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October 2021 Provider News

Date: 10/29/21

In this issue: 

  • General Updates - Inactive NPIs, 2021 Ambetter Provider NCQA Notification, Clinical Policy Updates, and Provider Portal Access
  • Training/Education - AWHP MCO Provider Resources Page, Geriatric Suicide Prevention Training, InterQual Connect (IQC) Training

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General Updates

Inactive NPIs: Requirement for Revalidation

Beginning January 1, 2022, Coordinated Care will deny 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 inactive NPI, providers should ensure they respond to HCA notices to complete revalidation. Upon receipt of a revalidation notification letter, a provider 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: https://www.hca.wa.gov/billers-providers-partners/apple-health-medicaid-providers/revalidation#am-i-currently-up-for-revalidation. If providers do not respond to their revalidation notification and therefore become inactive in ProviderOne, Coordinated Care will deny their claims beginning January 1, 2022.

If a provider’s enrollment with HCA has lapsed or they have never enrolled with HCA, they should complete the enrollment process specific to their provider type. More information about enrolling as a Medicaid Provider can be found here: https://www.hca.wa.gov/billers-providers-partners/apple-health-medicaid-providers/enroll-provider.

Please note that HCA will review requests for retro-active registration of providers if a provider’s registration has lapsed. A provider would need to complete the Effective Date Change form and other required documentation to be considered for retro-active registration: https://www.hca.wa.gov/billers-providers-partners/forms-and-publications?combine=effective+date&field_topic_tid=All&field_billers_document_type_value_1=All&sort=filename+ASC&=Search

As of October 29, 2021: The 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 state on your application the desired effective date they need their enrollment to start.

Please reach out to your Provider Network Specialist if you have any questions about the revalidation process.

2021 Ambetter Provider NCQA Notification

Helping you care for your patients is our top priority.

Strong communication and trust between you and your patients will help ensure they’re satisfied and have good outcomes. You can rely on Ambetter from Coordinated Care for information and support to help you keep those patient relationships strong.

  • Annual CAHPS Survey: The Consumer Assessment of Healthcare Providers and Systems (CAHPS) Health Plan Survey is an opportunity for your patients to share their healthcare experiences with you as their provider and with their health plan. Your patients are asked specific questions, which include how well their doctor communicates, if they felt their doctor listened to them, and if their doctor explained things in a way that was easy to understand. Also included are questions on how well different healthcare providers are communicating about care coordination and a (0-10) rating of the patient’s overall satisfaction with their healthcare, personal doctor and specialists.
  • Annual Provider Satisfaction Survey: You are essential to providing the highest quality healthcare possible for our members, and your satisfaction is very important to us, too. We assess your experience with the health plan through an annual Provider Satisfaction Survey and use the results to guide operational improvement activities.

Your Ambetter from Coordinated Care Support Doesn’t Stop There

Our provider website contains essential information, including your rights and other sources of support for you. Read more about our Quality Programs now: https://www.coordinatedcarehealth.com/providers/quality-improvement.html. If you have additional questions or need specific support, call Provider Services at 1-877-644-4613.

Clinical Policy Updates

The below policies received updates as part of our regular monthly review in October. These policy changes are effective November 1, 2021. You will find the policies, including a description of the revisions, posted on the policy site.

Policy NumberPolicy TitleLine of Business

WA.CP.MP.27

Hyperbaric Oxygen Therapy

Apple Health

WA.CP.MP.523

Sleep Apnea Diagnosis and Treatment

Apple Health

CP.MP.100

Allergy Testing and Therapy

Apple Health & Ambetter

CP.MP.107

Durable Medical Equipment and Orthotics and Prosthetics Guidelines

Apple Health & Ambetter

CP.MP.57

Lung Transplantation

Apple Health & Ambetter

CP.MP.40

Gastric Electrical Stimulation

Apple Health

CP.MP.51

Reduction Mammoplasty and Gynecomastia Surgery

Apple Health & Ambetter

WA.CP.MP.84

Cell-free Fetal DNA Testing

Apple Health

CP.MP.84

Cell-free Fetal DNA Testing

Ambetter

CP.MP.86

Neonatal abstinence syndrome guidelines

Apple Health & Ambetter

CP.MP.136

Home Birth

Apple Health & Ambetter

CP.MP.164

Caudal or Interlaminar Epidural Steroid Injections for Pain Management

Apple Health & Ambetter

WA.CP.MP.177

Video Electroencephalography (V-EEG)

Apple Health & Ambetter


The below policies are being retired effective November 1, 2022.

Policy Number

Policy Title

Line of Business

WA.CP.MP.119

Balloon Sinus Ostial Dilation for Treatment of Chronic Sinusitis

Apple Health
CP.MP.119Balloon Sinus Ostial Dilation for Treatment of Chronic SinusitisAmbetter


The below policies are new effective February 1, 2022. You will find the policies posted on the policy site.

Policy Number

Policy Title

Line of Business

WA.CP.MP.523

Sleep Apnea Diagnosis and Treatment

Ambetter

CP.MP.194

Osteogenic Stimulation

Apple Health & Ambetter


The below policy is being retired effective February 1, 2022.

Policy Number

Policy Title

Line of Business

WA.CP.MP.508

Bone Growth StimulatorApple Health


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

CP.MP.209

GI Pathogen Nucleic Acid Detection Panel Testing11/1/21Apple Health & Ambetter


The below policies were previously announced to have revisions effective on the dates noted. You will find the policies, including a description of the revisions, posted on the policy site.

Policy Number

Policy Title

Effective Date       

Line of Business

CP.MP.87

Inhaled Nitric Oxide12/1/21Apple Health & Ambetter
CP.MP.31Cosmetic and Reconstructive Procedures1/1/22Apple Health & Ambetter
CP.MP.165Selective Nerve Root Blocks and Transforaminal Epidural Injections for Pain Management1/1/22Apple Health & Ambetter
CP.MP.170Nerve Blocks for Pain Management1/1/22Apple Health & Ambetter

Introducing EntryKeyID

EntryKeyID is our new, single-password login experience. Anyone accessing health plans now have a single point of entry for all accounts.

EntryKeyID also improves account management and security.

  • Email verification replaces security questions and codes.
  • One password for all accounts using the same email.
  • Stronger password requirements.

What’s Changed for Start Screen?

  • New EntryKeyID branded screen template used throughout create account/registration.
  • Current provider home page is replaced by the EntryKeyID login start screen.
  • Log in becomes two separate screens – with users prompted to input password on next screen.
  • The “Create New Account” link will take users to the new EntryKeyID create account page flows.
  • Users who have “remember me” checked will skip enter username log in screen without having to use the identifier first. The remember me cookie will expire after 30 days.

What’s Changed for Password Screen?

  • “Trouble logging in?” will take users to the new EntryKeyID account recovery page flows.

Old Start Screen:

New Log In and Password Screens:

   

A common issue so far: Password reset emails are delayed or undelivered.

User Impact: Initially, the high volume of email requests for password changes resulted in many of the emails being delayed or quarantined. We have worked with our email service providers to help improve deliverability to end users. However, the emails can still sometimes be delayed or held by the recipient's email server.

Guidance for users: If a user has not requested an email within the past 1-2 days, they should complete the account recovery process again to trigger a new email to be sent. While most emails are delivered in less than a minute, some email carriers still have delays.

  • If they do not receive the email within a few moments, the user should first look in their spam, junk, or quarantine folders.
  • If they are unable to locate the email within 10-15 minutes, they should consider that the email may be blocked by their internal mail system.
  • To resolve this issue, users are advised to contact their own help desk to explain that they are expecting emails from the address no-reply@mail.entrykeyid.com in order to set their account password.

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Training/Education

AWHP MCO Provider Resources Page

Coordinated Care encourages providers to visit the Association of WA Health Care Plans MCO Provider Resources at https://www.wahealthcareplans.org/mco-resources. As a MCO member of AWHP, Coordinated Care is committed to ensuring providers have appropriate resources to deliver integrated care to Medicaid members across the state. Training and resources for providers are continuously developed by MCOs and shared on this site.

Geriatric Suicide Prevention: Suicide Safer Care Principles for Primary Care Providers and Their Teams

Tuesday, November 9, 2021 12:00 pm EST Register here. 

Suicide in elderly populations is a major public health issue. People aged 85 years and older have some of the highest suicide rates of any age group in the U.S., and older adults who attempt suicide are more likely to complete these attempts than others. Additionally, the COVID-19 pandemic has only exacerbated existing risk factors, such as social isolation, depression, and family discord or loss. However, primary care providers and their teams which work with geriatric populations have a critical opportunity to intervene.

Learn how Suicide Safer Care principles can help prevent elder suicide in our new webinar featuring experts from Concert Health and Adelphi University. This discussion will explore the dynamics of geriatric depression and suicide and why providers can play important roles in prevention and detail effective suicide prevention practices for geriatric populations, from screening tools to evidence-based interventions.

Learning objectives:

  • Provide an overview of geriatric suicide, how COVID-19 has impacted this phenomenon, and why primary care providers can play important roles in prevention.
  • Discuss common risk factors and warning signs.
  • Describe screening tools, clinical pathways, and evidence-based interventions for geriatric suicide prevention.

Speakers:

  • Dr. Virna Little, PSyD, LCSW-r, SAP, CCM, Chief Operating Officer and Co-Founder of Concert Health, Co-Founder of Zero Overdose
  • Dr. Daniel Kaplan, Assistant Professor at the Adelphi University School of Social Work, Faculty Director of the Center for Nonprofit Leadership, and Project Director and P.I. of Social Work Practice Fellows

InterQual Connect (IQC) Training

Effective September 1, 2021, Coordinated Care released the redesign of our web authorization request in our Secure Provider Portal and launched 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.

Coordinated Care is offering an hour-long training on the web authorization process and InterQual Connect in November.

  • Tuesday, November 16th from 1:00-2:00 pm
    • Here is the training registration link.
    • You can also reach out to TAC_Network_Management_Team@coordinatedcarehealth.com if you would like to receive an email with the registration link.

If this date or time doesn’t work for your organization , we’d be happy to schedule a separate live training. Please work with your Provider Network Specialist or reach out to us at TAC_Network_Management_Team@coordinatedcarehealth.com to get something scheduled.

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

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