The content in this preview is based on the last saved version of your email - any changes made to your email that have not been saved will not be shown in this preview.

December 2 2022


View as Webpage
Note: New Content Noted with Asterisks*** and Highlighted

Dear KHF Providers and Practice Administrators,

We have several updates to share regarding payor updates, programs and upcoming events. There is a lot of information, and we want to make sure we are keeping our membership informed. We recommend reading through this communication in its entirety and please reach out to us with any questions you may have!
Important Updates

***APP Credentialing Survey - Please Complete by Dec. 7***

 

Due to anticipated payor shifts in the credentialing of Advanced Practice Providers (APPs) and TCCN's delegated status we are assessing how many APPs are associated with network practices. Please take a few minutes to complete the survey linked below for your practice, even if you do not employ APPs. We are actively developing processes to credential APPs, so please respond to the survey by Wednesday, December 7th so that we can incorporate the information into our planning. Thank you in advance!

 

Advanced Practice Provider Survey

***Antibiotic Alternatives Tip Sheet***


TCCN Physicians, APPs, and Practice Administrators,

We are working with our colleagues at Children’s to address the recent antibiotic shortage and are sharing a one-page resource developed by the Children’s Antimicrobial Stewardship team which provides alternative medications for several common infections. Please note that clinicians must continue to use their own medical judgment in selecting therapies, including dosage, route, and frequency, for their patients.

 

Antibiotic Alternatives Tip Sheet

 

Below is an introduction from the team regarding the antibiotic shortage and the tip sheet linked above.

 

Thank you,

 

Brad Weselman, MD

Executive Director

The Children’s Care Network



There is currently a national backorder of commonly prescribed oral liquid antibiotics. Due to the increased volume of respiratory infections this has led to the amoxicillin shortage, which has subsequently impacted availability of other antibiotics. Currently, we are aware of inconsistent availability of amoxicillin and cefdinir at retail pharmacies. The Children’s Antimicrobial Stewardship team has developed a list of treatment options for common childhood infections, and we are sharing it with all of our providers. Note that we have provided several options under each infection, as we anticipate additional shortages developing in the future.

 

Children’s Antimicrobial Stewardship Team

Georgia Medicaid Fall Fair Updates


The department of Community Health (DCH) held a Medicaid Fair on Wednesday, November 2, 2022. All presentation materials from the Medicaid Fair are found here. Here are highlights from the opening session that you may find valuable. 

 

The Public Health Emergency (PHE) is potentially ending January 15, 2023. DCH is initiating the PHE Unwinding and providing updates to providers and members via https://staycovered.ga.gov/. DCH encourages providers to read and publish this website to their patients.

 

Medicaid Member Redetermination:

DCH has not contacted members in 2 years and will begin member redetermination outreach on February 1, 2023. They must initiate contact with all Medicaid members within 12 months and complete the redetermination within 14 months in accordance with CMS guidelines. Members will be contacted during their renewal month. For example, if a member had a historical renewal in April, they will not be contacted until April. If the member utilizes SNAP/TANF, DCH will align with those programs to only contact the member one time.

 

How can the provider community help?

  1. Please review https://staycovered.ga.gov/ for the latest PHE Unwinding information.
  2. Proactively encourage and remind Medicaid patients to update their personal information on the Gateway website: https://gateway.ga.gov/access/
  3. Share video, images, and the PHE toolkit that are found on https://staycovered.ga.gov/ with your patients.

 

 

Georgia Medicaid Provider Revalidation

Provider revalidation has also been voluntary due to the PHE. However, in 2023 the revalidation will become mandatory. Gainwell is reaching out to providers to assist with the revalidation process. The Revalidation/Recredential application is one application. For providers with multiple service locations, you will be required to Revalidate each additional service location. If you are unsure of your providers revalidation dates, log into www.mmis.gammis.gov Select Providers, then Demographic Maintenance, the Revalidation Date is present. Posted on GAMMIS in Provider Notices (9/1/2022) “Presentation-Physician Services-September 2022,” (Slides 25-27) 

 

 

Lactation Consultants

Lactation Consultants may now enroll via the MMIS web portal, www.mmis.georgia.gov, as an individual practitioner for the Medicaid and Peach Care for Kids programs. Lactation Consultants must have a State Lactation License via the Board of Lactation Consultants and be certified via the International Board of Lactation Consultant Examiners (IBCLC). Additionally, Lactation Consultants must be credentialed.

 

The scope of services provided by Lactation Consultants includes the provision of lactation care and services to pregnant and lactating women and children who are breastfeeding. Such services include lactation assessment, implementation of a plan of care, and education and counseling. Lactation services may be rendered in the following settings: hospital, physician practice, and home setting.

 

Providers may bill utilizing one or both of the following codes:

1. S4443 (Lactation Class)

2. S4445 (Patient Counseling)

Reimbursement is based upon the posted fee schedule. Lactation consultant services are limited to five (5) sessions unless deemed medically necessary.

Georgia DPH: Meningococcal Conjugate Vaccine Requirement


The Georgia Department of Public Health has published a letter to all providers regarding administration of the meningococcal conjugate vaccine (MenACWY). Please read the letter here for the full details and contact the Georgia Immunization Program if you have questions.

The Community Physician Leadership Award 2022


This year’s Big Deal event, presented by Pediatric Emergency Medicine Associates (PEMA) awarded the Community Physician Leadership Award to our very own Roy Benaroch, M.D! Please click here to read more!

Save the Date: Pediatric Coding Changes and Guidance Seminar for 2023

The meeting details are below:

Location: Zoom (will be recorded and deck will be sent prior)

Date and Time: November 17th 2022 10-12pm

Speaker: Jan Blanchard CPC, CPEDC, CPMA

TCCN Payor Updates

CMO State Request for Proposal (RFP) Update


As the State continues its CMO bidding process for contracts that are planned to start in 2024, you have likely noticed communications being sent to your practice by entities that are interested in entering our market with their CMO product. We are aware that the following entities may be reaching out to you:

 

  • Aetna
  • AmeriHealth Caritas
  • Humana
  • Molina
  • UnitedHealthcare

 

TCCN is in discussions with several of these entities regarding potential contracting through TCCN should they be selected by the State. If your practice intends to contract with any of these entities through TCCN, you do not need to respond to these requests.

 

We reached out earlier this summer to request your delegation responses for the new entities. If you have not yet responded, or you are not sure, please reach out to Sahdeja Serieux. We need responses from all primary care practices, whether you participate with the CMOs or not.

 

We will provide additional updates as the State RFP process continues. Thank you!

Anthem Updates


Click here to review previous Anthem alerts/updates

Click Here to Subscribe to Anthem's Provider News

To find the latest Provider News, visit the Anthem Provider News home page.


Anthem Delegated Credentialing and Claims Resolution

 

We are now ready to process demographic updates through TCCN. You no longer need to complete the new provider application or provider maintenance form through Anthem's website.

 

For provider updates going forward, please utilize the TCCN Provider Election Packet. This form will be used for all provider additions, changes, or terminations for any TCCN contract. Current TCCN contracts are listed on the first page of the packet. Please submit your completed forms to your assigned TCCN Provider Relations Representative for processing.

 

It is important that you continue to make sure your CAQH profile is updated and that it is set to “Allow payors to view profile”. Anthem will credential based on what is in the profile and will review the profile around the provider's re-credentialing date. More details on CAQH profile maintenance are provided in the Credentialing Update section below.

 

When contacting Anthem for help to resolve a denial, please follow these steps:

 

  • Review the EOB to confirm that the denial was received in error.
  • Call the member services number on the back of the I.D. card.
  • At the beginning of the call, request the rep’s name, and reference number and document the time of the call.
  • If the call is dropped, please call back presenting the reference number from the previous call and ask that they pull up that call.
  • If you feel the conversation is not being resolved, ask to speak to a supervisor. Please record the supervisor’s name, date, and time you spoke to them. You can submit this information to your TCCN rep to research with our Anthem representative. 
  • Initiate a claim inquiry using Availity.
  • Record the confirmation/tracking number of your Availity interaction.
  • You can submit this information to your TCCN rep to research with our Anthem representative. 

 

If your practice has exhausted the claims escalation process with no resolution (see above), you may submit escalated issues to your TCCN rep for assistance. Please add your escalated claims to the Anthem Claims Issue Escalation Spreadsheet and complete all required fields. Be sure to include thorough details that will assist with the resolution efforts.  All spaces must be completed to be submitted to the Anthem Escalation team. Please also submit supporting documentation such as EOB, letters, etc. If you have any questions please contact your TCCN representative.
KHF Payor Updates

Humana


Introducing an online community resource directory


https://humana.findhelp.com/

Addressing health-related social needs can be important to your patient’s health. That’s why Humana Community Navigator, powered by findhelp, offers an online directory of community resources with more than 500,000 social service programs across the United States.


For any patient, no matter their insurance carrier, Humana Community Navigator can unlock resources that support your patient’s care plan, leading to better health outcomes.

  • Access an easy-to-use directory of community resources at no cost to your practice.
  • Offer resources in over 100 languages that are free or at a reduced cost.
  • Share resources for needs such as food, housing, transportation and more! 

Medicaid – GAMMIS - Multi-Factor Authentication (MFA) Webinars

https://www.mmis.georgia.gov/portal/PubAccess.Provider%20Information/Provider%20Messages/tabId/19/Default.aspx

 

The Department of Community Health (DCH) and Gainwell Technologies invite you to participate in one of the Multi-Factor Authentication (MFA) webinars scheduled during the month of October 2022. There will be twenty webinars available. Providers are encouraged to send their practice managers and billing staff, as well as business associates, including billing/service agents that submit Medicaid claims. The webinars will provide important information you will need to know on the following topics including, but not limited to:

  1. Frequently Asked Questions (FAQs)
  2. Access to GAMMIS
  3. Benefits of MFA

 

To ensure all Georgia Medicaid providers can attend, there will be two webinars on the dates listed below. Each will take place at 10:00 AM and 1:00 PM, for a total of twenty webinars. Attendees must individually register to reserve a seat by clicking on the desired link to complete the registration form.

 

Upon completion of your registration, a confirmation notice will be sent via e-mail to the address provided during registration. Please review the confirmation e-mail for accuracy.

 

The webinar confirmation e-mail will include:

1. Date and time of the webinar workshop

2. Conference phone number and pass code 

3. Teams Meeting hyperlink

 

Should you have any questions regarding the Multi-Factor Authenticator (MFA) webinars for the month of October 2022, please contact Gainwell Technologies via e-mail at gaworkshopregistration@gainwelltechnologies.com.

Georgia Medicaid Provider Revalidation


Posted on GAMMIS in Provider Notices (9/1/2022) “Presentation-Physician Services-September 2022,” (Slides 25-27)

https://www.mmis.georgia.gov/portal/Portals/0/StaticContent/Public/ALL/NOTICES/Physician%20Services%20Webinar%20September%202022%20FINAL%20APPROVAL%20v2%2020220901124901.pdf

 

It is time for providers to revalidate their provider profile. Gainwell is reaching out to providers to assist with the revalidation process. The Revalidation/Recredential application is one application. For providers with multiple service locations, you will be required to Revalidate each additional service location.

 

If you are unsure of your providers revalidation dates, log into www.mmis.gammis.gov Select Providers, then Demographic Maintenance, the Revalidation Date is present.

CareSource Updates


CareSource published new modifier policies effective January 1, 2023. Please see the links below for specific details.

Modifier 25 New Policy

https://www.caresource.com/documents/medicaid-ga-policy-reimburse-py-1361-20230101/

 

Modifier 59 New Policy

https://www.caresource.com/documents/medicaid-ga-policy-reimburse-py-1365-20230101/


CareSource- CLIA-Waived Tests Update – Effective 11/14/2022

https://www.caresource.com/documents/ga-med-p-1499801-clia-waived-tests-network-notification-ga-mcd/

Beginning November 14, 2022 CareSource will deny Clinical Laboratory Improvement Amendments (CLIA)-waived tests billed in an office setting (place of service 11) when the appropriate QW modifier is not appended. This information is in accordance with the CLIA Guidance Portal from hhs.gov. Inclusion of the QW modifier is necessary to evaluate the claim to determine the eligibility of services performed based on CLIA-waived testing. Additional information regarding the categorization of laboratory tests by CLIA may be found on www.hhs.gov.

United Healthcare


***Effective with date of service January 1, 2023, the Evaluation and Management reimbursement policy will be revised to align with the Evaluation and Management (E/M) CPT coding and guideline changes from the American Medical Association (AMA) and the Centers for Medicare and Medicaid Services (CMS).***


Get ready to submit electronically in 2023

Reconsiderations, appeals and claims moving to digital submissions only


https://www.uhcprovider.com/en/resource-library/news/2022/paper-submissions-go-digital-2023.html

 

We started with transitioning mail we send you to electronic delivery. Next, we’ll shift to eliminating paper you send us.

 

In 2023, network (contracted) health care professionals, practices and facilities will be required to submit claim submissions, claim attachments, and reconsideration and appeal requests to UnitedHealthcare electronically. In response to feedback from members, we’ll also emphasize and encourage the use of digital ID cards for commercial plans.

 

We recognize that these changes are significant, so we’re alerting you early to give you more time to plan ahead. The effective dates for these incoming paper-to-digital transitions will be announced in Network News at least 90 days prior to the change.

Click the link for a preview of what to expect with these changes, as well as more information on digital ID cards for commercial members.

Cigna Updates

Q4 2022 Cigna Network News

 

Cigna has published their Q4 2022 news publication. There are several items of interest notes with page numbers below. 

  • Page 3 - For Billers: Claim Search Enhancement on CignaForHCP.com
  • Page 6 – EFT Enhancement: Enroll and Manage on One Screen
  • Page 6 – Speed Up Common Procedure Code Benefit Look Ups: New Feature
  • Page 10 – ID Card examples for a Strategic Alliance Plans under Cigna
  • Page 11-12 – Cigna + Oscar Health Plans Information with sample ID cards
  • Page 14-16 – Changes in Drug Formulary Effective January 1, 2023
  • Page 28 – Virtual Care Reimbursement Policy
  • Page 43 – Quick Guide to Cigna ID Cards

Cigna Network News : Third Quarter 2022 (editiondigital.net)

Virtual Care Services Should Now Be Billed With POS Code 02

Cigna recently updated our systems to ensure providers now receive 100 percent of face-to-face reimbursement for covered virtual care services when billed with POS code 02. Therefore, we now recommend providers bill with POS code 02 for all virtual care services. As an added benefit, when you bill with POS code 02, your patients may pay a lower cost share for the virtual services they received due to a recent change in some plans benefits.


Additional Virtual Care Services Now Permanently Reimbursable

virtual-care-reimbursement-policy.PDF (cigna.com)

Cigna has added the following services and codes as permanently reimbursable as part of our Virtual Care Reimbursement Policy (R31).

  • Quick five- to 10- minute telephone conversations between a provider and their patient: HCPCS code G2012
  • eConsults: CPT codes 99446-99449, 99451, and 99452
  • Virtual home health services: HCPCS codes G0151-G0153, G0155, G0157-G0158, G0299-G0300, G0493, S9123, S9128-S9129 and S9131

In Case You Missed It


Kids Health First Who to Call List

Here is the Kids Health First Who To Contact List. Please contact our team with any needs you may have.


Q&A for Parents:The Bivalent COVID-19 Vaccine for Children 5 years and Older

Please click here for a Q&A KHF has put together that you can distribute to your patient's parents regarding the bivalent COVID-19 vaccine.


UPDATED: CDC Fall Vaccination Operational Planning Guide

Information for the Fall Vaccine Campaign, Including Upcoming Pediatric Bivalent COVID-19 Vaccine as Boosters for Children Aged 5-11 Years . Click here for more information.


CDC Updates Guidelines for Mask Wearing by Health Care Providers(HCP) in the Clinical Setting

KHF has broken down the updated guidence into an easy to follow guide for you here.

 

Click here for a Sample Letter to Parents Re: Flu Vaccine 2022!


Supporting Patients with Down Syndrome

Please click here to read a great article for pediatricians from PCC on supporting patients with down syndrome.


Free OSHA Training

Here is the link to the OSHA Webinar held on 9/15/22.

Here is the pdf of the deck. 

Here is the end of course test.


If you attended the meeting live your certificate will be emailed to the email address you posted in the chat.  If you were unable to attend live and you watch the video above and complete the test and would like your certificate of completion, please email Tandric Bowden at tandric.bowden@tccn-choa.org. 


Unprecedented Emergency Department and Outpatient Volumes

On Thursday, Sept. 15th, Children's sent out a communication co-written by TCCN to all independent primary care physicians regarding the recent surge in patient volumes in both the outpatient and ED settings. This communication includes the following resources:

·   Fever patient information sheet

·   Suggested return to school/childcare messaging

·   Monkeypox guidance

·   Flu and COVID-19 vaccination guidance

 

TCCN will be following up with additional guidance and resources over the coming weeks as we prepare for flu season, so please stay tuned for more updates.

 Click here to read the full communication from Children's and TCCN


FDA announces amended emergency use authorization of bivalent COVID Pfizer-BioNTech and Moderna boosters-On August 31, 2022 the FDA issued a press release announcing the EUA approval of bivalent formulations of the vaccines for use as a single booster dose at least two months following primary or booster vaccination for specific age groups. Click here for more information.  


The CDC announces recommendation of the first updated COVID-19 booster. On Thursday, September 1, CDC Director CDC Rochelle P. Walensky, M.D., M.P.H., endorsed the ACIP's committee recommendations for the updated COVID-19 boosters from Pfizer-BioNTech (ages 12 years and older) and from Moderna (ages 18 years and older). Click here for more information.  


Monkeypox Q&A for Parents

Please click here for the Q&A KHF developed with our Medical Director Dr. Sally Marcus.


2-Week Data Submission Requirement

The TCCN Board of Directors met on May 18, 2022, and revisited the initial recommendation made in 2018. At this time, by vote of the BOD (as allowed by the TCCN agreement with Network Participants), the TCCN BOD requires all practices to submit claims data to the PHM Tool within 14 calendar days of the most recent encounter date. This requirement will take effect beginning August 1, 2022. Please click here for more information.


Q&A for Parents/COVID-19 Vaccine for Children Under the Age of 5: The Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices met June 17-18, 2022, to discuss the FDA recommendations on the emergency use (EUA) authorization of the Pfizer-BioNTech and Moderna COVID-19 vaccines in children between 6 months thru 5 years of age. We have created an important FAQ for practices as a resource for parents who may have questions. 

Communications:


TCCN Roundup:


***The TCCN Roundup is designed to be a twice weekly information hub for all things TCCN. 

  • Please to check out the latest issue.
  • Please note that the link above only accounts for some TCCN updates. In order to view the full TCCN Newsletter with your contracted payor updates please check your TCCN inbox!***


TCCN Quality Steps Newsletter

 
Resources
Kids Health First | 2480 Briarcliff Rd NE, Suite 6-334, Atlanta, GA 30329
Unsubscribe ddixon@khfirst.com
Update Profile | Constant Contact Data Notice
Sent by lbaldwin@khfirst.com powered by
Trusted Email from Constant Contact - Try it FREE today.
Try email marketing for free today!
The content in this preview is based on the last saved version of your email - any changes made to your email that have not been saved will not be shown in this preview.

November 18, 2022


View as Webpage
Note: New Content Noted with Asterisks*** and Highlighted

Dear KHF Providers and Practice Administrators,

We have several updates to share regarding payor updates, programs and upcoming events. There is a lot of information, and we want to make sure we are keeping our membership informed. We recommend reading through this communication in its entirety and please reach out to us with any questions you may have!
Important Updates

***Nov. 17th Pediatric Coding Seminar Recording and Materials***

Thank you to everyone who attended our annual Pediatric Coding Seminar! If you were not able to attend, a link to the recording is provided below along with color and black and white versions of the meeting slides for your records.

 

2023 Pediatric Coding Seminar Recording

Slides: Color and Black & White

Georgia Medicaid Fall Fair Updates


The department of Community Health (DCH) held a Medicaid Fair on Wednesday, November 2, 2022. All presentation materials from the Medicaid Fair are found here. Here are highlights from the opening session that you may find valuable. 

 

The Public Health Emergency (PHE) is potentially ending January 15, 2023. DCH is initiating the PHE Unwinding and providing updates to providers and members via https://staycovered.ga.gov/. DCH encourages providers to read and publish this website to their patients.

 

Medicaid Member Redetermination:

DCH has not contacted members in 2 years and will begin member redetermination outreach on February 1, 2023. They must initiate contact with all Medicaid members within 12 months and complete the redetermination within 14 months in accordance with CMS guidelines. Members will be contacted during their renewal month. For example, if a member had a historical renewal in April, they will not be contacted until April. If the member utilizes SNAP/TANF, DCH will align with those programs to only contact the member one time.

 

How can the provider community help?

  1. Please review https://staycovered.ga.gov/ for the latest PHE Unwinding information.
  2. Proactively encourage and remind Medicaid patients to update their personal information on the Gateway website: https://gateway.ga.gov/access/
  3. Share video, images, and the PHE toolkit that are found on https://staycovered.ga.gov/ with your patients.

 

 

Georgia Medicaid Provider Revalidation

Provider revalidation has also been voluntary due to the PHE. However, in 2023 the revalidation will become mandatory. Gainwell is reaching out to providers to assist with the revalidation process. The Revalidation/Recredential application is one application. For providers with multiple service locations, you will be required to Revalidate each additional service location. If you are unsure of your providers revalidation dates, log into www.mmis.gammis.gov Select Providers, then Demographic Maintenance, the Revalidation Date is present. Posted on GAMMIS in Provider Notices (9/1/2022) “Presentation-Physician Services-September 2022,” (Slides 25-27) 

 

 

Lactation Consultants

Lactation Consultants may now enroll via the MMIS web portal, www.mmis.georgia.gov, as an individual practitioner for the Medicaid and Peach Care for Kids programs. Lactation Consultants must have a State Lactation License via the Board of Lactation Consultants and be certified via the International Board of Lactation Consultant Examiners (IBCLC). Additionally, Lactation Consultants must be credentialed.

 

The scope of services provided by Lactation Consultants includes the provision of lactation care and services to pregnant and lactating women and children who are breastfeeding. Such services include lactation assessment, implementation of a plan of care, and education and counseling. Lactation services may be rendered in the following settings: hospital, physician practice, and home setting.

 

Providers may bill utilizing one or both of the following codes:

1. S4443 (Lactation Class)

2. S4445 (Patient Counseling)

Reimbursement is based upon the posted fee schedule. Lactation consultant services are limited to five (5) sessions unless deemed medically necessary.

Georgia DPH: Meningococcal Conjugate Vaccine Requirement


The Georgia Department of Public Health has published a letter to all providers regarding administration of the meningococcal conjugate vaccine (MenACWY). Please read the letter here for the full details and contact the Georgia Immunization Program if you have questions.

The Community Physician Leadership Award 2022


This year’s Big Deal event, presented by Pediatric Emergency Medicine Associates (PEMA) awarded the Community Physician Leadership Award to our very own Roy Benaroch, M.D! Please click here to read more!

Save the Date: Pediatric Coding Changes and Guidance Seminar for 2023

The meeting details are below:

Location: Zoom (will be recorded and deck will be sent prior)

Date and Time: November 17th 2022 10-12pm

Speaker: Jan Blanchard CPC, CPEDC, CPMA

TCCN Payor Updates

CMO State Request for Proposal (RFP) Update


As the State continues its CMO bidding process for contracts that are planned to start in 2024, you have likely noticed communications being sent to your practice by entities that are interested in entering our market with their CMO product. We are aware that the following entities may be reaching out to you:

 

  • Aetna
  • AmeriHealth Caritas
  • Humana
  • Molina
  • UnitedHealthcare

 

TCCN is in discussions with several of these entities regarding potential contracting through TCCN should they be selected by the State. If your practice intends to contract with any of these entities through TCCN, you do not need to respond to these requests.

 

We reached out earlier this summer to request your delegation responses for the new entities. If you have not yet responded, or you are not sure, please reach out to Sahdeja Serieux. We need responses from all primary care practices, whether you participate with the CMOs or not.

 

We will provide additional updates as the State RFP process continues. Thank you!

Anthem Updates


Click here to review previous Anthem alerts/updates

Click Here to Subscribe to Anthem's Provider News

To find the latest Provider News, visit the Anthem Provider News home page.


Anthem Delegated Credentialing and Claims Resolution

 

We are now ready to process demographic updates through TCCN. You no longer need to complete the new provider application or provider maintenance form through Anthem's website.

 

For provider updates going forward, please utilize the TCCN Provider Election Packet. This form will be used for all provider additions, changes, or terminations for any TCCN contract. Current TCCN contracts are listed on the first page of the packet. Please submit your completed forms to your assigned TCCN Provider Relations Representative for processing.

 

It is important that you continue to make sure your CAQH profile is updated and that it is set to “Allow payors to view profile”. Anthem will credential based on what is in the profile and will review the profile around the provider's re-credentialing date. More details on CAQH profile maintenance are provided in the Credentialing Update section below.

 

When contacting Anthem for help to resolve a denial, please follow these steps:

 

  • Review the EOB to confirm that the denial was received in error.
  • Call the member services number on the back of the I.D. card.
  • At the beginning of the call, request the rep’s name, and reference number and document the time of the call.
  • If the call is dropped, please call back presenting the reference number from the previous call and ask that they pull up that call.
  • If you feel the conversation is not being resolved, ask to speak to a supervisor. Please record the supervisor’s name, date, and time you spoke to them. You can submit this information to your TCCN rep to research with our Anthem representative. 
  • Initiate a claim inquiry using Availity.
  • Record the confirmation/tracking number of your Availity interaction.
  • You can submit this information to your TCCN rep to research with our Anthem representative. 

 

If your practice has exhausted the claims escalation process with no resolution (see above), you may submit escalated issues to your TCCN rep for assistance. Please add your escalated claims to the Anthem Claims Issue Escalation Spreadsheet and complete all required fields. Be sure to include thorough details that will assist with the resolution efforts.  All spaces must be completed to be submitted to the Anthem Escalation team. Please also submit supporting documentation such as EOB, letters, etc. If you have any questions please contact your TCCN representative.
KHF Payor Updates

Humana


Introducing an online community resource directory


https://humana.findhelp.com/

Addressing health-related social needs can be important to your patient’s health. That’s why Humana Community Navigator, powered by findhelp, offers an online directory of community resources with more than 500,000 social service programs across the United States.


For any patient, no matter their insurance carrier, Humana Community Navigator can unlock resources that support your patient’s care plan, leading to better health outcomes.

  • Access an easy-to-use directory of community resources at no cost to your practice.
  • Offer resources in over 100 languages that are free or at a reduced cost.
  • Share resources for needs such as food, housing, transportation and more! 

Medicaid – GAMMIS - Multi-Factor Authentication (MFA) Webinars

https://www.mmis.georgia.gov/portal/PubAccess.Provider%20Information/Provider%20Messages/tabId/19/Default.aspx

 

The Department of Community Health (DCH) and Gainwell Technologies invite you to participate in one of the Multi-Factor Authentication (MFA) webinars scheduled during the month of October 2022. There will be twenty webinars available. Providers are encouraged to send their practice managers and billing staff, as well as business associates, including billing/service agents that submit Medicaid claims. The webinars will provide important information you will need to know on the following topics including, but not limited to:

  1. Frequently Asked Questions (FAQs)
  2. Access to GAMMIS
  3. Benefits of MFA

 

To ensure all Georgia Medicaid providers can attend, there will be two webinars on the dates listed below. Each will take place at 10:00 AM and 1:00 PM, for a total of twenty webinars. Attendees must individually register to reserve a seat by clicking on the desired link to complete the registration form.

 

Upon completion of your registration, a confirmation notice will be sent via e-mail to the address provided during registration. Please review the confirmation e-mail for accuracy.

 

The webinar confirmation e-mail will include:

1. Date and time of the webinar workshop

2. Conference phone number and pass code 

3. Teams Meeting hyperlink

 

Should you have any questions regarding the Multi-Factor Authenticator (MFA) webinars for the month of October 2022, please contact Gainwell Technologies via e-mail at gaworkshopregistration@gainwelltechnologies.com.

Georgia Medicaid Provider Revalidation


Posted on GAMMIS in Provider Notices (9/1/2022) “Presentation-Physician Services-September 2022,” (Slides 25-27)

https://www.mmis.georgia.gov/portal/Portals/0/StaticContent/Public/ALL/NOTICES/Physician%20Services%20Webinar%20September%202022%20FINAL%20APPROVAL%20v2%2020220901124901.pdf

 

It is time for providers to revalidate their provider profile. Gainwell is reaching out to providers to assist with the revalidation process. The Revalidation/Recredential application is one application. For providers with multiple service locations, you will be required to Revalidate each additional service location.

 

If you are unsure of your providers revalidation dates, log into www.mmis.gammis.gov Select Providers, then Demographic Maintenance, the Revalidation Date is present.

CareSource Updates


CareSource published new modifier policies effective January 1, 2023. Please see the links below for specific details.

Modifier 25 New Policy

https://www.caresource.com/documents/medicaid-ga-policy-reimburse-py-1361-20230101/

 

Modifier 59 New Policy

https://www.caresource.com/documents/medicaid-ga-policy-reimburse-py-1365-20230101/


CareSource- CLIA-Waived Tests Update – Effective 11/14/2022

https://www.caresource.com/documents/ga-med-p-1499801-clia-waived-tests-network-notification-ga-mcd/

Beginning November 14, 2022 CareSource will deny Clinical Laboratory Improvement Amendments (CLIA)-waived tests billed in an office setting (place of service 11) when the appropriate QW modifier is not appended. This information is in accordance with the CLIA Guidance Portal from hhs.gov. Inclusion of the QW modifier is necessary to evaluate the claim to determine the eligibility of services performed based on CLIA-waived testing. Additional information regarding the categorization of laboratory tests by CLIA may be found on www.hhs.gov.

United Healthcare

Get ready to submit electronically in 2023

Reconsiderations, appeals and claims moving to digital submissions only


https://www.uhcprovider.com/en/resource-library/news/2022/paper-submissions-go-digital-2023.html

 

We started with transitioning mail we send you to electronic delivery. Next, we’ll shift to eliminating paper you send us.

 

In 2023, network (contracted) health care professionals, practices and facilities will be required to submit claim submissions, claim attachments, and reconsideration and appeal requests to UnitedHealthcare electronically. In response to feedback from members, we’ll also emphasize and encourage the use of digital ID cards for commercial plans.

 

We recognize that these changes are significant, so we’re alerting you early to give you more time to plan ahead. The effective dates for these incoming paper-to-digital transitions will be announced in Network News at least 90 days prior to the change.

Click the link for a preview of what to expect with these changes, as well as more information on digital ID cards for commercial members.

Cigna Updates

Q4 2022 Cigna Network News

 

Cigna has published their Q4 2022 news publication. There are several items of interest notes with page numbers below. 

  • Page 3 - For Billers: Claim Search Enhancement on CignaForHCP.com
  • Page 6 – EFT Enhancement: Enroll and Manage on One Screen
  • Page 6 – Speed Up Common Procedure Code Benefit Look Ups: New Feature
  • Page 10 – ID Card examples for a Strategic Alliance Plans under Cigna
  • Page 11-12 – Cigna + Oscar Health Plans Information with sample ID cards
  • Page 14-16 – Changes in Drug Formulary Effective January 1, 2023
  • Page 28 – Virtual Care Reimbursement Policy
  • Page 43 – Quick Guide to Cigna ID Cards

Cigna Network News : Third Quarter 2022 (editiondigital.net)

Virtual Care Services Should Now Be Billed With POS Code 02

Cigna recently updated our systems to ensure providers now receive 100 percent of face-to-face reimbursement for covered virtual care services when billed with POS code 02. Therefore, we now recommend providers bill with POS code 02 for all virtual care services. As an added benefit, when you bill with POS code 02, your patients may pay a lower cost share for the virtual services they received due to a recent change in some plans benefits.


Additional Virtual Care Services Now Permanently Reimbursable

virtual-care-reimbursement-policy.PDF (cigna.com)

Cigna has added the following services and codes as permanently reimbursable as part of our Virtual Care Reimbursement Policy (R31).

  • Quick five- to 10- minute telephone conversations between a provider and their patient: HCPCS code G2012
  • eConsults: CPT codes 99446-99449, 99451, and 99452
  • Virtual home health services: HCPCS codes G0151-G0153, G0155, G0157-G0158, G0299-G0300, G0493, S9123, S9128-S9129 and S9131

In Case You Missed It


Kids Health First Who to Call List

Here is the Kids Health First Who To Contact List. Please contact our team with any needs you may have.


Q&A for Parents:The Bivalent COVID-19 Vaccine for Children 5 years and Older

Please click here for a Q&A KHF has put together that you can distribute to your patient's parents regarding the bivalent COVID-19 vaccine.


UPDATED: CDC Fall Vaccination Operational Planning Guide

Information for the Fall Vaccine Campaign, Including Upcoming Pediatric Bivalent COVID-19 Vaccine as Boosters for Children Aged 5-11 Years . Click here for more information.


CDC Updates Guidelines for Mask Wearing by Health Care Providers(HCP) in the Clinical Setting

KHF has broken down the updated guidence into an easy to follow guide for you here.

 

Click here for a Sample Letter to Parents Re: Flu Vaccine 2022!


Supporting Patients with Down Syndrome

Please click here to read a great article for pediatricians from PCC on supporting patients with down syndrome.


Free OSHA Training

Here is the link to the OSHA Webinar held on 9/15/22.

Here is the pdf of the deck. 

Here is the end of course test.


If you attended the meeting live your certificate will be emailed to the email address you posted in the chat.  If you were unable to attend live and you watch the video above and complete the test and would like your certificate of completion, please email Tandric Bowden at tandric.bowden@tccn-choa.org. 


Unprecedented Emergency Department and Outpatient Volumes

On Thursday, Sept. 15th, Children's sent out a communication co-written by TCCN to all independent primary care physicians regarding the recent surge in patient volumes in both the outpatient and ED settings. This communication includes the following resources:

·   Fever patient information sheet

·   Suggested return to school/childcare messaging

·   Monkeypox guidance

·   Flu and COVID-19 vaccination guidance

 

TCCN will be following up with additional guidance and resources over the coming weeks as we prepare for flu season, so please stay tuned for more updates.

 Click here to read the full communication from Children's and TCCN


FDA announces amended emergency use authorization of bivalent COVID Pfizer-BioNTech and Moderna boosters-On August 31, 2022 the FDA issued a press release announcing the EUA approval of bivalent formulations of the vaccines for use as a single booster dose at least two months following primary or booster vaccination for specific age groups. Click here for more information.  


The CDC announces recommendation of the first updated COVID-19 booster. On Thursday, September 1, CDC Director CDC Rochelle P. Walensky, M.D., M.P.H., endorsed the ACIP's committee recommendations for the updated COVID-19 boosters from Pfizer-BioNTech (ages 12 years and older) and from Moderna (ages 18 years and older). Click here for more information.  


Monkeypox Q&A for Parents

Please click here for the Q&A KHF developed with our Medical Director Dr. Sally Marcus.


2-Week Data Submission Requirement

The TCCN Board of Directors met on May 18, 2022, and revisited the initial recommendation made in 2018. At this time, by vote of the BOD (as allowed by the TCCN agreement with Network Participants), the TCCN BOD requires all practices to submit claims data to the PHM Tool within 14 calendar days of the most recent encounter date. This requirement will take effect beginning August 1, 2022. Please click here for more information.


Q&A for Parents/COVID-19 Vaccine for Children Under the Age of 5: The Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices met June 17-18, 2022, to discuss the FDA recommendations on the emergency use (EUA) authorization of the Pfizer-BioNTech and Moderna COVID-19 vaccines in children between 6 months thru 5 years of age. We have created an important FAQ for practices as a resource for parents who may have questions. 

Communications:


TCCN Roundup:


***The TCCN Roundup is designed to be a twice weekly information hub for all things TCCN. 

  • Please to check out the latest issue.
  • Please note that the link above only accounts for some TCCN updates. In order to view the full TCCN Newsletter with your contracted payor updates please check your TCCN inbox!***


TCCN Quality Steps Newsletter

 
Resources
Kids Health First | 2480 Briarcliff Rd NE, Suite 6-334, Atlanta, GA 30329
Unsubscribe ddixon@khfirst.com
Update Profile | Constant Contact Data Notice
Sent by lbaldwin@khfirst.com powered by
Trusted Email from Constant Contact - Try it FREE today.
Try email marketing for free today!

The content in this preview is based on the last saved version of your email - any changes made to your email that have not been saved will not be shown in this preview.
Volume 05 | February 19, 2021
Your Guide to News & Updates
News & Updates
Check out the Peach State / WellCare Resources Page on the KHF Intranet!

Please see below for the link to our Peach State/WellCare Resources Page on the Intranet.


It is located in the resources section of the intranet. This page will have updated information as we receive it, including our PA meeting recordings, sample letters, and other resources you may need.

Please reach out to Toni (twilliams@khfirst.com), Tandric (tbowden@khfirst.com) or Laura Baldwin (lbaldwin@khfirst.com) if you have any questions or if we can assist in any way.

Please let us know if you have any trouble accessing the resources on the intranet. Thank you!
Peach State / WellCare Merger: What You Need to Know

We have summarized the information given at our last Practice Administrator meeting. Please check out our bulleted list of hot topics and be sure to check out the recorded webinar and resources on our intranet page listed here!
Helpful E / M Tools:

Please check out the following resources for additional information on the 2021 E/M changes:

  • AMA: 2021 E/M Office Visit Changes (What changes can you expect?) - video here





Dr. Tuck Pediatric Coding Seminar- Slides and Recording

Thank you to all who joined us for our informative pediatric coding seminar with Dr. Tuck!
Please click the links below for a pdf version of the slides (we improved the layout slides 36 and 37 of the presentation from yesterday for clarity) and well as the recorded webinar.
Action Items
Aetna Claims Issues

Please let us know if you are still experiencing issues with claims for CPT 96160.

If you are having issues, please send an email to payorconcerns@khfirst.com and answer the questions listed below.

Are you still experiencing issues with CPT 96160?
  • Include the date range
  • Estimated amount of outstanding payments.


Please list any changes that you made (modifiers etc.) if any, to get the claims paid.
Multiplan / PHCS Claims Issues

We are seeing a lot claim issues related to network participation status.

Please follow the steps below to verify participation and reprocess claims.

  1. Please call 1-800-950-7040 with the patient’s demographics and the EOBs.
  2. Confirm that the provider is participating.
  3. Ask that the claim be priced and reprocessed. You will be given a reference number.
  4. The representative may request that you fax the EOBs.

*Please reach out to Toni Williams if the steps listed above do not work.*

Please submit an email with the information listed above to payorconcerns@khfirst.com.
Payor Updates
Aetna
Note about Aetna Whole Health Plan

KHF does not participate with the Aetna Whole Health Plan which is offered by Coca Cola and other employers in the Atlanta area.
Cigna
CAQH Reminder

Please make sure that your CAQH files are updated at least 3 months prior to recredentialing time for providers.
CareSource
Correction of claims for CPT 96110

Per our representative, the error causing issues with CPT 96110 has been corrected.

Affected claims will be automatically reprocessed.
Toni's Tips
Reminders & Quick Tips
Please do not only rely on the patient’s ID cards to confirm if a practice participates with a payor. We are seeing denied claims that cannot be reconsidered due to eligibility issues.

When in doubt about benefits, reimbursement policies, and other revenue cycle issues please reach out to the payor's provider relation’s customer service line and/or KHF.
Resources For You