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November 2021 Provider News - Special Edition

Date: 11/16/21

In This Issue

  • General Updates - 2022 Billing and Rendering Taxonomy Requirements, Recognizing and Intervening in Substance Use Disorder, Mental Health EBP Reporting for Behavioral Health Providers, HCA announces 2nd primary care stakeholder survey
  • Training and Education - COVID-19 & Suicide Prevention Training

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General Updates

Billing and Rendering Taxonomy Requirements: Changes Coming in 2022

Beginning in 2022, Coordinated Care will reject any Medicaid claims submitted without valid billing and/or rendering taxonomy codes. Claims will need to be submitted with a valid billing and/or rendering taxonomy to be considered clean.

Additional information about Taxonomy codes can be found here: https://taxonomy.nucc.org/

Behavioral Health Providers should consult the Mental Health Services Billing Guide for more information on billing and appropriate use of taxonomy codes: https://www.hca.wa.gov/assets/billers-and-providers/mental-health-svcs-bg-20210901.pdf

Tribal providers should consult the Tribal Billing Guide for more details on billing with a valid taxonomy: https://www.hca.wa.gov/assets/billers-and-providers/Tribal-health-bg-20210701.pdf Tribal provider claims must include both the appropriate billing taxonomy and the appropriate American Indian/Alaskan Native (AI/AN) or non-AI/AN tribal modifier to pay the IHS tribal encounter rate.

Coordinated Care will provide additional information and education on billing with a valid taxonomy in the coming months. If you have questions about billing and rendering taxonomy requirements, please contact your Provider Network Specialist.

Red Flags: Recognizing and Intervening in Substance Use Disorder

Providers contracted with Coordinated Care of Washington (CCW) are expected to follow best practices and appropriate standards of care. In this spirit, we’d like to reiterate the importance of recognizing and intervening in substance use disorder and support your practice in doing so. Substance misuse and substance use disorder remain a primary concern in addressing the health of our community members. Opioid misuse and fatal overdoses continue to rise, with emergency department visits for methamphetamine use also rising. Early screening, intervention, and referral to treatment, including medication when indicated are preventative resources in combating mortality and adverse health outcomes caused by substance misuse. CCW recommends the following as best practices in recognizing and effectively intervening in substance misuse and substance use disorder:

  • Make substance use screening a routine part of patient visits. For more information, refer to the National Institute on Drug Abuse (NIDA) website to explore evidence-based screening tools that best support your patient population.
  • Be alert to changing behaviors and presentation of your patients that cannot be attributed to other known medical or psychological conditions and discuss these changes with your patients. The following are some physical and behavioral signs that can be indicative of impairment due to substance use: changes in grooming and overall physical presentation, tremors, impaired speech, impaired motor function, changes in appetite, mood swings, paranoia, hallucinations, personality changes, and major changes in energy or motivation. Clinical indicators of substance use disorder also include difficulty functioning across the domains of employment and personal relationships as well as abandoning activities that one previously enjoyed. Increased drug tolerance and symptoms of withdrawal, which can vary by drug class, should also be considered in assessing for substance use disorder.
  • Have literature about substance use available to patients from resources such as SAMHSA or NIDA. If you need assistance with these resources, please contact your CCW Provider Rep.
  • Provide access to Naloxone to prevent opioid overdose by educating patients about where to get Naloxone and how to use it. Find educational literature and a Naloxone distribution locator at stopoverdose.org. Your office or clinic can also request through the Department of Health to become a Naloxone distribution site. If you need assistance in this process, please contact your CCW Provider Rep.
  • If you are having difficulty with or would like assistance in connecting your patients insured by CCW to substance use treatment including medication for opioid use disorder, please contact your CCW Provider Rep.
  • In addition to clinical and medical treatment, it can be helpful to connect your patients to sober support meetings. Your patients can find an online directory of in-person or virtual meetings that address their needs.

Mental Health EBP Reporting for Behavioral Health Providers

Coordinated Care would like to remind all clinics and providers who deliver Children’s Mental Health Evidence Based Practices (EBPs) to clients under age 18 that they should include the appropriate SERI code for Mental Health providers when billing for these services. EBP codes are specially designated identifiers on a claim or encounter that are used to report specific research- or evidence-based practices for children’s public mental health care provided by licensed or certified mental health providers to children and youth under 18 in Washington State. Coordinated Care is required by law to track and report to HCA quarterly all children’s mental health visits and how many of these visits were billed as an Evidence Based Practice. EBP codes and all associated history and criteria can be found in the Evidence-Based Practices Reporting Guide: https://www.hca.wa.gov/assets/program/ebp-reporting-guides.pdf

The utilization of EBP codes does not impact payment of your claims. Coordinated Care will not deny any claims due to EBP code utilization. Additionally, please know that billing correctly also helps Coordinated Care to be able to refer new clients to you for Evidence Based Practices.

Please reach out to your Provider Network Specialist if you have any questions/concerns about billing with EBP codes. 

HCA announces 2nd primary care stakeholder survey

Coordinated Care would like to encourage all primary care experts, Tribal partners, and other stakeholders to provide input on Health Care Authority’s (HCA) proposed Multi-payer Primary Care Transformation Model (PCTM). More information about the PCTM can be found here: https://www.hca.wa.gov/about-hca/value-based-purchasing/multi-payer-primary-care-transformation-model. Please note the link to the survey can be found about one-third of the way down this page. All stakeholders are also encouraged to review the model briefing paper before completing the survey: https://www.hca.wa.gov/assets/program/pctm-model-for-public-comment-11-02-21.pdf

HCA encourages all to give feedback, including those who previously gave feedback on the first draft of the PCTM in 2020. The deadline to share feedback with HCA is Friday, November 19, 2021.

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Training and Education

COVID-19 & Suicide Prevention: Unique Considerations and the Need for Increased Awareness

Thursday, November 18, 2021 1 p.m. ET

https://clinicians.webex.com/clinicians/onstage/g.php?MTID=e118a00626e0c3887ae886e570e9e5971

The COVID-19 pandemic has significantly impacted numerous social determinants of health, from individuals’ income and job security to their access to primary and behavioral healthcare. These stressful life events consistently identify as risk factors for suicide, and the uncertainty of the pandemic is exacerbating mental health symptoms associated with suicide risk. It is crucial for frontline providers of all disciplines to understand the increased risk of suicide during and after the pandemic and how to effectively identify and intervene with patients at risk of suicide in both in-person and telehealth visits.

The Association of Clinicians for the Underserved has developed a new fact sheet addressing this topic, and this accompanying webinar will outline this and other resources to help providers and staff at health centers and other facilities understand COVID-19’s impact on suicide prevention, detail essential steps for identifying patients at risk for suicide, assessing risk, and responding with evidenced-based interventions, and share unique considerations in providing care to patients at risk for suicide via telehealth.

Learning objectives:

  1. Detail COVID-19’s impact on social determinants of health and suicidality, and why providers and staff at health centers and other facilities can play important roles in prevention.
  2. Share practical steps to address suicide risk in patients during the COVID-19 pandemic.
  3. Describe unique considerations in providing care to patients at risk for suicide via telemedicine.

Presenters:

  • Dr. Virna Little, PSyD, LCSW-r, SAP, CCM, Chief Operating Officer and Co-Founder of Concert Health, Co-Founder of Zero Overdose
  • Dr. Bart Andrews, PhD, Vice President of Clinical Practice and Evaluation of Behavioral Health Response, Faculty Member of Zero Suicide Institute

This webinar is made possible by the generous support of Coordinated Care’s parent company, The Centene Corporation and draws from resources developed by ACU in partnership with Concert Health.

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