May 2021 Provider News
Date: 05/26/21
In This Issue
- Quality - Evidenced Based Practices
- Apple Health Core Connections - Trainings, webinars, resources
- Pharmacy - July 1, 2021 Preferred Drug List Changes
- Updates - Clinical Policy Updates and other News
- COVID-19 - Updates
Save the Date! Spokane Medicaid Forum
Thursday, June 17th - 9:00am-11:00am and Friday, June 18th - 9:00am-11:00am
Coordinated Care is hosting a Forum for the Spokane Region. Come and meet who will be a choice for the community in healthcare needs and coverage in Medicaid effective July 1, 2021.
Purpose: To provide guidance on our operational practices to health agencies and community organizations as we enter the Spokane Region on July 1, 2021. We believe Community Collaboration is a key driver of how we serve our members, so we’re offering an opportunity for you to meet some of Coordinated Care’s Team and to learn about their roles in supporting you and your organization. More information to come in next month’s faxblast or reach out to Carin.sauer@coordinatedcarehealth.com.
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Notice 1: Quality
Better Patient Outcomes through Evidence Based Practices
This Month: Positive Parenting Program (Triple P) Level 4 (EPA Number 870001580- group, 870001581- individual, SERI: 860139000-group, 860140000- individual)
Who benefits: Parents of children with severe behavioral difficulties (or in the case of Group Triple P/Group Teen Triple P, for motivated parents interested in gaining a more in-depth understanding of Positive Parenting). It is available for parents of children from birth to 12 years and 12–16 years and covers Triple P's 17 core positive parenting skills that can be adapted to a wide range of parenting situations.
Improves/helps with these outcomes:
- Reduces problem behavior in children and improves parents’ wellbeing and parenting skills
- Shown to slow rates of child abuse, reduce foster care placements and decrease hospitalizations from child abuse injuries
- Tested and shown to be effective in many culturally and ethnically diverse populations around the world
- In communities where Triple P is widely available, children have fewer behavioral and emotional problems
- Parents using Triple P say they are less stressed, less depressed, and don’t use harsh discipline
Brief description of intervention: Triple P Level 4 is for parents of children with severe behavioral difficulties (or in the case of Group Triple P/Group Teen Triple P, for motivated parents interested in gaining a more in-depth understanding of Positive Parenting). It is available for parents of children from birth to 12 years and 12–16 years and covers Triple P's 17 core positive parenting skills that can be adapted to a wide range of parenting situations.
Delivered as:
- Group Triple P/Group Teen Triple P – Groups of no more than 12 parents attend five sessions and are supported with three phone counseling/catch-up sessions at home. Uses DVDs and workbook to engage parents and reinforce strategies.
- Standard Triple P/Standard Teen Triple P – For parents who need intensive support. Individual counseling delivered over ten (1 hour) sessions. Uses DVD, workbook.
- Triple P Online – A comprehensive, eight-session web-based program that guides parents through Triple P's 17 core parenting skills. Based on the Standard Triple P program it includes opt-in text or email reminders of session goals and strategies.
- Self-directed Triple P – A ten-week self-help program, based on a workbook. Parents who need additional support can receive weekly 15–30 minute telephone consultations.
Cultural adaptations available? YES
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.
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Notice 2: Apple Health Core Connections
WEBINARS/TRAININGS:
On January 1, 2019, Coordinated Care became 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.
Visit Centene’s Clinical Provider Training website 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 February:
- Substance Related and Addictive Disorders Module 1. Attendees receive an overview of DSM-5 criteria and diagnostic information specific to substance use disorders. In addition, the course teaches the alterations that substance use may make to important brain areas needed for life-sustaining functions. 1.5 CE hours available for NBCC. June 1, 2021, 10am-11:30am. Register here.
- Substance Related and Addictive Disorders Module 2. Attendees receive an overview of DSM-5 criteria and diagnostic information specific to Alcohol Related Disorders. In addition, the course teaches the alterations that substance use may make to important brain areas needed for life-sustaining functions. 1.5 CE hours for NBCC. June 2, 2021, 10am-11:30am. Register here.
- Co-Occurring Substance Use and Mental Health Disorders. Behavioral health providers learn the relationship between substance use and co-occurring mental health disorders and methods to screen and assess co-occurring disorders. The course also offers guidance on treatment options. 1.5 CE hours available for NBCC. June 22, 2021. 12pm-1:30pm. Register here.
Trainings
Trauma Informed Resilience Oriented Crisis Leadership. Hosted by The National Council. Our nation is experiencing a series of collective traumatic events, yet how we each manage this prolonged crisis period will determine its individual and collective long-term impact. In response, join us for an overview of Trauma-Informed, Resilience-Oriented Crisis Leadership. The overview is intended to support public health leaders in their own behavioral health, as well as to build their capacity to enhance trauma-informed resiliency-oriented practices within their jurisdiction through this unprecedented public health crisis. June 2, 2021 9am-1pm. Register here.
Protect Your Brain: Addressing Adolescent African American Males and Substance Use. Hosted by NAADAC. This workshop will explore the use of various substances within the United States by American youth, and, more specifically, among African American youth and African American males as compared to the larger population of young people in the US. We will review the research data associated with use among each of these groups, including prevalence, age of onset, and short- and long-term effects. We will closely examine patterns of use over the last 10 years in adolescent African American males. Outlining the effects on the adolescent brain, we will discuss the implications for mental health practitioners in working with youth. We will share interventions that can assist with remediating use and its effects. June 9 12pm-1:30pm. Register here.
2021 Pediatric Mental Health Conference hosted by the Partnership Access Line (PAL). Seattle Children's PAL Program is hosting a free educational webinar for primary care providers. Topics include anxiety, postpartum depression screening, trauma, and adolescent suicidality and the COVID 19 pandemic. June 12, 2021 8am-12pm. Register here.
Perinatal Support Washington presents: Best Practices in Prevention, Identification, and Treatment of Perinatal Mood and Anxiety Disorders- 2 Day Training. Learn how to effectively identify and screen parents experiencing perinatal mood and anxiety disorders. This two-day training is appropriate for a range of providers, including OBs, pediatricians, midwives, RNs, social workers, mental health therapists, doulas, public health employees, home visitors, IBCLCs, and more. June 7 & 14, 2021, 9am-5pm. Register here.
2021 Behavioral Healthcare Conference. Hosted by the Washington National Council on Behavioral Health. We’re all living in and through incredibly challenging times. Our theme, Stronger Together – A Path Forward, will be supported through critical content on race and equity in behavioral health, COVID-related innovations, connections between corrections and behavioral health, and best practices in team-based care. National and regional experts, consumer leaders, and local providers will share their experience, knowledge, and tools, bringing you timely new resources to use in your agencies and communities. June 16-18. Register here.
Supporting the Mental Wellbeing of Native Youth: Depression. Hosted by The Child & Adolescent Mental Health ECHO (Extension for Community Healthcare Outcomes) for Native American Children and Youth Project. Objectives: 1. Provide comprehensive, integrated and responsive mental health services in community-based settings for early recognition and evidence-based management of childhood mental disorders. 2. Formulate and implement acceptable treatment modalities according to evidence-based guidelines.3. Acquire new skills, competencies, and best practices in pediatric mental healthcare. June 17, 2021 12pm-1:30pm. Register here.
Equitable Care Webinar: Physical Spaces. Hosted by the Washington Chapter of the American Academy of Pediatrics. Designing at the Edges: Making a case for why representation matters. How engaging and understanding diverse patient populations leads to making more equitable and inclusive design decisions. June 30, 2021 7-8am. Register here.
Safe Kids Academy
The Washington State Traumatic Brain Injury Council, DSHS, DOH Safe Kids Coalition, and the UO Center for Brain Injury Research and Training would like to invite all participants to the upcoming Safe Kids Virtual Academy.
The Safe Kids Virtual Academy is fun, and has FREE events at home for kids, teens and parents that teach important safety messages with games, prizes, and more.
The Summer events are set-up for ages 3 – 5 yr olds / 6 – 12 year olds / 13 – 18 yrs old / and parents (caregivers).
Events are OPEN to all kids across the state.
3 – 5 year olds - Parents will learn key information about how to keep kids safe while having fun at the same time. Safety information is targeted for kids 3 to 5 years old. Learn how to properly install car seats, prevent accidental poisoning, learn about swim safety, safe sleep and much more in a fun presentation.
6-12 year olds - Kids aged 6-12 years old will learn about how to stay safe when biking, skateboarding, swimming, playing sports and much more. Learn how to pick the right helmet for the right activity and learn how to wear it correctly.
13 – 18 year olds - Teens aged 13-18 years old will learn about car and driver safety, how to stay safe and keep their friends safe when biking, skateboarding, swimming, playing sports and much more. Learn how to pick the right helmet and how to wear it correctly.
Registration is OPEN. More information can be found here.
Behavioral Health Model Ordinance & Communications Toolkit Overview
Join us for a webinar on June 17
On Thursday June 17, from 11a.m. - 12 noon, Commerce and BERK Consulting will host a Zoom webinar to provide an overview of the completed behavioral health model ordinance and communications toolkit and answer any questions.
The final model ordinance and communications toolkit will be posted to the project webpage shortly after the webinar.
How can I join the meeting?
Go to this Zoom link at 11:00 a.m. on June 17.
INTERESTING ARTICLES & RESOURCES:
- June is Pride Month. Visit the LGBTQ+ Behavioral Health Equity Center of Excellence for learning opportunities here.
- Visit the Health Care Authority’s newly updated Family Initiated Treatment page to learn more about FIT and access resources.
- Child Trends. Early Childhood Health Equity Landscape Project.
- WA State DOH Essentials for Childhood is offering Vroom Brain Building starter kits and technical assistance on how to use Vroom (PDF). Applications due June 11, 2021.
- Stanford Social Innovation Review (May 2021). It takes a multigenerational village to raise foster kids.
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Notice 3: Pharmacy
Effective 07/01/2021, certain medications will no longer be preferred by Coordinated Care. Please see list of medications below. Impacted members will be notified of these changes.
EFFECTIVE DATE | DRUG NAME | POTENTIAL ALTERNATIVES |
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07/01/2021 |
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Ambetter PA Request Fax Number Update
We have updated the Ambetter PA request fax number, which can be used today, on our PA request forms. The new fax number is (800) 977-4170. The overall forms have not changed, and the new fax number will be used for our Ambetter members. Please visit our Ambetter website to get the updated PA request forms.
There has been no change in our electronic Prior Authorization (ePA) process. Please continue to use CoverMyMeds to submit your ePA requests.
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Notice 4: Updates
Clinical Policy Updates
NIA Policy Updates
NIA manages complex radiology authorization for both Apple Health and Ambetter. They recently updated the following policies. You will find the revised policies on the NIA Website. A link is available on our Prior Authorization page.
Policy Number | Policy Title | Line of Business |
|---|---|---|
NIA_CG_009 | Sinus Maxillofacial CT | Apple Health |
NIA_CG_014 | Sinus Face Orbit MRI | Apple Health |
Clinical Policy Updates
The below policies received updates as part of our regular monthly review in May. These policy changes are effective June 1, 2021. 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.506 | Psychological Testing | Apple Health |
WA.CP.MP.507 | Oral & Enteral Nutrition | Apple Health |
CP.BH.200 | Transcranial Magnetic Stimulation | Apple Health & Ambetter |
CP.BH.201 | Deep TMS for OCD | Ambetter |
WA.CP.MP.54 | Hospice Services | Apple Health |
CP.MP.54 | Hospice Services | Ambetter |
CP.MP.163 | Total Parenteral Nutrition and Intradialytic Parenteral Nutrition | Apple Health & Ambetter |
WA.CP.MP.185 | Skin Substitutes for Chronic Wounds | Apple Health |
CP.MP.185 | Skin Substitutes for Chronic Wounds | Ambetter |
The below policy received significant updates as part of our regular monthly review in May. This policy update is effective September 1, 2021. You will find the policy, including a description of the revisions, posted on the policy site.
Policy Number | Policy Title | Line of Business |
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CP.MP.107 | Durable Medical Equipment (DME) | Apple Health & Ambetter |
The below policy is new effective September 1, 2021.
Policy Number | Policy Title | Line of Business |
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CP.MP.211 | Electromygraphy and Nerve Conduction Studies | Apple Health & Ambetter |
The below new policy was previously announced to be effective on the date noted. You will find the policy posted on the policy site.
Policy Number | Policy Title | Effective Date | Line of Business |
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WA.CP.MP.207 | Home Prothrombin Time Monitoring | 8/1/21 | Apple Health |
Upcoming Improvements to Web Authorization on Provider Portal
Coordinated Care is pleased to announce, effective of September 1, 2021, 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. Look for upcoming training dates in August 2021.
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
- Provides the assigned Authorization ID on submitted web authorization Service Lines
New Behavioral Health Facilities grant application now open
$3.5 million available for crisis stabilization projects in rural communities
Thanks to a unique public-private partnership between Premera Blue Cross and the Department of Commerce $3.5 million in capital construction funding is available for behavioral health facilities targeting crisis stabilization needs in rural communities in Washington State. Grants will range from $150,000 - $1 million.
Funding is open to nonprofits, public entities, Tribes and for-profit businesses. Nonprofit and for-profit business applicants must be registered in the State of Washington and all applicants must meet specific licensing and certification requirements. Grants are for reimbursement for capital projects only.
The Crisis Stabilization Grant application has two parts, a threshold clearance and the general application. The threshold clearance closes at 12:00pm on July 1. Applicants must submit answers to the threshold questions by July 1 to be eligible to complete the general application questions. Completed applications must be submitted by 5:00pm on July 15.
For more information, program guidelines and application materials visit their webpage.
Changes to BHSO Claims
MCOs under their BHSO contract provide: Higher-acuity behavioral health care services through a BHSO for FFS clients. Services are provided by a community mental health center. The mental health claim must be billed with a billing taxonomy 261QM0801X or 251S00000X.
Exception: FQHCs and Tribal Health Clinics must refer to respective program specific billing guides for direction on taxonomy billing requirements.
- For lower acuity mental health services, bill HCA as described in Part 1 of this guide.
- See How do providers identify the correct payer?
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Notice 5: COVID-19
From the WA State Health Care Authority:
Children 12 to 15 years old may now be vaccinated against COVID-19 in Washington.
We recommend children age 12 and up get vaccinated as soon as possible. Vaccination will allow kids to safely get back to activities like in-person schooling, sports, and visiting friends. COVID-19 vaccine offers protection for kids and peace of mind for their parents.
Please help us share this news with your networks, community partners, and families in Washington to get eligible children vaccinated for COVID-19. We’ve provided resources for you to use at the bottom of this email.
Here’s what you can do:
- Spread the word about expanded age eligibility so families understand that children age 12 and up can get the Pfizer vaccine.
- Share vaccine information and resources with youth-serving community partners and encourage them to promote COVID-19 vaccination.
- Work with providers in your area and help them get ready to begin vaccinating 12 to 15-year-olds.
- Encourage families to get eligible children vaccinated for COVID-19.
Changes to Telehealth
As of 7/1/21, the following changes will go into effect in regards to telehealth to ensure that service utilization data reflects the type of telehealth technology by which the service is provided, in addition to the service itself. (see the COVID-19 and Telehealth FAQs):
- The CR modifier will only apply to services provided via telephone and no other telehealth technologies for the remainder of the COVID-19 PHE.
- Non-HIPAA compliant audio-video platforms, such as Skype and FaceTime, will no longer be permitted. All video chat platforms must be HIPAA-compliant that meet the telemedicine criteria so that the claims can be billed using the GT modifier regardless of the status of the COVID-19 Public Health Emergency.
- Texting and email are not to be used for service delivery. They can be used only for virtual check-ins using the HCPCS code G2012.
Provider Billing Guidance for COVID-19 CMS CLIA Requirements
All facilities that perform laboratory testing on human specimens for health assessment or the diagnosis, prevention, or treatment of disease are regulated under the CMS Clinical Laboratory Improvement Amendments of 1988 (CLIA).
When a test is categorized as waived, it may be performed by laboratories with a Certificate of Waiver. CMS requires the QW modifier for most waived tests. Modifier QW is defined as a Clinical Laboratory Improvement Amendment (CLIA) waived test. Claims billed without the required QW modifier, or where modifier QW is incorrectly appended, will deny. Please note, the requirement of the QW modifier is addition to any other modifiers required by HCA, such as the CR. A CLIA waived test still requires the provider to include their CLIA number on the claim.
Of note, we are seeing a high volume of claims denying for not including modifier QW in addition to modifier CR, on COVID tests. You will need to submit corrected claims to include all required modifiers, if appropriate.
Below are examples of where the QW Modifier is required.
Examples:
- Codes U0002 and 87635 (PDF)
- Modifier QW is required Effective 3/1/2020 (HCA also requires modifier CR)
- Codes 87811 and 87428 (PDF)
- Modifier QW is required Effective 11/10/2020 (HCA also requires modifier CR)
Additional Links
- CMS List of TESTS GRANTED WAIVED STATUS UNDER CLIA (PDF)
- Center for Medicare and Medicaid Service’s (CMS) Research Testing and Clinical Laboratory Improvement Amendments of 1988 (CLIA) Regulations (PDF)
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Remember to check the Provider News section of the Coordinated Care website to refer back to previous fax notices as well as many other informational updates!
To be removed from these notices or to request to be added to our email list for these notices, please reply to CoordinatedCareProvider@centene.com.
Thank you for being our partner in care and helping us collectively improve the health of our members. Please reach out to your Provider Services team if you have questions about any of these announcements or need more information.
Coordinated Care Provider Services: (877) 644-4613.