March 2022 Provider News
Date: 03/31/22
In this issue:
- Billing Updates - Inactive NPIs: Requirement for Revalidation
- Quality - ADHD, Asthma Refills, Mammograms
- Apple Health Core Connections - General Update
- Clinical Policy - New Genetic Testing Policies, Monthly Policy Updates
- General Updates - Billing for Dementia Care Planning, Youth Mental Health Campaign, Say It Out Loud! Conference
- Training/Education - Centene’s Clinical Provider Training, HCA's Apple Health DC:0-5™ Training, Seattle Children's Pediatric Mental Health Event
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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 currently 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
ADHD Follow-Up in Kids:
Children with a new prescription for ADHD medication should receive a follow up visit within 30 days of starting the medication.
Asthma and 90-Day Medication Refills:
Moving members with asthma to 90-day medication refills may increase their maintenance medication adherence.
Mammograms (HEDIS Measure):
This HEDIS measure assesses women ages 50–74 who had at least one mammogram to screen for breast cancer in the past two years.
Depression Remission or Response for Adolescents and Adults—DRR-E (HEDIS MEASURE):
The DRR-E HEDIS measure is the percentage of members 12 years and older, with a diagnosis of depression and an elevated PHQ-9 score, with evidence of response or remission within 4–8 months of the initial elevated score. Depression Remission is defined as the percentage of members who achieved remission within 4-8 months after the initial elevated PHQ-9 score. Depression Response is defined as the percentage of members who showed response within 4-8 months after the initial elevated PHQ-9 score.
The American Academy of Pediatrics recommends adolescents with depression be assessed for treatment response and remission of symptoms using a depression assessment tool such as the PHQ-9 Modified for Teens.
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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
Clinical Policy Updates
Reminder: 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, are effective May 1, 2022. You will find the policy, including a description of the revisions, on the NIA Website. A link is available under “provider resources” on CoordinatedCareHealth.com.
Genetic Testing: Twenty-seven new genetic testing policies will be implemented on July 1, 2022. The policies are listed below and can be found on our provider website starting April 15, 2022. Please note, the policy names are new. Previously posted genetic testing policies will be archived as of June 30 and are also noted below.
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 (replaces 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 | Apple Health & Ambetter |
| WA.CP.MP.231 | Genetic Testing Non-Invasive Prenatal Screening (NIPS) (replaces 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 | 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 |
Policies to be archived as of 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.524 | Whole Exome Sequencing | Apple Health |
The below clinical policies received updates as part of our regular monthly review in March. These policy changes are effective April 1, 2022. You will find the policies, including a description of the revisions, on the policy page of our website.
| Policy Number | Policy Title | Line of Business |
WA.CP.MP.130 | Fertility Preservation | Apple Health |
WA.CP.MP.502 | Cochlear Implants: Bilateral vs. Unilateral | Apple Health |
WA.CP.MP.521 | Behavioral Health Personal Care Services | Apple Health |
WA.CP.MP.523 | Sleep Apnea Diagnosis and Treatment | Apple Health & Ambetter |
WA.CP.MP.501 | Continuous Glucose Monitoring System | Apple Health |
CP.MP.57 | Lung Transplantation | Apple Health & Ambetter |
CP.MP.58 | Intestinal and Multivisceral Transplant | Apple Health & Ambetter |
CP.MP.102 | Pancreas Transplantation | Apple Health & Ambetter |
CP.MP.120 | Pediatric Liver Transplant | Apple Health & Ambetter |
CP.MP.132 | Heart-Lung Transplant | Apple Health & Ambetter |
CP.MP.138 | Pediatric Heart Transplant | Apple Health & Ambetter |
CP.MP.141 | Non-Myeloablative Allogenic Stem Cell Transplants | Apple Health & Ambetter |
CP.MP.162 | Tandem Transplant | Apple Health & Ambetter |
CP.MP.160 | Implantable Wireless Pulmonary Artery Pressure Monitoring | Ambetter |
CP.MP.187 | Radiofrequency Ablation of Uterine Fibroids | Ambetter |
CP.MP.34 | Hyperemesis Gravidarum Treatment | Apple Health & Ambetter |
WA.CP.MP.36 | Experimental Technologies | Apple Health |
| CP.MP.36 | Experimental Technologies | Ambetter |
| CP.MP.40 | Gastric Electrical Stimulation | Apple Health |
| WA.CP.MP.46 | Ventricular Assist Devices | Apple Health |
| CP.MP.46 | Ventricular Assist Devices | Ambetter |
The below policies are effective April 1, 2022. You will find the policies on the policy page of our website.
| Policy Number | Policy Title | Line of Business |
CP.MP.187 | Radiofrequency Ablation of Uterine Fibroids | Apple Health |
CP.MP.40 | Gastric Electrical Stimulation | Ambetter |
The below policy was updated as part of our regular monthly review in March. The policy changes are effective July 1, 2022. You will find the policy, including a description of the revisions, on the policy page of our web site.
| Policy Number | Policy Title | Line of Business |
CP.MP.86 | Neonatal Abstinence Syndrome Guidelines | Apple Health & Ambetter |
The below policy is archived effective April 1, 2022. If prior authorization is required, review will be based on InterQual criteria.
| Policy Number | Policy Title | Line of Business |
CP.MP.211 | Electromyography and Nerve Conduction Studies | Apple Health & Ambetter |
The below policy was revised as of the date noted and part of a previous news blast. Find the policy on the policy page of our website.
| Policy Number | Policy Title | Effective Date | Line of Business |
CP.MP.173 | Implantable Intrathecal or Epidural Pain Pump | 6/1/22 | Apple Health & Ambetter |
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General Updates
Billing for Dementia Care Planning
Effective 1/1/2022, Providers may bill for the comprehensive assessment and care planning for persons living with cognitive impairment using CPT® code 99483. This service is billable as a 50-minute visit, once every 180 days. There are specific diagnosis code and taxonomy requirements to provide and bill for this service. For more information about this, see pages 71-72 of the HCA Physician-related services/Health Care Professional Services Billing Guide. Please contact your Provider Network Specialist if you have any additional questions about Dementia Care planning services or billing.
HCA Launches Youth Mental Health Campaign
HCA launched a new mental health promotion campaign, “No Shame in Your Brain,” directed towards youth ages 13-18.
The campaign focuses on socializing mental health as a positive concept and celebrates unique qualities of teens. Messages are in English and Spanish, promoting easy-to-access resources by text or phone for youth who want to connect and talk with someone.
This campaign is funded by the Systems of Care grant from the Substance Abuse and Mental Health Administration (SAMHSA), which focuses on expanding the continuum of care for youth, families, and caregivers. Ongoing campaign activities will complement this work through September.
For more information and resources to use/share:
- Social media toolkit for No Shame in Your Brain here.
- Email Sonya Wohletz at Sonya.wohletz@hca.wa.gov with questions.
Coordinated Care is proud to sponsor the 21st Annual Say It Out Loud Conference, focusing on LGBTQIA+ health. Register today!
Registration is Now Open!
Join us on Thursday, May 26 for the 21st Annual Say It Out Loud Conference (SIOL)!
SIOL is a conference committed to increasing competency in serving LGBTQ+ individuals, families, and communities.
This year's conference theme, "We Are Family," is meant to honor and recognize the many structures and diverse expressions of families there are, biological and chosen.
LOCATION: Virtual
General Registration is FREE!
Interested in sponsoring or exhibiting at the 2022 SIOL Conference? Find more information here: Sponsor/Exhibitor Information
Visit the Say It Out Loud conference website for additional information.
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Training/Education
Visit Centene’s Clinical Provider Training website (https://www.envolveu.com/clinical-provider-training.html) 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 has scheduled numerous trainings for Apple Health mental health clinicians and allied professionals on new policy changes requiring Apple Health mental health professionals to use the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC: 0 – 5™) when assessing and diagnosing children from birth through age five. Sign up for an upcoming webinar here.
Health Care Authority and DBHR are sponsoring the annual Say It Out Loud Conference which focuses on improving behavioral health services and decreasing disparities faced by lesbian, gay, bisexual, transgender, and questioning (LGBTQ+) individuals. Virtual conference, May 26, 2022. Check the conference webpage for registration info and updates: sayingitoutloud.org.
Seattle Children’s Partnership Access Line is hosting a Pediatric Mental Health Event. This is a free webinar for primary care providers with CME credit. April 30, 2022, 8 a.m.-12:30 p.m.. Learn more and register here.
ARTICLES & RESOURCES:
- Five Year Trends in US Children’s Health and Wellbeing, 2016-2022 (March 2022)
- Blueprint for Youth Suicide Prevention: A guide for pediatric health providers on how to implement suicide prevention in medical and community settings from The American Academy of Pediatrics and the American Foundation for Suicide Prevention.