Skip to Main Content

July 2021 Provider News

Date: 07/30/21

In This Issue

______________________________________________________________________________________

Quality: Better Patient Outcomes through Evidence Based Practices

This Month: Eye Movement Desensitization and Reprocessing Therapy (EMDR) (EPA Number 870001598, SERI: 860043000)

Who benefits: Eye Movement Desensitization and Reprocessing (EMDR) therapy is an integrative psychotherapy approach that has been extensively researched and proven effective for the treatment of trauma.  Children, adolescents, and adults who have experienced trauma; posttraumatic stress disorder (PTSD), posttraumatic stress, phobias, and other mental health disorders. Children and adolescents ages 2-17 and adults.

Improves/helps with these outcomes:

  • Target the past events that trigger disturbance
  • Target the current situations that trigger disturbance
  • Affective distress is relieved
  • Negative beliefs are reformulated
  • Physiological arousal is reduced

Brief description of intervention:  A typical EMDR session lasts from 60 to 90 minutes. The type of problem, life circumstance and the amount of previous trauma will determine how many treatment sessions are necessary. Eye movement desensitization and reprocessing is a form of psychotherapy in which the person being treated is asked to recall distressing images while generating one type of bilateral sensory input, such as side-to-side eye movements or hand tapping.

Cultural adaptations available? YES

Source: https://www.emdr.com/ , https://www.cebc4cw.org/program/eye-movement-desensitization-and-reprocessing/detailed

If you are a provider practicing an EBP make sure and use the accompanying EPA or SERI number when you bill Coordinated Care.

Mental Health providers should use the Reporting Guide for Evidence-based Practices

Physical health providers who deliver these services should include the appropriate EPA number from the HCA Provider Billing Guides and Fee Schedules, Mental Health Services.

Back to Top

______________________________________________________________________________________

Apple Health Core Connections

Coordinated Care is the single managed care organization to administer the Integrated Managed Care Apple Health Foster Care program in collaboration with the Health Care Authority and Department of Children Youth and Families. This program serves children and youth in foster care, adoption support, alumni of foster care (ages 18-26), and children reunified with their parents. Coordinated Care’s program is named “Apple Health Core Connections.” You can reach us at 1-844-354-9876 or AHCCTeam@coordinatedcarehealth.com .

The Coordinated Care Community Education 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

TRAININGS/RESOURCES:

  • Child Welfare League of America Present’s Fostering School Success: How Caregivers and Social Workers Can Support the Educational Needs of Children.  CWLA will be hosting Dr. Gwen Bass for a webinar based on the four-part skill building training. September 7, 2021 at 10am. Learn more and register at: https://www.cwla.org/conferences-events/e-learning/
  • Safe Environment for Every Kid (SEEK) is an evidence-based, practical model for improving primary healthcare for children and their families. SEEK helps primary healthcare professionals (PCPs) address common psychosocial problems to help prevent child maltreatment. Training videos and implementation support is available at www.seekwellbeing.org .Training videos and resources are available at no cost, CMEs are available at a cost.

Back to Top

______________________________________________________________________________________

General Updates

Prior Authorization Requirement changes for Ambetter coming November 1, 2021

Beginning November 1, 2021, prior authorization will be required for the following services for all Ambetter providers:

Procedure Code

Procedure Description

54401

INSRT PENILE PROSTH; INFLATABLE –Volume for WA 1 spend 32,036

54405

INSRT INFLATBL PENILE PROSTH W/PLCMT-Volume for WA 1 paid 974

61885

INCS & SUBQ PLCMT CRANIAL NEUROSTIM GEN/RECEIVER Volume for WA 1 cost 36,303

61886

IMPLANT NEUROSTIM ARRAYS 0/0

69714

IMPLANT TEMPLE BONE W/STIMUL 0/0

77371

SRS MULTISOURCE Volume 3 paid 46,76

1

Ambetter Home Health Prior Authorization Changes coming November 1, 2021

Starting on November 1, 2021 the requirement that all services rendered in the home setting require Prior Authorization is being removed. You will see changes to our Pre-Auth check tool. Instead only professional nursing/aide service codes in the Home Health table below will require Prior Authorization for all providers. These codes will state PA is required for all providers when entered in our Pre-Auth check tool on or after November 1st.

Home Physical Therapy/Occupational/Speech Therapy requirements are not changing. 

Home Health Services- Require Prior Authorization for All Providers

PROC_NBR

DESCRIPTION

99600

UNLISTED HOME VISIT SERVICE/PROC

G0155/561

HHCP-SVS OF CSW,EA 15 MIN

G0156/571

HHCP-SVS OF AIDE,EA 15 MIN

G0299/551

DIR SNS RN HH/HOSPICE SET EA 15 MIN

G0300

DIR SNS LPN HH/HOSPCE SET EA 15 MIN

G0493

RN CARE EA 15 MIN HH/HOSPICE

G0494      

LPN CARE EA 15MIN HH/HOSPICE                                            

G0495      

RN CARE TRAIN/EDU IN HH                                                

G0496      

LPN CARE TRAIN/EDU IN HH                                               

S9123

NURSING CARE, IN THE HOME; BY REGISTERED NURSE, PER HOUR

S9124

NRSG HOME CARE LPN PER HOUR

S9127

SOCIAL WORK VISIT  HOME PER DIEM

T1019

PERSONAL CARE SERVICES PER 15 MINS

T1021

HOME HLTH AIDE/CERT NURSE ASST VST

T1030

NRS CARE HOME REGISTERED NURSE-DIEM

T1031

NURSING CARE THE HOME LPN PER DIEM

T1002

RN SERVICES, UP TO 15 MINUTES

T1003

LPN/LVN SERVICES, UP TO 15 MINUTES

T1004

Services of a qualified nursing aide, up to 15 minutes


______________________________________________________________________________________

Clinical Policy Updates

Due to clarification from the Health Care Authority about coverage, Medicaid clinical policy WA.CP.MP.115 – Discography, is being archived and replaced with CP.MP.115 – Discography effective August 1, 2021.

The below policies received updates as part of our regular monthly review in July. These policy changes are effective August 1, 2021. You will find the policies, including a description of the revisions, posted on the policy site.

 

Policy NumberPolicy TitleLine of Business

WA.CP.MP.503

Private Duty Nursing

Apple Health

CP.MP.170

Nerve Blocks for Pain Management

Apple Health & Ambetter

WA.PCP.MP.37

Bariatric Surgery

Apple Health

CP.MP.38

Ultrasound in Pregnancy

Apple Health & Ambetter

CP.MP.49

Physical, Occupational and Speech Therapy Services

Apple Health & Ambetter

CP.MP.81

NICU Discharge Guidelines

Apple Health & Ambetter

CP.MP.82

NICU Apnea Bradycardia Guidelines

Apple Health & Ambetter

CP.MP.115

Discography

Ambetter

CP.MP.123

Laser Therapy for Skin Conditions

Apple Health & Ambetter

CP.MP.125

DNA Analysis of Stool

Ambetter

CP.MP.166

Sacroiliac Joint Interventions for Pain Management

Apple Health & Ambetter


The below policies are being retired effective August 1, 2021. For Carrier Screening in Pregnancy, codes that require pre-authorization will be evaluated using InterQual criteria.

Policy Number

Policy Title

Line of Business

WA.CP.MP.115

Discography

Apple Health

CP.MP.83Carrier Screening in Pregnancy

Apple Health & Ambetter

The below policy is new effective August 1, 2021. You will find the policy posted on the policy site.

Policy Number

Policy Title

Line of Business

CP.MP.115

DiscographyApple Health

The below policy is new effective November 1, 2021. You will find the policy posted on the policy site.

Policy Number

Policy Title

Line of Business

CP.MP.209

GI Pathogen Nucleic Acid Detection Panel TestingApple Health & Ambetter

The below new policies was previously announced to be effective on the dates noted. You will find the policies posted on the policy site. 

Policy NumberPolicy TitleEffective DateLine of Business
WA.CP.MP.207Home Prothrombin Time Monitoring8/1/21Apple Health
CP.MP.211Electromygraphy and Nerve Conduction Studies9/1/21Apple Health & Ambetter
CP.BH.201Deep TMS for OCD9/1/21Ambetter
CP.MP.210Repair of Nasal Valve Compromise10/1/21Apple Health & Ambetter

The below policy was previously announced to have revisions effective on the date noted. You will find the policy posted on the policy site. 

Policy Number

Policy Title

Effective Date

Line of Business

CP.MP.107

Durable Medical Equipment (DME)9/1/21Apple Health & Ambetter

 

First Steps Maternity Support Services (MSS) – First Steps

All pregnant enrollees who are covered under Washington Apple Health (Medicaid) are eligible to receive First Steps Maternity Support Services (MSS) through the First Steps program. First Steps is a preventive health program designed to ensure healthy birth outcomes.

MSS is voluntary and offers a variety of enhanced services for low income pregnant individuals to help them have a healthy pregnancy and a healthy baby. Some services include:

  • A screening and assessment to determine risk factors
  • Patient centered interventions for determined risk factors
  • Brief counseling
  • Basic health messages related to pregnancy and infant care
  • Referral to community resources

MSS can be provided in the clinic, at the patient’s home, or in a community setting and they are provided by an interdisciplinary team who coordinates and supports the medical provider’s plan of care for the pregnant individual and/or infant. This team includes a:

  • Community Health Nurse
  • Behavioral Health Specialist
  • Certified Dietitian
  • Community Health Worker (some locations)

After the infant is born and MSS has ended, the family may be eligible to receive Infant Case Management (ICM) services to help them learn about and how to use needed medical, social, educational, and other resources in their community so the baby and family can thrive.

If you would like more information about First Steps, or to find a provider in the area, visit hca.wa.gov/health-care-services-supports/apple-health-medicaid-coverage/first-steps-maternity-and-infant-care. You can also direct your patients to this website or refer them to Coordinated Care at 877-664-4613. Coordinated Care of Washignton Inc. recommends that all eligible pregnant enrollees be referred to the First Steps program.

Vision Hardware Coding Update

Attention providers: on July 1, 2021, the Health Care Authority (HCA) made updates to the ProviderOne billing system to direct claims for vision hardware fitting fees and some prescription fees for clients enrolled in a managed care organization (MCO) to the client’s MCO for payment. These fees were previously covered under fee-for-service (FFS).

Retroactive for claims with dates of service on and after July 1, 2021, all medical providers must bill these codes directly to the MCOs.

CPT® codes affected by this change:

92071 Contact lens fitting for tx

92072 Fit contact lens for managmnt

92310 Contact lens fitting

92311 Contact lens fitting

92312 Contact lens fitting

92313 Contact lens fitting

92340 Fit spectacles monofocal

92341 Fit spectacles bifocal

92342 Fit spectacles multifocal

92352 Fit aphakia spectcl monofocl

92353 Fit aphakia spectcl multifoc

92354 Fit spectacles single system

92355 Fit spectacles compound lens

What has not changed?

The prescription CPT® codes and repair CPT® codes listed below should continue to be billed to HCA through FFS, not through the client’s MCO. HCA will reprocess claims with dates of service on and after July 1, 2021, that were denied for these CPT® codes.

92314 Prescription of contact lens

92315 Rx cntact lens aphakia 1 eye

92316 Rx cntact lens aphakia 2 eye

92317 Rx corneoscleral contact lens

92370 Repair & adjust spectacles

92371 Repair & adjust spectacles

HCA will notify providers of any future changes through Provider Alerts and the billing guides for Physician-Related Services/Health Care Professional Services and Vision Hardware for Clients 20 Years of Age and Younger.

Coordinated Care will update our benefit design documents accordingly – look for that updated document linked in future News blasts.

Back to Top

______________________________________________________________________________________

Training and Education

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 Medicaid members across the state. Training and resources for providers are continuously developed by MCOs and shared on this site.

Visit Centene’s Clinical Provider Training website at https://www.envolveu.com/clinical-provider-training.html  to find upcoming National Provider Webinars.  These webinar events are available to any Centene provider, stakeholder, community member and/or staff. Webinars are on clinical topics appropriate for web learning and usually offer free continuing education hours. Click on the “National Provider Webinars” button on the right side of the page and scroll down to find a complete listing. Here are a few coming up in August: 

  • Motivational Interviewing Level 1 Part 1. The purpose of the training is an introduction to the basics of Motivational Interviewing (MI). This is part 1 of 2. Attendees will be exposed to and begin to learn key concepts and skills. This training is considered a Level 1 MI training. 2.5 CE hours available for NBCC. August 5, 2021, 8:30am-11:00am. Register at: https://www.envolveu.com/clinical-provider-training.html#
  • Social Determinants of Health and Mental Health. This training identifies Social Determinants of Health (SDOH) and how they can affect factors such health care utilization and health disparities. 2 CE hours for NBCC. August 10, 2021, 9am-11am. Register at: https://www.envolveu.com/clinical-provider-training.html#
  • Motivational Interviewing Level 1 Part 2. The purpose of the training is an introduction to the basics of Motivational Interviewing (MI). This is part 2 of 2. Attendees will be exposed to and begin to learn key concepts and skills. This training is considered a Level 1 MI training. 2.5 CE hours available for NBCC. August 17, 2021. 11:30am-2pm Register at: https://www.envolveu.com/clinical-provider-training.html#

Region 10 Opioid Summit: Future Directions in the Opioid Crisis: Improving Systems to Better Serve Individuals and Families. Join us for a three-day Opioid Summit including multiple breakout sessions focused around Prevention, Intervention and Harm Reduction, Treatment, and Recovery and Plenary Sessions you don’t want to miss! Registration is $25. August 3-5, 2021. http://region10opioidsummit.org/registration-2/ 

Harm Reduction 101. Join the Northwest MHTTC and the Mental Health and Addiction Association of Oregon for this 90-minute webinar introducing harm reduction with Haven Wheelock, Drug Users Health Services Program Coordinator at Outside In of Portland, Oregon. August 4, 2021. https://washington.zoom.us/webinar/register/WN_V3zs-UzhRsC-56bWYlqF

ARTICLES & RESOURCES:

Back to Top

______________________________________________________________________________________

Pharmacy Updates

Effective September 15th 2021, the following drugs will be dispensed by our preferred specialty pharmacy, Pantherx Specialty

  1. Ayvakit
  2. Crysvita-Ambetter only
  3. Dojolvi-Ambetter only
  4. Gavreto
  5. Givlaari-Ambetter only
  6. Hetlioz
  7. Oxlumo
  8. Wakix

If you have any questions, please contact Pantherx Specialty, LLC

Phone: 855-726-8479

Fax: 855-246-398

Website: https://www.pantherxrare.com

Back to Top