March 2024 Provider News

Date: 03/29/24

In this issue:

General Updates - Provider Alert: Change Healthcare Cybersecurity Incident and Its Impact to Coordinated Care of Washington, Clinical Data Repository (CDR), Smoking and Tobacco Cessation
Quality - ADHD Follow Up on Kids, Mammograms, Topical Fluoride Treatment for Children, March National Health Observances: Nutrition, Colorectal Cancer, and National Disability Month
Tribal - Claims Assistance Data Elements, Change Healthcare Impacts
Clinical Policy - Monthly Updates - Effective April 1, 2024
Pharmacy Updates - Preferred Drug List Changes Effective 4/01/2024, Physician Administered Drug Updates: Hyaluronic Acid, Physician Administered Drug Updates: Lifileucel
Wellcare - Medical Clinical Policy Updates
Apple Health Core Connections - Two New Foster Care Centers of Excellence
Training/Education - Upcoming Training Opportunities for Providers

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General Updates

Change Healthcare Cybersecurity Incident and Its Impact to Coordinated Care of Washington

On February 21, Change Healthcare, a software and data analytics subsidiary of UnitedHealth Group’s Optum unit, experienced a cybersecurity incident that has impacted its network and operations. The cybersecurity incident has created a service disruption impacting Coordinated Care’s members and provider network in several ways.

As of now, Change Healthcare has not provided a timeline for resolution. To protect our members and providers, Coordinated Care fully disconnected system access to and from Change Healthcare on Feb. 21. We are working on multiple solutions to restore provider functionality and ensure continuity of care for our members. We will continue to provide updates as this situation evolves.

Electronic Claim Submission

The ability to electronically submit claims to Coordinated Care through Change Healthcare is currently down. Providers can easily submit electronic claims to Coordinated Care via many alternative methods including other claims clearinghouses, our secure provider portal or mail. Our preferred clearinghouse for electronic claims submission is Availity. To enroll, please visit the Availity Essentials Portal Registration page and/or call Availity Client Services at 1-800-AVAILITY (1-800-282-4548). For step-by-step instructions for Availity, visit the Availity Lifeline
page. Additional information on claims submission can be found in our Provider Manual located on our website.

Reimbursement via Paper Check and Virtual Credit Card (VCC)

Some paper check and virtual credit card payment processes for Coordinated Care have been disrupted due to this incident. We apologize for any inconvenience this causes. Please know we are working quickly to implement a new process to ensure payments are operational as soon as possible. An alternate way to speed up your payment process is to set up an automated clearing house (ACH) for electronic funds transfer (EFT). Coordinated Care’s preferred ACH/EFT partner, PaySpan (now part of Zelis), has offered to help expedite the sign-up process for providers by calling 1-877-331-7154 or visiting www.payspanhealth.com.

Chart Retrieval

Change Healthcare performs retrieval of medical records for several of our programs, such as HEDIS® and Risk Adjustment. You may have received a request via phone or fax from Change Healthcare on behalf of Coordinated Care, where you either scheduled appointments or provided medical records. Change Healthcare is unable to honor any fulfillment requests at this time; however, we will be employing two of our existing medical record retrieval vendors, Datavant (formerly Ciox) and Datafied, to satisfy these prior commitments.

These retrievals are required to report on clinical quality measures and diagnosis data to Health and Human Services (HHS), the Centers for Medicare & Medicaid Services (CMS) and the National Committee for Quality Assurance (NCQA). We ask that you please honor the same commitment dates for these vendors, even if you have already committed to providing medical records to Change Healthcare. If you have provided medical records from the time period of Feb. 19, 2024 to current, you may be asked to provide these medical records again.

Providers always have 24-hour access to the Coordinated Care Provider Portal where you can access member eligibility and submit claims in real time. If you are encountering an issue related to the Change Healthcare cybersecurity incident that is not discussed here (e.g., timely filing limits, verification of enrollee eligibility or file transactions and/or provider exclusivity issues), please contact your Provider Engagement representative or our Provider Services team at 1-877-644-4613. Thank you for your patience and partnership as we continue to navigate this situation. We apologize for any inconvenience in this matter. We will continue to keep you apprised as we learn more. You are also always welcome to visit Centene’s Change Healthcare Outage Overview.

Clinical Data Repository (CDR)

The Washington State Health Care Authority (HCA) requires providers seeing Apple Health members, who have an ONC (Office of the National Coordinator) – certified EHR, and who have received Promoting Interoperability funding to send care summaries from their EHR to the CDR.

The CDR is a secure, cloud database managed by OneHealthPort, who has hosted the state’s health information exchange (HIE) since 2009.

For more information, please see this one-pager.

Smoking and Tobacco Cessation

Coordinated Care (Medicaid) and Apple Health Core Connections (Foster Care) have Smoking and Tobacco Cessation Programs that have health coaches who will provide support to your members who are ready to quit.

We accept referrals from our members and providers via phone or email:

Washington Apple Health (Medicaid):
- Toll-Free: 1-866-274-5791
- E-mail: caremanagement@coordinatedcarehealth.com
Apple Health Core Connections (Foster Care):
- Toll-Free: 1-844-882-3827
- E-mail: ahccteam@coordinatedcarehealth.com

We also have a Puff Free Pregnancy program.

Start Smart for Your Baby - Case management and support for your member’s pregnancy includes smoking cessation assistance.

Toll-Free: 1-877-644-4613 (TTY: 711)
E-mail: WASSFB@centene.com
Visit: Coordinated Care Benefits and Services

Tobacco Cessation/Smoking Deterrent medications are outlined on Pages 163 and 164 of the Preferred Drug List.

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Quality

Medicaid Quality

Healthcare Effectiveness Data and Information Set (HEDIS) HEDIS is a set of standardized performance measures developed by the National Committee for Quality Assurance (NCQA) which allows comparison across health plans

ADHD Follow Up on Kids

The HEDIS measure Follow-Up Care for Children Prescribed ADHD Medication monitors follow-up visits for patients 6-12 years old, who have been prescribed Attention Deficit Hyperactivity Disorder (ADHD) medications.

The target population is members 6- 12 years old, who have been prescribed stimulants, alpha-2 receptor agonists, or other miscellaneous ADHD medications.

Description of Measure The measure breaks down the prescribing of medications used to treat ADHD into two phases:

Initiation Phase: The member should be seen when the first initial prescription is written and must be seen again for a follow-up visit within the first 30 days of starting the medication. Children with new prescription for ADHD medication should receive a follow up visit within 30 days of their first initial visit and prescription being written.
Continuation and Maintenance Phase: After the initiation phase has passed, the member should be seen for two follow-up visits within a 10-month period.

Children need routine follow-up appointments for the physician to evaluate response to therapy and make any necessary changes in a timely manner.

In order to encourage return visits to refill their prescriptions, it is recommended providers schedule follow-up visits and write the following initial prescription for members on ADHD medications.

Mammograms

The HEDIS measure assesses women ages 50-74 who had at least one mammogram to screen for breast cancer in the past 2 years.

Does your patient have any of these risk factors? They may need to be assessed for early onset Breast Cancer:

Reproductive history- menstrual history of starting periods before age 12 and menopause after 55
Having dense breasts
Breast/ ovarian cancer personal/family history or personal/family history of genetic mutations

Topical Fluoride Treatment for Children

Fluoride varnish is a safe, American Dental Associated (ADA) approved tasteless, fast setting and easy to apply protective coating painted on a child's teeth to prevent decay. The varnish releases fluoride over several month and strengthens the outer layer of the teeth that it is applied on. The varnish needs reapplication every 3-4 months to maintain its effectiveness.

Tips to keep your teeth healthy Dental hygiene is important. Taking care of your teeth can prevent bad breath, gum disease, and tooth decay. But did you know that poor dental health can affect the overall health of your entire body? An unhealthy mouth and particularly gum disease are linked to stroke and heart disease.

Get into a Daily Routine. You should brush your teeth twice a day. Brushing is one of the easiest ways to keep your teeth healthy. It removes bacteria and cleans off leftover food. Be sure to brush all sides of your teeth and your tongue. Change your toothbrush every three to four months. This helps avoid passing germs from your toothbrush to your mouth. You should also change your toothbrush after you have been sick. Flossing helps get rid of plaque between your teeth. Usually this is where cavities start to form. Slide the floss between your teeth and gently up between the tooth and the gum line for the best results.

Visit the Dentist. A dental exam removes the plaque that you may have missed with brushing and flossing. Your dentist can catch tooth decay and gum disease early on. If you have already had dental work done it is important you go back to the dentist to make sure everything is still in place. Your dentist will examine your mouth for signs of other health issues like vitamin deficiencies and even diabetes.

What You Eat Affects Your Teeth! Food and drinks high in sugar can damage the enamel on your teeth, which can lead to decay. Avoid chewy, sticky, sugary foods when you can. If you chew gum, choose sugar free. When you do eat something sugary, rinse your mouth with water or brush your teeth. Drinking water is an easy way to wash away food and bacteria during the day. Foods high in calcium and protein are good for your teeth. Instead of a sugary snack try carrots, almonds, or cheese.

Wellcare Quality

March National Health Observances: Nutrition, Colorectal Cancer, and National Disability Month

The Office of Disease prevention and Health Promotion (ODPHP) features select monthly National Health Observances (NHOs) that align with their priorities for improving health across our nation.

National Nutrition Month^®
- During National Nutrition Month^®, ODPHP focuses on sustainable and healthy eating habits. This year’s theme is “Beyond the Table”, which highlights the farm-to-fork approach to nutrition, from food production to eating habits. Check out information and resources from the Academy of Nutrition and Dietetics to learn more! The Dietary Guidelines for Americans offers guidance on what to eat and drink to meet nutrition needs and promote health. Take a look at the current Guidelines — and save the date for the next public Dietary Guidelines Advisory Committee meeting on May 30, 2024. And if you’re looking to address nutrition and healthy eating in your work, consider the Healthy People 2030 evidence-based resources. Finally, share our consumer friendly MyHealthfinder resources on nutrition and these inspiring Move Your Way^® healthy eating and physical activity stories.
National Colorectal Cancer Awareness Month
- This March, spread the word about the importance of getting regular colorectal cancer screenings, starting at age 45 years. Share the National Cancer Institute’s colorectal cancer resources to help people learn about prevention, treatment, and more. Share awareness resources from the Centers for Disease Control and Prevention (CDC) with your networks — and don’t forget to check out our Healthy People 2030 resources and MyHealthfinder resources on colorectal cancer.
Promoting kidney health during National Kidney Month
- This month, CMS OMH is highlighting the importance of early screening for CKD to prevent kidney failure and other health problems, especially for those who have an increased risk of the disease.
  
  People with early-stage kidney disease usually do not experience symptoms, 9 in 10 adults living with CKD are unaware they have the disease.
  
  Chronic kidney disease affects an estimated 14% of adults in the United States—about 35.5 million people—and is most common in people aged 65 years or older. Some of the largest risk factors for CKD include diabetes, high blood pressure, heart disease, and obesity. These conditions continue to disproportionately affect minority populations. Among adults aged 18 years old and older with CKD, Black Americans are most heavily affected by the disease (20%), followed by Asian Americans (14%) and Hispanic Americans (14%). To help prevent CKD and lower the risk for kidney failure, patients should learn about their risk factors, get tested annually, increase physical activity, take all medications as instructed, and visit the doctor regularly.

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Tribal

Claims Assistance Data Elements

We are always happy to assist with claims questions for all lines of business. To best serve you, please send the following data points with your inquiry:

Member name and/or ID number
Member Date of birth (DOB)
Date of Service (DOS) in question
Claim number in question
Summary of concern

If you have any questions regarding these data points, please don’t hesitate to reach out to IndianHealthCareProviderAssistance@coordinatedcarehealth.com. We encourage you to contact us rather than our customer service team.

Change Healthcare Impacts

Communications were emailed out in 3/11/24 to all Indian Health Care and Urban Indian Health Providers outlining the current known claims and payment impacts. Please reach out to IndianHealthCareProviderAssistance@coordinatedcarehealth.com with any questions related to your specific situation and needs.

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Clinical Policy Updates

The below clinical policies received updates as part of our regular monthly review in February. These policy changes are effective April 1, 2024. 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.515	Fecal Microbiota Transplantation	Apple Health
WA.CP.MP.510	Tinnitus Treatment	Apple Health
WA.CP.MP.526	Stem Cell Therapy for Musculoskeletal Conditions	Apple Health
WA.CP.MP.117	Percutaneous Electrical and Peripheral Nerve Stimulation	Apple Health & Ambetter
WA.CP.MP.130	Fertility Preservation	Apple Health
CP.BH.104	Applied Behavioral Analysis	Apple Health & Ambetter
CP.BH.105	Applied Behavioral Analysis Documentation Requirements	Apple Health & Ambetter
CP.MP.81	NICU Discharge Guidelines	Apple Health & Ambetter
CP.MP.85	Neonatal Sepsis Management	Apple Health & Ambetter
CP.MP.86	Neonatal Abstinence Syndrome Guidelines	Apple Health & Ambetter
CP.MP.129	Fetal Surgery in Utero for Prenatally Diagnosed Malformations	Apple Health & Ambetter
CP.MP.136	Home Birth	Apple Health & Ambetter
CP.MP.99	Wheelchair Seating	Ambetter
CP.MP.105	Digital EEG Analysis	Apple Health & Ambetter
CP.MP.55	Assisted Reproductive Technology	Ambetter
CP.MP.130	Fertility Preservation	Ambetter

The Health Care Authority announced coverage of cochlear implants for adults effective January 1, 2024. The below policy was updated retro-active to January 1, 2024, to reflect this coverage change.

Policy Number	Policy Title	Line of Business
WA.CP.MP.502	Cochlear Implants	Apple Health

The below policies were updated as part of our regular monthly review in February. The policy changes are effective July 1, 2024. 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.22	Stereotactic Body Radiation Therapy	Apple Health & Ambetter
CP.MP.62	Hyperhidrosis Treatments	Apple Health & Ambetter
CP.MP.82	NICU Apnea Bradycardia Guidelines	Apple Health & Ambetter
CP.MP.173	Implantable Intrathecal or Epidural Pain Pump	Apple Health & Ambetter
CP.MP.190	Oxygen Use and Concentrators	Ambetter
CP.MP.243	Implantable Loop Recorder (Implantable Cardiac Monitor)	Apple Health & Ambetter
CP.MP.248	Facility Based Sleep Studies for Obstructive Sleep Apnea	Apple Health & Ambetter

The below policies were previously announced as revised on the date noted. You will find the policies posted on the policy site.

Policy Number	Policy Title	Effective Date	Line of Business
V1.2024	All Genetic Testing Policies	4/1/24	Apple Health & Ambetter
CP.MP.186	Burn Surgery	5/1/24	Apple Health & Ambetter

The below genetic testing policies received updates as part of our twice-yearly review. Previously announced as effective January 1, these policy changes are now effective April 1, 2024. You will find the policies, including a description of the revisions, posted on the policy site.

Policy Number	Policy Title	Line of Business
V1.2024	CG Aortopathies and Connective Tissue Disorders	Apple Health & Ambetter
V1.2024	CG Cardiac Disorders	Apple Health & Ambetter
V1.2024	CG Dermatologic Conditions	Apple Health & Ambetter
V1.2024	CG Epilepsy Neurodegenerative and Neuromuscular Conditions	Apple Health & Ambetter
V1.2024	CG Exome and Genome Sequencing for DX of Genetic Disorders	Apple Health & Ambetter
V1.2024	CG Eye Disorders	Apple Health & Ambetter
V1.2024	CG Gastroenterologic Disorders Non-cancerous	Apple Health & Ambetter
V1.2024	CG General Approach to Genetic Testing	Apple Health & Ambetter
V1.2024	CG Hearing Loss	Apple Health & Ambetter
V1.2024	CG Hematologic Conditions Non-cancerous	Apple Health & Ambetter
V1.2024	CG Hereditary Cancer Susceptibility	Apple Health & Ambetter
V1.2024	CG Immune Autoimmune and Rheumatoid Disorders	Apple Health & Ambetter
V1.2024	CG Kidney Disorders	Apple Health & Ambetter
V1.2024	CG Lung Disorders	Apple Health & Ambetter
V1.2024	CG Metabolic Endocrine Mitochondrial Disorders	Apple Health & Ambetter
V1.2024	CG Multisystem Inherited Disorders, Intellectual Disability and Developmental Delay	Ambetter
WA.CP.MP.230	Genetic Testing Multisystem Inherited Disorders, Intellectual Disability and Developmental Delay	Apple Health
V1.2024	CG Non-Invasive Prenatal Screening	Ambetter
WA.CP.MP.231	Genetic Testing Non-Invasive Prenatal Screening (NIPS)	Apple Health
V1.2024	CG Oncology Algorithmic Testing	Apple Health & Ambetter
V1.2024	CG Oncology Cancer Screening	Apple Health & Ambetter
V1.2024	CG Oncology Circulating Tumor DNA Tumor Cells Liquid Biopsy	Apple Health & Ambetter
V1.2024	CG Oncology Cytogenetic Testing	Apple Health & Ambetter
V1.2024	CG Oncology Molecular Analysis Solid Tumors & Hematolgic Malignancies	Apple Health & Ambetter
V1.2024	CG Pharmacogenetics	Apple Health & Ambetter
V1.2024	CG Preimplantation Genetic Testing	Apple Health & Ambetter
V1.2024	CG Prenatal and Preconception Carrier Screening	Apple Health & Ambetter
V1.2024	CG Prenatal Diagnosis Pregnancy Loss	Apple Health & Ambetter
V1.2024	CG Skeletal Dysplasia Rare Bone Disorders	Apple Health & Ambetter

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Pharmacy Updates

Preferred Drug List Changes Effective 04/01/2024

Drug Name	Current Formulary Status	Formulary Status Effective 04/01/2024
Vraylar	Preferred (Prior Authorization Required)	Non-Preferred. Potential preferred alternatives include: Invega Hafyera (with prior authorization) Invega Sustenna Invega Trinza Risperidone Risperidone ODT Rykindo Risperidone ER Risperdal Consta Clozapine Quetiapine Fumarate Quetiapine Fumarate ER Olanzapine Olanzapine ODT Aristada Lurasidone Hydrochloride Ziprasidone Hcl Ziprasidone Hydrochloride Geodon Ziprasidone Mesylate
Austedo, Austedo Titration Kit	Preferred (Prior Authorization Required)	Preferred (Prior Authorization not required)
Austedo Extended Release Austedo Titration Kit Extended Release	Non-Preferred (Prior Authorization Required)	Preferred (Prior Authorization not required)
Ingrezza	Non-Preferred (Prior Authorization Required)	Non-Preferred (Prior Authorization Required) Preferred alternative: Austedo
Mavenclad	Non-Preferred (Prior Authorization Required)	Non-Preferred. Potential preferred alternatives include: Avonex Betaseron Copaxone Dimethyl Fumarate Kesimpta (with prior authorization)

Hyaluronic Acid

Effective 7/1/2024, as instructed by the Health Care Authority, Coordinated Care will no longer cover hyaluronic acid products.

Code	Description of Codes
J7320	Hyaluronan or derivitive, GenVisc 850, for intra-articular injection, 1 mg
J7321	Hyaluronan or derivative, hyalgan, Supartz or VISCO-3, for intra-articular injection, per dose
J7322	Hyaluronan or derivative, Hymovis, for intra-articular injection, 1 mg
J7323	Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose
J7324	Hyaluronan or derivative, Orthovisc, for intra-articular injection, per dose
J7325	Hyaluronan or derivative, synvisc or Synvisc-One, for intra-articular injection, 1 mg
J7326	Hyaluronan or derivative, Gel-One, for intra-articular injection, per dose
J7327	Hyaluronan or derivative, Monovisc, for intra-articular injection, per dose
J7328	Hyaluronan or derivative, gelsyn-3, for intra-articular injection, 0.1 mg
J7332	Hyaluronan or derivative, Synojoynt, for intra-articular injection, 1 mg
J7332	Hyaluronan or derivative, TRILURON, for intra-articular injection, 1 mg

Lifileucel - Ambetter Only

On 2/16/2024, the FDA approved Amtagvi (lifileucel) for the treatment of adult patients with unresectable or metastatic melanoma previously treated with a PD-1 blocking antibody, and if BRAF V600 mutation positive, a BRAF inhibitor with or without a MEK inhibitor. As a reminder, oncology/supportive drugs need to be verified by New Century Health. Please submit prior authorization request to New Century Health.

HCPCS	Generic Name	Brand Name	PA Required
J9999	LIFILEUCEL INJECTION	AMTAGVI	Yes

Wellcare

Medical Clinical Policy Updates

May 1, 2024-Facility Based Sleep Studies

Provider Newsletter 2024-Issue 1

Apple Health Core Connections (AHCC)

Coordinated Care is honored to partner with Mt. Spokane Pediatrics and Northwest Pediatrics to establish two new Foster Care Centers of Excellence in Spokane and Lewis counties. We are thrilled to offer additional specialized centers of health care for youth who have been impacted by the child welfare system.

Foster Care Centers of Excellence (FC COE) are medical centers with trauma-informed providers who understand the needs of families impacted by the child welfare system. In 2020, Coordinated Care launched its first Foster Care Center of Excellence (FC COE) in partnership with the UW Pediatric Clinic at Harborview. Since then, we have established Foster Care Centers of Excellence at Community Health Care’s Foster and Adoption Clinic in Pierce County as well as Excelsior Family Medicine in Spokane County.

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Training/Education

Coordinated Care is hosting a no-cost Trauma Focused Cognitive Behavioral Therapy Training on May 1-2, 2024. TF-CBT is an evidenced based treatment for children and adolescents (ages 3-18) impacted by trauma that includes participation by their parents or caregivers. The two-day training will be from 8:15a-5p each day and held at Northwest Indian College in Bellingham, WA. This training is open to contracted, in-network Coordinated Care providers and Indian Health Care Providers with a master's degree or above in a mental health discipline, professional licensure (or under supervision for licensure), and actively treating children/adolescents involved in the child welfare system. As part of the certification, providers must commit to and participate in the follow-up TF-CBT Consultation Call Program. Participants must also complete two pre-training requirements. For more information and to register, email katherine.ferguson@coordinatedcarehealth.com.

Deep Dive into Prevention Ethics: Nature of Services and the SPF This is the fourth of six highly interactive sessions focused on taking a deep dive into principles of the code of ethics for substance misuse prevention specialists. The focus of this session will be on the principle of Nature of Services and how to apply it to the Strategic Prevention Framework (SPF). After a short presentation participants will work together in small groups to look at how this principle can be applied to the SPF. April 4^th 7:30am – 9:00am Register here.

Prevention Across the Lifespan - Webinar 1: Substance Use Prevention Among Young Adults In our prevention efforts, we most often focus on children and youth. However, prevention is important across the entire lifespan. In this 3-part series, participants will learn about substance use among young adults, mid-life adults, and older adults. Participants will also learn about preventive strategies that can be used with the adult population. April 11^th 10:30am – 12:00pm Register here.

Cultural Humility & Collectivism vs. Individualism By delving into the concept of cultural humility and understanding the distinctions between individualist and collectivist cultures, our aim is to harness this knowledge to enhance equity and the quality of services provided to underserved communities of color. Up to 1.5 total hour AAFP credit; on approval. April 18^th 12:00pm – 1:30pm Register here.

Responding to the Sexual Exploitation and Trafficking of Youth Responding to the Sexual Exploitation and Trafficking of Youth" training will provide information on what, who, how, and why of Commercial Sexual Exploitation including a detailed discussion of identification and the “red flags.” This training will focus on victim engagement and interventions with a focus on King County’s Coordinated Response. April 30^th & May 1^st 9:00am – 12:00pm Register here.