September 2022 Provider News
Date: 09/30/22
In this issue:
- General Updates - Clinical Trial Payments – Attestation Form, Amazon Connect
- Quality - Well-child Visits and Medication Adherence
- Tribal - PaySpan, Provider Portal Updates
- Clinical Policy - Clinical Policy Updates, NIA Announcement
- Pharmacy Updates - Updated Apple Health Codes
- Apple Health Core Connections - Sports Physical, EPSDT
- Training/Education - Clinical Provider Training, LGBTQIA+ Training, CDC Naloxone Training, Washington State Prevention Summit
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General Updates
Clinical Trial Payments – Attestation Form
Please review the Health Care Authority’s Apple Health News Alert issued on September 24th around an FAQ for CMS Attestation Form for Qualifying Clinical Trials
Amazon Connect
New enhancements to our telephony systems nationwide are coming soon to Washington.
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Quality
Well-Child Outreach
Coordinated Care can provide a list of children with critical care gaps. Immunizations and
well-child care are care gaps that can be provided to you. For more information, please contact Eboney Reece-Herrera, our EPSDT Coordinator at: Eboney.A.ReeceHerrera@coordinatedcarehealth.com
Asthma: 90-Day Medication Refills
Moving patients with asthma to 90-day refills may help increase their adherence to maintenance medication. Mail order information is available to Providers located on our website.
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Tribal
Payspan: Sign up to receive Electronic Fund Transfers (EFT) and Electronic Remittance Advices (ERA)
Our Partnership with Payspan offers access to EFT’s and ERA’s allowing you to receive payments and remits quickly, without mail delays or bank deposit preparation. Click the links below for more information or reach out to your Provider Network Specialist for assistance in enrollment.
Provider Portal Updates: Taxonomy updates in Corrected Claims
We recently updated our Secure Provider Portal to allow submission of corrected claims for taxonomy changes through our portal. This update gives you, as one of our partners, an additional option for submitting corrected claims—through the secure provider portal, your clearinghouse, or paper. Reach out to your Provider Network Specialist for additional training on this new feature or access it in the Provider Portal.
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Clinical Policy
Announcement:
The planned implementation of National Imaging Associates, Inc’s. (NIA) review of interventional pain management, left heart catheterization, and cardiac implant services has been delayed. No changes to clinical policies will be made on October 1, as previously announced. We tentatively plan an implementation in spring of 2023. More information will be shared as it becomes available.
Monthly Updates:
The below clinical policies received updates as part of our regular monthly review in September. These policy changes are effective October 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 |
WA.CP.MP.519 | Administrative Days | Apple Health |
WA.CP.BH.104 | Applied Behavioral Analysis | Apple Health |
CP.BH.104 | Applied Behavioral Analysis | Ambetter |
WA.CP.MP.516 | Carotid Artery Stenting | Apple Health |
WA.CP.MP.95 | Gender Affirming Procedures | Ambetter |
CP.MP.167 | Intradiscal Steroid Injections for Pain Management | Apple Health & Ambetter |
CP.MP.170 | Nerve Blocks for Pain Management | Apple Health & Ambetter |
CP.MP.133 | Posterior Tibial Nerve Stimulation for Voiding Dysfunction | Ambetter |
CP.MP.206 | Skilled Nursing Facility Leveling | Apple Health & Ambetter |
CP.MP.169 | Trigger Point Injections for Pain Management | Apple Health & Ambetter |
| CP.MP.12 | Vagus Nerve Stimulation | Ambetter |
The below new policies were approved as part of our regular monthly review in September. You will find the policies posted on the policy site.
| Policy Number | Policy Title | Effective Date | Line of Business |
CP.BH.500 | Behavioral Health Treatment Documentation Requirements | 10/1/22 | Apple Health & Ambetter |
CP.BH.100 | Substance Use Treatment and Services | 10/1/22 | Apple Health & Ambetter |
| CP.MP.12 | Vagus Nerve Stimulation | 10/1/22 | Apple Health |
The below policy will be retired October 1, and replaced with CP.MP.12, as noted under “New Policies”.
| Policy Number | Policy Title | Effective Date | Line of Business |
WA.CP.MP.12 | Vagus Nerve Stimulation | 10/1/22 | Apple Health |
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Pharmacy Updates
Effective January 1, 2023, the following codes for Apple Health (Medicaid) will be updated from "Pre-authorization required for all providers except when services are rendered by a hospital, hematologist, or oncologist" to "Authorization required for all providers."
| J-Code | Brand Name | Generic Name |
J9019 | Erwinase | asparaginase erwinaze |
| J9034 | Bendeka | bendamustine |
| J9039 | Blincyto | blinatumomab |
| J9055 | Erbitux | cetuximab |
| J9119 | Libtayo | cemiplimab-rwlc |
| J9179 | Halaven | eribulin mesylate |
| J9228 | Yervoy | ipilimumab |
| J9264 | Abraxane | paclitaxel protein bnd particle |
| J9301 | Gazyva | obinutuzumab |
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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.
Sports Physical & EPSDT: To support back-to-school season and the return to extracurricular activities, use this checklist to turn a Sports Physical into a full EPSDT.
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.
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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.
CDC Naloxone Training. Earn free CE and increase your knowledge in Talking to Patients about Naloxone, Reducing Stigma Surrounding Naloxone, and Risk Factors for an Opioid Overdose. Complete the recorded training series here.
Washington State Prevention Summit. Advancing Prevention: Connection and Hope. The Prevention Summit is an enriching training and networking opportunity for youth, volunteers, and professionals engaged in health promotion and the prevention of substance misuse, violence, and other high-risk behaviors, in a setting that promotes cultural humility. November 8-9, 2022. Register here.