October 2022 Provider News
Date: 10/31/22
In this issue:
- General Updates - Secure Provider Portal Enhancements
- Quality - Air Quality and Breast Cancer Screening
- Billing - Maternity Bundle and Code 0500F Utilization, Rawlings COB – Post Pay Expansion
- Tribal - Network Providers and Coordinating with Indian Health Care Providers
- Clinical Policy - Clinical Policy Updates
- Apple Health Core Connections - Updates to DCYF’s COVID Vaccine Process and Consent Forms for Youth in Foster Care
- Training/Education - November Updates, Joint MCO Live Training Sessions for Apple Health (Medicaid) Providers
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General Updates
Secure Provider Portal Enhancements
Coordinated Care values our relationship with our provider partners and believes a key component of meeting provider needs is our Secure Provider Portal. The portal enables providers to conduct business with Coordinated Care from the convenience of their desktops seamlessly and in real time.
Enhancement launched October 2022:
Coordinated Care would like to inform you of an exciting new feature that can be found in the new “Manage Practice” tab of our Secure Provider Portal. The feature will enable providers to complete practice demographic updates.
The Manage Practice tab will be available to all Coordinated Care, Ambetter and Cascade Select providers.
The new capabilities include:
- Allows a provider to view/change contracted practitioner demographic information
- Allows a provider to view/change contracted provider group/facility demographic information
We believe these updates to our secure provider portal will create a more user-friendly experience and enhance your ease of doing business with us. We hope that you will take a moment to explore these new features once they are available in October. Additional capabilities will be made available later in the year so look out for an announcement of additional enhancements.
Please contact your local provider relations representative with any questions.
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Quality
Air Quality and Asthma
Getting members with asthma to a 90-day refill may increase maintenance medication adherence.
Breast Cancer Screening
Does your patient have any of these risk factors? They may need to be assessed for early onset Breast Cancer:
- Thoracic radiation between ages 10 and 30.
- Lobular carcinoma in situ or atypical hyperplasia.
- Breast or ovarian cancer.
Breast cancer screening guidelines for women chart provided by the CDC.
Early Onset Breast Cancer Provider Risk Assessment
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Billing Updates
Maternity Bundle and Code 0500F Utilization
The Washington State Health Care Authority (HCA) has identified a long-standing compliance issue in which OB/prenatal providers (all provider types – licensed midwives, certified nurse midwives, family physicians, OB/GYNs, maternal fetal medicine specialists) are not reporting the 0500F code when they initiate prenatal care with a Medicaid/AH client.
This is the language from the Physician-related/professional services Billing Guide (pg. 220):
- Use HCPCS code 0500F along with the appropriate diagnosis code6 on the first prenatal visit. HCA is tracking the date a client begins receiving obstetrical care (date the OB record is initiated). Note this date by entering HCPCS code 0500F with the appropriate ICD diagnosis codes Z33.1, Z34.00, Z34.80, or Z34.90 on the claim.
- The superscript notes - 6 HCA collects this code for quality measurement, tracking, and care coordination. Other payers use the code in the same way
HCA has pulled data on the 0500F code recently and less than 10% of all pregnant Medicaid/AH clients have this reporting code in claims.
HCA contracted providers must comply with this requirement and report the 0500F code when they initiate prenatal care/the first prenatal visit.
HCA requests your communication and outreach with your networks as we do not want providers to be reporting the 0500F code later in pregnancy or even post-delivery when they submit the global codes.
New Vendor for Coordination of Benefits Review
Centene and Coordinated Care have employed a new partner, The Rawlings Company LLC, to coordinated Coordination of Benefits reviews. Providers may see correspondence from this company, but branding will continue to include Coordinated Care for reference.
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Tribal
Network Providers and Coordinating with Indian Health Care Providers
Supporting Indian Health Care Providers is a priority for Coordinated Care. This is a friendly reminder to our network providers that American Indians/Alaska Natives (AI/AN) have federal protections we all must abide by. These include 1. Allowing AI/ANs to stay in Fee-For-Service. 2. Coordinating care for AI/ANs with an Indian Health Care Provider when the member is receiving care at an IHCP. Washington State Health Care Authority has specific requirements for us to ensure that psychiatric hospitals and Evaluation and Treatment facilities are coordinating with an AI/AN enrollee’s IHCP for discharge planning.
Learn more about the Indian Health Care Delivery System from the American Indian Health Commission’s “Tribal Sovereignty and the Indian, Tribal and Urban Health System in Washington State”
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Clinical Policy
Monthly Updates:
The below clinical policies received updates as part of our regular monthly review in October. These policy changes are effective November 1, 2022. 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.156 | Cardiac Biomarker Testing for Acute MI | Apple Health & Ambetter |
| CP.MP.203 | Diaphragmatic Phrenic Nerve Stimulation | Apple Health & Ambetter |
| CP.MP.105 | Digital EEG Spike Analysis | Apple Health & Ambetter |
| CP.MP.155 | EEG in Evaluation of Headache | Apple Health & Ambetter |
| CP.MP.106 | Endometrial Ablation | Apple Health & Ambetter |
| CP.MP.134 | Evoked Potential Testing | Apple Health & Ambetter |
| CP.MP.153 | H. Pylori Serology Testing | Apple Health & Ambetter |
| CP.MP.113 | Holter Monitors | Apple Health & Ambetter |
| CP.MP.194 | Osteogenic Stimulation | Apple Health & Ambetter |
| CP.MP.154 | Thyroid Hormones and Insult Testing in Pediatrics | Apple Health & Ambetter |
| CP.MP.143 | Wireless Motility Capsule | Ambetter |
The below new policies were approved as part of our regular monthly review in October. You will find the policies posted on the policy site.
| Policy Number | Policy Title | Line of Business | Line of Business |
CP.MP.246 | Pediatric Kidney Transplant | 2/1/23 | Apple Health & Ambetter |
| WA.CP.MP.117 | Percutaneous Electrical and Peripheral Nerve Stimulation | 2/1/23 | Apple Health & Ambetter |
| CP.MP.242 | Pulmonary Function Testing | 2/1/23 | Apple Health & Ambetter |
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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), children reunified with their parents, and youth in the Unaccompanied Refugee Minor program. 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.
Updates to DCYF’s COVID Vaccine Process and Consent Forms for Youth in Foster Care
The Washington State Department of Children, Youth, and Families (DCYF) has updated their guidance and forms for youth in out-of-home (foster) care to get consent for and access to COVID vaccinations and boosters. (Youth ages 18 and up do not need any additional consent to receive the vaccine.)
Primary care providers and vaccination sites may be asked to vaccinate youth in foster care, and youth will arrive with caregivers with the Youth and Parent Consent forms show below. DCYF has indicated that the previous forms without specific booster approval should not be used as parental or court consent for boosters.
Youth under age 13 do not need to have the Youth Consent Form, only the Parent Consent form or a court order for the vaccine. Examples of the forms are below.
If a bio-parent does not consent for a youth to receive the vaccine, or if a court order is needed, you may also be asked to determine if a youth is healthy enough to receive the COVID vaccine. This consultation can occur in an office visit or by telehealth. DCYF will accept your COVID Vaccine recommendation on a Visit Summary as documentation.
For more information, please contact:
- Jen Estroff, AHCC Liaison: jestroff@coordinatedcarehealth.com, 206-492-9019
- Apple Health Core Connections Care Coordination Team: AHCCTeam@coordinatedcarehealth.com
DCYF - COVID Vaccine Guidance for Children in Care:
November is National Adoption Month. Coordinated Care is offering an Adoption Success presentation that outlines the adoption process for children who are in the child welfare system. It includes the steps involved in the adoption process through DCYF as well as useful resources for families post adoption. This training is designed to help behavioral and medical health providers gain knowledge of the adoption process so they can better support their patients. Join us on November 16, 2022 12-1pm. Register here.
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Training/Education
Visit Centene’s Clinical Provider Training website 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.
LGBTQIA+ Training: Health Care Seminar Series. Seattle Children’s Gender Clinic, Matt Goldenberg, PsyD, and Gina Sequeira, MD will cover Increasing Family Support for LGBTQ+ Youth, Creating Patient-Centered Care in Youth Gender Transition, and Medical Care for Gender Diverse Youth. Oct. 13, 27, & Nov. 3 12-1pm. Register here.
This comprehensive Clinical Training on DC:0-5™ Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood is designed for advanced practitioners such as mental health clinicians, psychiatrists, pediatricians, nurse practitioners, and early intervention specialists whose work with infants, young children, and their families involves assessment, diagnosis, and case formulation. November 30, December 1, or December 2, 2022 9am-12pm. Register here.
UW and Seattle Children’s Autism Center’s Autism Center of Excellence Certification. Training covers: Evaluation and diagnosis of children exhibiting signs and symptoms of autism spectrum disorder and determining which evidence –based treatments, including ABA, are likely to be helpful for individual children, community/state resources, the lived experience of autism, writing a prescription for ABA treatment, billing, and process to complete to become a HCA recognized COE after the training. December 9, 2022 8:30-4:30pm. Register here.
Joint MCO Live Training Sessions for Apple Health (Medicaid) Providers
Washington’s Managed Care Organizations (MCOs) request your participation in 2022 joint Apple Health Integrated Managed Care (IMC) & Medicare Advantage Provider Training. You will hear from Amerigroup, Community Health Plan of Washington, Coordinated Care of Washington, Inc., Molina Healthcare of Washington, and United Healthcare about this training.
Joining one of the training sessions will satisfy your annual attendance requirement under 42 CFR 38.608(a)(1)iv.
Who: Providers servicing Medicaid enrollees.
What is Covered:
- Enrollee Rights & Responsibilities
- Advanced Directives
- Fraud, Waste and Abuse
- False Claims Act
- Cultural Awareness
Where: Webinar. To register, please use this link.
When: Please register for one of the below training sessions.
- Tuesday, November 1st 10:00-11:00 am
- Thursday, November 3rd 11:00-12:00pm
- Wednesday, November 9th 12:00-1:00pm
- Thursday, November 10th 1:00-2:00pm
- Tuesday, November 15th 10:00-11:00am
- Thursday, November 17th 11:00-12:00pm
- Tuesday, November 29th 12:00-1:00pm
- Wednesday, November 30th 1:00-2:00pm
After the training, you will be asked to complete a short survey, which confirms your participation and provides an opportunity to submit feedback on this presentation.
If you have questions regarding this training requirement, please contact MHWJointMCOproviderquestions@molinahealthcare.com.
We appreciate your partnership in serving our patients and look forward to your attendance!