Provider FAQs

Below are some frequently asked questions specifically for providers on the Apple Health Core Connections (AHCC) program.  

The Apple Health Foster Care (AHFC) program known as Apple Health Core Connections is a managed care program that provides coordinated health care services for children and youth in foster care, extended foster care, adoption support, and young adult alumni of the foster care program.

Through a competitive bidding process, the Health Care Authority (HCA) selected Coordinated Care as the statewide plan to provide AHFC services, beginning April 1, 2016.

Apple Health Core Connections provides:

  • A collaborative approach to serving this vulnerable population by working with the Children’s Administration to ensure better coordination of care for enrollees and involve the child’s parents, caregivers, health care providers and social workers.
  • Contracted providers with access and technology to securely share medical information.
  • Access to clinical experts and training to support providers caring for children who have experienced trauma, abuse and neglect.
  • Improved access to care by establishing a medical home with an assigned primary care provider for Apple Health Core Connections members. 
  • Smooth health care transitions as children and youth move from home to foster care, between placements, hospitals or other institutional settings. 

Coordinated Care covers all Medicaid managed care health services including: physical health, routine vision, pharmacy, and outpatient behavioral health for low to moderate behavioral health needs.

The benefits will be the same Washington Apple Health (Medicaid) benefits the child previously received, with some additional programs that Coordinated Care designed specifically for Apple Health Core Connections members.

Automatic enrollees include:

  • Children and youth in out-of-home dependencies (foster care placement)
  • Extended Foster Care, age 18-21
  • Children and youth receiving Adoption Support (without comparable private health insurance. If a child has other private full medical insurance they will remain in fee-for-service).
  • Young adults between 18 and 26 years old who were in foster care on their 18th birthday, or were older than 18 when they left the foster care program.

Exceptions:

  • Alaska Native and American Indian children and youth in foster care may choose to enroll in the Apple Health Core Connections program but will not be automatically enrolled.
  • Children enrolled in the Medically Intensive Children’s Program 
  • Juvenile Rehabilitation (JR)
  • Detention Facility, incarcerated 
  • Unaccompanied Minor program 
  • Voluntary Placement Programs (VPP) 
  • Dual Medicaid and Medicare eligible, In Hospice 
  • From another state and not 4E eligible placed in WA

Children in foster care are enrolled with Apple Health Core Connections, with same day eligibility, retroactive to the first day of the month. You can verify eligibility through the provider portal at Provider.CoordinatedCareHealth.com. You can also call provider services at 1-844-354-9876.

When verification is delayed, an interim voucher will serve as proof of the child’s eligibility as an Apple Health Core Connections enrollee. A provider may receive an interim voucher from either a social worker or caregiver. Please do not withhold health care services, including the filling of prescriptions, based on lack of verified eligibility in the ProviderOne or Coordinated Care provider portal for a child in foster care.

The billing, coverage, and reimbursement policies applicable for children enrolled in Medicaid apply to services provided to a child in foster care with an interim voucher. Providers will be paid by Coordinated Care. If for any reason the child is in foster care and remains on the HCA fee-for-service Apple Health program, Coordinated Care will assist providers in submitting for payment to HCA.

For more information, call 1-844-354-9876 and select the “providers” option. For information on joining the Coordinated Care network you can:

Yes. If you have a Medicaid contract with Coordinated Care, no additional contracting is needed. Continue to bill us the same way for any Medicaid member. Provider Services at 1-877-644-4613 is available regarding any Coordinated Care member.

Children placed in foster care should have an EPSDT exam as quickly as possible, no later than 30 days of being placed into care. It is important that this appointment happens quickly and the report is provided to the DSHS Children’s Administration Child Health and Education Tracking (CHET) worker within the 30-day time frame. 

No. Dental will continue to be accessed through Apple Health fee-for-service Medicaid using the ProviderOne card. 

Mental health services for mild to moderate mental health concerns, such as depression or anxiety, are covered and will be coordinated within the Coordinated Care network. Services for more serious mental health conditions are offered through a Behavioral Health Organization (BHO) with the support of their Coordinated Care behavioral health care coordinator. Coordinated Care will screen members to determine if they meet BHO access to care standards and make a referral to BHO services.

In Chelan, Douglas and Grant counties all our members have physical health, mental health, and drug and alcohol treatment covered by Coordinated Care. This integrated managed care approach will apply state-wide to the AHCC program in January 2019. For more information, visit our Integrated Managed Care page for providers.

Coordinated Care’s behavioral health team has national experience in evidence-based and promising practices for children in the child welfare system. We are working to expand our behavioral health provider network, and find providers who are trained in evidence-based practices and TIC.

We will work with providers, caregivers, social workers and stakeholders to identify and build relationships with providers who deliver TIC. Coordinated Care also has a team of community educators who provide training on evidence-based practices, TIC, and other relevant topics to providers and the community. 

Our health care coordination model is tailored to the complex health and social/behavioral needs of our members. The model provides a scalable, intensive service coordination role with full integration of physical and behavioral health roles. The health care coordination team is based on an Integrated Care Coordination Team (ICCT) model using a multidisciplinary approach—coordinating across the health and child welfare system—to deliver care management and coordination services, with a health care coordinator assigned as the team lead and single point of contact.

For complex member needs, the team lead is a nurse or behavioral health clinician, dependent upon the primary needs. Outreach is conducted as frequently as needed, and the member stays with the care coordinator in complex care management for as long as needed.

Biological parents have the option to keep their child with Coordinated Care if the family is eligible for Medicaid.

Beginning July 2018, a child returning to their biological parents may remain part of the AHCC program during the trial time with their parents and possibly for some time after. For more details and information, call our team at 1-844-354-9876.

 

Coordinated Care Provider Services staff can help you with filing a claim. They will answer your questions about claim status and payments and assist with appeals. Call Provider Services at 1-877-644-4613.

Our team of community educators provides Apple Health Core Connections overview training statewide. They also offer specialized topic training for your staff. Our library of topics includes in-person and web-based instruction on Trauma Informed Care, resiliency, behavior management and much more. If your agency is interested in having a community educator present a program overview or specialized topic training for staff or foster parents, please email CommunityEducation@coordinatedcarehealth.com.

Please check our schedule of provider events for updates and other provider trainings.

HCA updated the Newborn eligibility and billing on page 83 of the inpatient billing guide with a crosswalk to provide guidance to determine program eligibility for infants and mothers. 

Placed in Out-of-Home Placement?

HCA crosswalk for newborn eligibility and billing
Eligibility Status* No (newborn is not going into foster care) Yes (newborn is going into foster care)
Mother is Apple Health eligible, enrolled in MCO

Newborn is opened on Family
Medical for month of birth and
enrolled in the same Managed
Care Organization (MCO) as the birth mother to cover the first 21 days of life.

If newborn is never deemed
eligible, newborn has no
continuing coverage after first 21
days of life.

Mother’s MCO is responsible to
cover newborn nursery services as
required for at least the first
twenty-one days of life.

Newborn is opened on Family
Medical and enrolled in mother’s MCO for the month of birth. Apple Health Foster Care (AHFC) Medical enrollment is established
prospectively the first of the month
following the placement.

Nursery services provided after birth are covered by mother’s MCO. If the newborn remains in the hospital after the month of birth, the mother’s MCO covers the hospital costs as a continuing health event.

Mother is Apple Health eligible, not enrolled in MCO

Newborn is opened on Family Medical for the month of birth and enrolled into an MCO according to assignment rules.

If Newborn is deemed eligible, Newborn will be retro-enrolled for the current month based on earlier enrollment rules. MCO may request a retro-eligibility determination up to 365 days after birth upon completion of a premium payment request report.

Nursery services provided after birth are covered by assigned MCO. If the newborn remains in the hospital after the month of birth, the assigned MCO covers the hospital costs as a continuing health event

Newborn is opened family medical and assigned to Apple Health Managed Care as of month of birth. Newborn is opened prospectively on AHFC beginning the 1st of the month following placement and enrolled in AHFC.

Nursery services provided after birth are covered by assigned MCO. If the newborn remains in the hospital after the month of birth, the assigned MCO covers the hospital costs as a continuing health event.

Mother is enrolled in AHFC

Newborn is eligible for Family Medical the month of birth. The newborn will be enrolled with Apple Health Managed Care (AHMC) in same plan as the mother if available.

Eligibility and enrollment will begin from the newborns’ date of birth or mother’s date of enrollment, whichever is sooner.

Newborn is eligible for AHFC and enrolled the month of birth.

Nursery services provided after birth are covered by AHFC as a continuing health event.

Mother has NO Apple Health coverage and does not have private insurance

Family must apply for eligibility. If deemed eligible, newborn is enrolled in AHMC according to assignment rules.

If newborn eligibility is received in ProviderOne (P1) within the birth month, Newborn will be retro-enrolled to first of the month newborn is reported to HCA based on earlier enrollment rules.

If newborn eligibility is not received in P1 birth month, Newborn is enrolled first of month deemed AHMC eligible. Eligibility back to birth month must be requested based on medical need and is Fee for Service (FFS).

Newborn is opened on FC as of month of placement. The newborn will be enrolled with AHFC MCO the first of the month of placement. 

*Note: Family Medical as defined includes Newborn Medical (N10) [RAC1202])

HCA crowsswalk for newborn eligibility and billing
Eligibility Status* No (Newborn is not going into foster care) Yes (Newborn is going into foster care)
     
     
     
     
HCA crowsswalk for newborn eligibility and billing
Eligibility Status* No (Newborn is not going into foster care) Yes (Newborn is going into foster care)
     
     
     
     

Please check our Training Materials page for a variety of online resources on trauma, abuse and neglect. 

Our community educators have community training on topics related to trauma, abuse and neglect. Additional resources on childhood trauma can be found at www.nctsn.org, www.nfpaonline.org, and www.acestoohigh.com