April 2022 Provider News
Date: 04/29/22
In this issue:
- Billing Updates - Inactive NPIs: Requirement for Revalidation, Mental Health EBP Reporting for Behavioral Health Providers
- Quality - Postpartum/Newborn Visits, Lead Screening
- Apple Health Core Connections - April Update
- Clinical Policy - Reminders, Clinical Policy Updates
- Training/Education - Coordinated Care’s Lunch and Learn Webinar Presentation, Centene’s Clinical Provider Training, Say It Out Loud Conference, 2022 Washington Behavioral Healthcare Conference, Targeted Interventions: Firearms, Culture & Suicide Care Training
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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 the desired effective date they need their enrollment to start, on your application. 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 is 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.
CMS Blood Lead Testing Mandate – Lead Screening
Did you know Federal law mandates testing for all children covered by Medicaid? Completion of a 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.
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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. 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
CT Coronary Angiography: National Imaging Associates, Inc. (NIA), reviews certain requests to see if they are medically necessary and a covered service under Coordinated Care health plans. NIA has announced changes to policy CG-062, CT Coronary Angiography, will be effective May 1, 2022. You will find the policy, including a description of the revisions, on the NIA Website. A link is available on our Prior Authorization page.
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: Coordinated Care requires prior authorization of cell-free fetal DNA testing for Apple Health members. 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 Updates
The below clinical policies received updates as part of our regular monthly review in April. These policy changes are effective May 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.124 | ADHD Assessment | Apple Health & Ambetter |
CP.MP.100 | Allergy Testing | Apple Health & Ambetter |
WA.CP.MP.513 | Cardiac Stents | Apple Health |
WA.CP.MP.50 | Drugs of Abuse: Definitive Testing | Apple Health |
CP.MP.50 | Drugs of Abuse: Definitive Testing | Ambetter |
CP.BH.201 | Deep Transcranial Magnetic Stimulation for the Treatment of Obsessive Compulsive Disorder | Ambetter |
CP.MP.106 | Endometrial Ablation | Apple Health & Ambetter |
CP.MP.209 | GI Pathogen Nucleic Acid Detection Panel Testing | Apple Health & Ambetter |
CP.MP.121 | Homocysteine Testing | Apple Health & Ambetter |
CP.MP.123 | Laser Therapy for Skin Conditions | Apple Health & Ambetter |
CP.MP.139 | Low-Frequency Ultrasound and Noncontact Normothermic Wound Therapy | Ambetter |
WA.CP.MP.505 | Microprocessor-Controlled Lower Limb Prosthetics | Apple Health |
CP.MP.181 | Polymerase Chain Reaction Respiratory Viral Panel Testing | Apple Health & Ambetter |
WA.CP.MP.517 | Testosterone Testing | Apple Health |
CP.BH.200 | Transcranial Magnetic Stimulation for Treatment Resistant Major Depression | Apple Health & Ambetter |
WA.CP.MP.520 | Tympanostomy Tubes | Apple Health |
CP.MP.38 | Ultrasound in Pregnancy | Apple Health & Ambetter |
| CP.MP.98 | Urodynamic Testing | Apple Health & Ambetter |
| CP.MP.99 | Wheelchair Seating | Ambetter |
The below policies are archived effective May 1, 2022. If prior authorization is required, review will be based on InterQual criteria.
| Policy Number | Policy Title | Line of Business |
CP.MP.96 | Ambulatory EEG | Apple Health & Ambetter |
CP.MP.149 | Testing for Rupture of Fetal Membrane | Apple Health & Ambetter |
CP.MP.177 | Video Electroencephalography (V-EEG) | Apple Health & Ambetter |
CP.MP.189 | Thymus Transplantation (see CP.PHAR.563, Allogenic Processed Thymus Tissue) | Apple Health & Ambetter |
The below policies were previously announced to be revised as of 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 |
| 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 |
CP.MP.230 | Genetic Testing Multisystem Inherited Disorders, Intellectual Disability and Developmental Delay | Ambetter |
| 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 |
Old 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 |
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Training/Education
Coordinated Care’s Lunch and Learn Webinar Presentation: Join us on May 12th at 12 pm to discuss the HCA’s NPI Registration/Validation requirement and the Taxonomy requirement for claims submission. The webinar will review the background, requirements, and process. Registration is now open.
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.
Health Care Authority and DBHR are sponsoring the annual Say It Out Loud Conference which focuses on information sharing and networking to improve behavioral health services and decrease disparities faced by lesbian, gay, bisexual, transgender, and questioning (LGBTQ+) individuals. Virtual, May 26, 2022. Check the conference webpage for updates on registration.
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.
Safer Homes Suicide Aware at Forefront Suicide Prevention at the University of Washington present, Targeted Interventions: Firearms, Culture & Suicide Care. Training consists of three modules covering 1) firearms and culture, 2) firearms and suicide care, and 3) firearms, culture and suicide care – lethal means counseling. It is available on demand at no cost, or a fee if seeking CME. Register here.