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August 2021 Provider News

Date: 08/30/21

In This Issue

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Quality

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.

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 lists of kids with critical care gaps. For more information please contact Eboney Reece-Herrera, our EPSDT Coordinator at: Eboney.A.ReeceHerrera@Centene.com. 

Wildfire Season

For those impacted by the fires in Washington – status updates and shelter resources can be found here on the governor.wa.gov web site.

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Payment Integrity Updates

Diagnosis-Related Group (DRG) Audits – Ambetter

Effective 11/1/2021

In an ongoing effort to ensure high quality claims processing and payment, Coordinated Care Corporation is taking additional steps to verify the accuracy of payments made to our contracted facilities. Beginning in November, 2021, Coordinated Care will begin auditing selected claims and associated medical records to ensure payments were applied in accordance with national correct coding standard rules.

Coordinated Care has contracted with Cotiviti to assist us in this effort. If you have claims selected for audit, you will receive a letter from Cotiviti requesting medical records for these claim audits on behalf of Coordinated Care Corporation.

If you have any questions, please contact Provider Relations. We appreciate your participation in our network and your dedication to the health and welfare of our members and your patients. 

Durable Medical Equipment (DME) /Home Health (HH) /Skilled Nursing Facilities (SNF) Post-Payment Audit Process

DME – Apple Health Core Connections & Ambetter

HH/SNF – Ambetter Only

Effective 11/1/2021

Effective November 1, 2021, Coordinated Care of Washington, Inc. and Coordinated Care Corporation (collectively Coordinated Care) will implement a DME, Home Health, and Skilled Nursing Facility Post Payment audit process for a select sample of network claims each month.  

To support this process Coordinated Care will be using an approved vendor, Performant, to complete these audits.

For providers who may have a claim selected for post-payment audit they will be provided written notice of the audit and asked to supply Medical Record documentation to Performant to substantiate the services associated with the claim.

If you have any questions please contact Provider Relations.

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General Updates

CCW Response to COVID-Surge- Supporting Discharges

In response to the rising census levels across the State and reports of capacity issues at Acute Care Hospitals Coordinated Care is notifying providers of efforts to expedite safe discharges.

  • A $6,000 one-time payment  will be made to SNFs for members newly admitting from Acute Care Hospitals to expedite discharges and open up acute care beds
    • Additional funding is currently approved from 8/9/2021-9/30/2021
    • For Apple Health (Medicaid) members Health Care Authority will issue additional payment. Payments will be issued from Home and Community Services for Dual eligible (Medicare/Medicaid) members. 
  • Prior authorization requirements for in-network Skilled Nursing Facility (SNF) admissions are suspended. Coordinated Care will approve the first 7 calendar days following admission at the level of care requested. We ask that facilities provide notification of admission within those 7 calendar days. 
    • Prior Authorization for Long Term Acute Care and Inpatient Rehabilitation admissions is still required. 
  • We continue to up-level all SNF admissions to provide additional per diem payment. On a case-by-case basis, we offer additional per diem increases for members with complex or unique care needs. 
  • Coordinated Care continues to issue SNF Pre Admission approval letters which include an authorized Level of Care and a guaranteed approval time frame. These letters can be sent from Hospitals or Coordinated Care staff to Skilled Nursing Facilities. 
  • Authorizations necessary to facilitate discharge will be processed within 24 hours. This includes Skilled Nursing Facilities, Durable Medical Equipment, Home Health etc…
    • To assist us with expediting authorizations please submit requests as urgent. You can also note the member is currently inpatient. We do not require signatures of any kind to submit a Prior Authorization as urgent.
    • Please note Coordinated Care will authorize medically necessary services retrospectively if authorization could not be obtained timely due to a pending discharge

Our Complex Discharge Planning Team is here to assist with any barriers to discharge. Please contact us at ComplexDischargePlanning@CoordinatedCareHealth.com. 

Provider Relief Funds

The Health Care Authority has received additional federal resources for distribution to behavioral health treatment providers. Funds from the newly passed Senate Bill 5096 under 215 (67) includes proviso language on the American Rescue Plan Act (ARPA) of 2021, and the Coronavirus State Fiscal Recovery Fund (CSFRF). The proviso will replace loss of revenue or increase of expenses due to the COVID-19 pandemic during March 1, 2020, through June 30, 2021. More detail can be found on HCA's fact sheet (PDF).

Thank you for continuing to provide services to individuals who had their services paid for with public funds during the COVID Pandemic. As the economic consequences of the COVID-19 pandemic have progressed, more people than ever rely on behavioral health providers as a safety net for access to mental health and substance use disorder treatment. Your efforts have been vital to ensuring the health of some of our state’s most vulnerable residents.

Requests can be completed through a quick and simple online application on HCA's web site. The application process will be open for three weeks, ending on September 10.

Questions can be sent to HCADBHRBHCOVID19@hca.wa.gov.

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Training and Education

InteQual Connect (IQC)

Coordinated Care is pleased to announce, effective September 1, 2021, we will launch the redesign of our web authorization request in our Secure Provider Portal, and the integration of an exciting new tool, InterQual Connect™. InterQual Connect (IQC), is an integrated medical review solution, enabling payers and providers to streamline the medical review process, and eliminate redundant reviews. Adding these features will simplify the provider experience. 

Coordinated Care will offer 3, hour-long webinars to cover IQC and authorization updates in the Secure Provider Portal. These webinars will be offered during the following dates and times:

If these dates or times don't work for your organization, we’d be happy to share our full presentation deck with your team. If you’d like to schedule a separate live training, please work with your Provider Network Specialist or reach out to us at TAC_Network_Management_Team@coordinatedcarehealth.com to get something scheduled.

The web authorization redesign and InterQual Connect, offers several new capabilities:

  • Streamlined web authorization request
  • Advises users if a service requires/does not require authorization or is not covered
  • Easy access to InterQual Connect to complete medical review
    • Completed InterQual medical review will automatically be included with your web authorization submission 
    • Possible instant approval based on outcome of a completed InterQual medical necessity review 
  • Identifies non-submitted Service Lines and provides reason for non-submittal

AWHP MCO Provider Resources Page

Coordinated Care encourages providers to visit the Association of WA Health Care Plans MCO Provider Resources at https://www.wahealthcareplans.org/mco-resources.  As a MCO member of AWHP, Coordinated Care is committed to ensuring providers have appropriate resources to deliver integrated care to Apple Health (Medicaid) members across the state. Training and resources for providers are continuously developed by MCOs and shared on this site.

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Pharmacy

Effective 10/01/2021, certain medications will no longer be preferred by Coordinated Care. Please see list of medications on the Pharmacy page in the provider section of our web site (PDF). Impacted members will be notified of these changes. 

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