Ambetter |
CP.MP.221 | Genetic Testing Gastroenterologic Disorders (non-cancerous) | Apple Health & Ambetter |
CP.MP.222 | Genetic Testing General Approach to Genetic Testing | Apple Health & Ambetter |
CP.MP.223 | Genetic Testing Hearing Loss | Apple Health & Ambetter |
CP.MP.224 | Genetic Testing Hematologic Conditions (non-cancerous) | Apple Health & Ambetter |
CP.MP.225 | Genetic Testing Hereditary Cancer Susceptibility | Apple Health & Ambetter |
CP.MP.226 | Genetic Testing Immune, Autoimmune and Rheumatoid Disorders | Apple Health & Ambetter |
CP.MP.227 | Genetic Testing Kidney Disorders | Apple Health & Ambetter |
CP.MP.228 | Genetic Testing Lung Disorders | Apple Health & Ambetter |
CP.MP.229 | Genetic Testing Metabolic, Endocrine and Mitochondrial Disorders | Apple Health & Ambetter |
| CP.MP.230 | Genetic Testing Multisystem Inherited Disorders, Intellectual Disability and Developmental Delay | Ambetter |
| WA.CP.MP.230 | Genetic Testing Multisystem Inherited Disorders, Intellectual Disability and Developmental Delay (addresses previous WA.CP.MP.512- Genomic Microarray Testing) | Apple Health |
| WA.CP.MP.231 | Genetic Testing Non-Invasive Prenatal Screening (NIPS) (addresses previous policy WA.CP.MP.84 – Cell-free Fetal DNA Testing) | Apple Health |
| CP.MP.231 | Genetic Testing Non-Invasive Prenatal Screening (NIPS) | Ambetter |
| CP.MP.232 | Genetic Testing Pharmacogenetics | Apple Health & Ambetter |
| CP.MP.233 | Genetic Testing Pre-Implantation | Apple Health & Ambetter |
| CP.MP.234 | Genetic Testing Prenatal and Preconception Carrier Screening | Apple Health & Ambetter |
| CP.MP.235 | Genetic Testing Prenatal Diagnosis (via Amniocenteses, CVS or PUBS) and Pregnancy Loss | Apple Health & Ambetter |
| CP.MP.236 | Genetic Testing Skeletal Dysplasia and Rare Bone Disorders | Apple Health & Ambetter |
| CP.MP.237 | Oncology Algorithmic Testing (addresses previous policy WA.CP.MP.511 - Gene Expression Profile Testing for Cancer Tissue) | Apple Health & Ambetter |
| CP.MP.238 | Oncology Cancer Screening | Apple Health & Ambetter |
| CP.MP.239 | Oncology Circulating Tumor DNA and Circulating Tumor Cells (Liquid Biopsy) | Apple Health & Ambetter |
| CP.MP.240 | Oncology Cytogenetic Testing | Apple Health & Ambetter |
| CP.MP.241 | Oncology Molecular Analysis of Solid Tumors and Hematologic Malignancies | Apple Health & Ambetter |
Coordinated Care Genetic Testing Policies to be archived effective 6/30/22:
| Policy Number | Policy Title | Line of Business |
WA.CP.MP.84 | Cell-free Fetal DNA Testing | Apple Health |
CP.MP.84 | Cell-free Fetal DNA Testing | Ambetter |
CP.MP.89 | Genetic and Pharmacogenetic Testing | Apple Health & Ambetter |
| WA.CP.MP.511 | Gene Expression Profile Testing for Cancer Tissue | Apple Health |
| WA.CP.MP.512 | Genomic Microarray Testing | Apple Health |
WA.CP.MP.524 | Whole Exome Sequencing | Apple Health |
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General Updates
Coordinated Care is Joining OneHealthPort's Single Sign-On Service
Coming Soon, you'll be able to use your OneHealthPort Subscriber ID and password to access the Coordinated Care Provider Portal. We’ll update you as soon as it is available.
Your OneHealthPort Subscriber ID and password give you access to more than 25 health plan provider portals for eligibility, benefits, claim status, and more while only managing one ID and password. Once Coordinated Care is available on OneHealthPort, you'll be able to access Coordinated Care and Ambetter on the Coordinated Care provider portal by going to onehealthport.com/sso and clicking on the Coordinated Care logo.
If you're already registered with OneHealthPort, you're all set.
If your organization is not registered with OneHealthPort, your Administrator will need to register here and then nominate you for an account.
If you have questions about OneHealthPort or need assistance registering, please contact the OneHealthPort Help Desk at 800.973.4797.
Hepatitis C
We are striving to eliminate Hepatitis C in our state!
In order to work toward this goal, Coordinated Care has made policy changes:
- Anti-Viral MAVYRET medication is fully covered, and does not require prior authorization (PA)
- Anyone licensed to prescribe direct acting anti-viral medications is allowed to screen and treat members to support this effort.
BioTelemetry for Diabetes Management with the On.Demand Program
The On.Demand program is designed to enhance engagement, improve health outcomes, and reduce unnecessary spending. This diabetes management approach leverages real-time monitoring and supply delivery to enable the right intervention at the right time. On.Demand can track activation of the diabetic monitoring device, compliance and provide triage and coaching support. To qualify, members must have Type 1 or Type 2 Diabetes and:
- Test their blood sugar
- Be aged 14 or older
- Have HbA1c of 8 or greater
Members excluded from the program are those with gestational diabetes, in permanent nursing home place, or on hospice.
Members can be referred through the toll free customer service number: 1-888-982-7618, option 1 to enroll, or can be referred to Coordinated Care's Care Management Program: CareManagement@coordinatedcarehealth.com.
Providers must fill out a prescription at the request from the DME provider. This helps ensure our members are successful in their diabetes management.
Medicaid State Plan Amendment for Extended Postpartum Coverage
HCA Medicaid State Plan Amendment for extended post-partum coverage from the current 60-day period to 12 months.
What is After-Pregnancy Coverage (APC)?
Coming in June 2022, APC will be comprehensive Apple Health (Medicaid) coverage for individuals to access health care services any time in the 12 months after their pregnancy ends.
How to apply?
Beginning June 2022, if you are already on an Apple Health (Medicaid) program and a pregnancy is reported, coverage for APC will begin the first day of the month following the date the pregnancy ends.
APC is automatic if the pregnancy is reported with the estimated or actual pregnancy end date. It continues up to 12 months regardless of a change in income or the number of household members living at home during enrollment.
Individuals not enrolled in an Apple Health program during their pregnancy can still apply for APC if their last pregnancy ended within the past 12 months.
Report a change in pregnancy status
Current Apple Health clients should continue to report changes in their pregnancy status (including estimated due date). Without this information we cannot guarantee an additional 12 months of APC, starting the month after your pregnancy ends.
After-Pregnancy Coverage | Washington State Health Care Authority
HCA’s Primary Care Transformation Model Survey
HCA is reaching out to Washington’s primary Care providers. Please provide your perspective to shape implementation of the WA Primary Care Transformation Model!
About the Primary Care Transformation Model (PCTM)
HCA is working with the state’s purchasers, providers, and others to improve primary care for Washingtonians. The overarching goal of these transformation efforts is to achieve the quadruple aim of enhancing patient experience, improving population health (i.e., health outcomes), reducing costs, and improving the work life of health care providers, including clinicians and staff. The model supports this goal by:
- Promoting and incentivizing integrated, whole-person and team-based care
- Improving primary care provider capacity and access
- Increasing investment in a transformed primary care system while better managing total cost of care over time
- Aligning payment incentives as well as quality metrics across payers and providers
- Working with interested public and private employers to spread and scale the model throughout Washington State
For more information on the model, visit HCA’s PCTM website.
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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.
CoLab for Community and Behavioral Health Policy hosted a webinar that focused on the updated 2021 Reporting Guide for Research- and Evidence-based Practices in Children's Mental Health in Washington State. Discussed updates to the guide, what reporting looks like from a provider and supervisory perspective, reviewed a case example, and discussed some of the technical aspects of reporting via EHR and billing systems. Watch here.
On June 8th from 7:00-8:00am WCAAP presents: Caring for Russian and Ukrainian Families in Washington State. Understanding fear, trauma, and hesitancy with Dr. Tetyana Odarich. Dr. Odarich began her medical education at National Medical University in Kyiv. She moved the US in 2001 and received her medical degree from Oregon Health and Science University. Register here.
Pediatric Mental Health CME Event hosted by Seattle Children’s Partnership Access Line. Topics include depression, psychosis, and perinatal psychiatry. June 11, 2022, 8:00am-12:30pm. Register here.
2022 Washington Behavioral Healthcare Conference: Surviving and Thriving in a Changing World. Virtual conference. June 15-17, 2022. Register and learn more on the conference website.
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Pharmacy Update
Effective July 1, 2022, certain medications will no longer be preferred by Coordinated Care. Please see list below as well as potential alternatives.
| Effective Date | Drug Name | Potential Alternatives |
07/01/2022 | Novolog Mix 70/30 |
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| 07/01/2022 | Brand Vandazole Gel |
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| 07/01/2022 | Mycozyl AC Cream |
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