|
|
|
Provider Access and Availability Survey |
|
|---|
|
AmeriHealth Caritas Ohio will soon email and call our provider partners to complete the 2023 Appointment Availability Survey to assess the availability of routine and urgent appointments. All managed care plans in Ohio are required to survey their providers annually to help ensure appointments are offered in a timely manner. The results will help AmeriHealth Caritas Ohio better evaluate members’ access to provider services.
|
|
|---|
|
Prior Authorizations
Did you know you can submit prior authorizations through the NaviNet portal? AmeriHealth Caritas Ohio created this tool to provide a higher auto-approval rate and quicker turnaround time compared to faxing the authorizations. There is also a report function that gives a status report allowing you to have visibility to all prior authorization requests you have submitted. We are happy to offer training or any assistance your team may need to transition to this process. Please reach out to your local Account Executive.
|
|
|---|
|
Ohio Department of Medicaid fraud warning
Criminals are targeting Medicaid recipients for sensitive, personal, and financial information. If your patient gets a call, text, or email about Medicaid benefits asking for a Social Security number, payment, bank, debit, or credit card information, advise your patient to not respond. They’re not from the State of Ohio or any agency. Instead, it should be reported to the Ohio Attorney General at 800-282-0515 or https://www.ohioprotects.org/.
The Electronic Data Interchange (EDI) brings new functionality
One of the new features launched in EDI is the ability to confirm eligibility for specific procedures using CPT/HCPCS codes in the 270/271 inquiry within the EDI. This enables trading partners, on behalf of their providers, to proactively request information about member benefit coverage in addition to Medicaid member eligibility. Providers can work with their trading partners to obtain this information. By using the CPT/HCPCS values in the 270/271 inquiry, providers can obtain crucial information in advance of specific procedures enabling a more streamlined administrative process.
Ohio Department of Medicaid in-person site visits to resume July 1
The public health emergency has ended, and Ohio Department of Medicaid (ODM) is resuming site visits for initial provider enrollments and revalidations effective July 1, 2023. Site visits had been paused without impacting provider enrollment status. Site visits are part of ODMs provider enrollment screening process and are required by state and federal regulations for certain provider types.
What action do you need to take?
Public Consulting Group (PCG), will be contacting you to schedule a site visit, which may be conducted either virtually or onsite. Please be responsive to PCG when they contact you.
For questions, email OH_Provider_Screening@pcgus.com. For more information about provider enrollment and resources check out the Provider Enrollment page on the ODMs website.
Attaching documents to a claim
To attach a document to a claim, you will need to access the Medicaid Information Technology System (MITS) portal via the Provider Network Management (PNM) module. This Quick Reference Guide can assist with accessing the self-service functions in MITS via the PNM.
For assistance with attaching documents to a claim submitted through the MITS portal, providers can refer to item #4 in the Web Portal section of this document.
Check out new Ohio Medicaid micro videos
ODM has developed a variety of short videos to help members, providers, stakeholders, and advocates better understand Ohio Medicaid and the Next Generation program. Each video explains an important topic and provides resources for additional information or where to go with questions.
In the newest micro video, Learn about the Ohio Medicaid managed care member ID card members learn what information is on their card, what to do if they have not received a card, and where they can go with questions. We encourage providers and advocates to familiarize themselves with this to help members and to understand what they will be receiving when a member arrives for services.
COVID-19 vaccination billing
For hospital and institutional providers billing for COVID vaccinations, if you are billing the following vaccine administration CPT codes, the payment will be capped at the lesser of billed charges or fee schedule amount. To bypass the grouper packaging logic and receive payment, ODM is requiring the vaccination administration codes to be billed using RCC 771 with modifier HE.
0001A, 0002A, 0003A, 0004A, 0011A, 0012A, 0013A, 0031A, 0034A, 0041A, 0042A, 0044A, 0051A, 0052A, 0053A, 0054A, 0064A, 0071A, 0072A, 0073A, 0074A, 0081A, 0082A, 0083A, 0091A, 0092A, 0093A, 0094A, 0111A, 0112A, 0113A, 0124A, 0134A, 0144A, 0154A, 0164A, 0173A and 0174A
Find ODMs COVID-19 billing guidelines here.
Practice/Partnership Reports
The Q4-2022 Quarterly Practice/Partnership Reports have now been posted for your review. All those who participated in the 2022 CPC program year will need to log into the Provider Network Management module to access these files.
Annual report
ODM and its vendors are still currently working on the 2021 Annual Reports. At this time we do not have a date for when those reports will be finalized and made available. They appreciate everyone's patience as they work through closing out the 2021 Comprehensive Primary Care (CPC) program year. For assistance accessing your CPC reports, review the How to Access your CPC Reports guide.
|
|
Do not send paper claims
The Next Generation of Ohio Medicaid program's guidelines require all claims to be submitted via the Electronic Data Exchange (EDI). If you have submitted a paper claim, you will be advised that your claim has not been processed and what your next steps should be. You can get started on our website with claims how-to's, quick guides, links and contact info.
Billing guidelines
Clarifying language is being added to the behavioral health section of our billing guidelines:
for services billed under the provider’s primary license, modifiers are not to be used.
Access AmeriHealth Caritas Ohio's provider resources
Step 1: Visit our provider webpage
Step 2: Sign up for NaviNet
Step 3: Attend a Provider Orientation Meeting
Step 4: Submit claims through Electronic Data Interchange (EDI)
|
|
Info for our vision providers
We have contracted with two optical laboratories to provide your patients (our members) with glasses: Robertson Optical and Classic Optical. You are required to order member glasses through one of these labs. A prior authorization (PA) is not required; however, you must confirm eligibility.
Classic Optical Laboratories
- The available frame choices are conveniently the same frames included in the Ohio Medicaid frame collection which many provider offices have
- Orders may be placed through the Classic Optical website directly
- Classic Optical will check the member’s eligibility in real-time prior to the order being placed
- If you have questions for Classic Optical, call 1-888-522-2020
Robertson Optical Laboratories
- All vision providers will be required to display the Medicaid frame kits provided by Robertson Optical
- Orders must be placed through the dedicated Robertson Optical portal
- The cost per frame kit is $200
- If you have questions for Robertson Optical Laboratories, they can be reached at: 1-800-922-5525
|
|
|---|
|
Value-added benefits - Bright Start
Being pregnant is an exciting time for your patients (our members)! AmeriHealth Caritas Ohio has many tools available to help your patient have a healthy, full-term pregnancy.
- Bright Start is the maternity care management program at AmeriHealth Caritas. The program is staffed with RN Care Managers, Care Guides and Care connections to assist members and provide support, aiming to enhance the care experience during pregnancy and after delivery.
- Bright Start helps with health education and providing information, counseling, and educational materials on various pregnancy-related topics such as healthy habits during pregnancy, managing behavioral and physical health concerns, and breastfeeding benefits and lactation resources.
- We also have several specialized services and supports like Keys to Your Care (KTYC), Two Way Texting, and Optum OB Homecare (nurse visitation).
- Bright Start is available to all pregnant ACOH members. If you have a patient that is pregnant, encourage the member to contact our Bright Start Hotline at 1-833-606-2727 to speak with a staff member to assist with the member’s needs.
|
|
Claims Payment Systemic Error (CPSE) Report
The Claims Payment Systemic Errors (CPSE) report is updated and posted on the ‘Alerts and Newsletter’ page monthly. AmeriHealth Caritas Ohio encourages you to review this log frequently and before contacting our Provider Services team. If after reviewing you still have additional questions, please feel free to reach out to Provider Services at 1-833-644-6001 and, as always, you can reach out to your local account executive. Click here to view the report.
|
|
|---|
|
Billing evaluation and management services with behavioral health evaluation codes |
|
|---|
|
To improve the integration of behavioral medicine with physical medicine, AmeriHealth Caritas Ohio (ACOH) is taking steps to make it easier for providers to make impact in their community.
In an effort to reduce administrative burden and expand access to behavioral health services, ACOH will reimburse claims for evaluation and management services and behavioral health evaluations, when the level of care warrants the usage of the behavioral health evaluation and documentation supports that these services are separately identifiable, in accordance to Ohio Administrative code 5160-27.03 and Appendix A, 5160-27-03.
How this impacts billing:
- If the evaluation meets the 30 minute minimum for the following time based codes: 90832, 90836, or 90838, providers can bill with them with same day/ same physician services rendered for codes 99201-99215
- If the services do not meet the requirements to bill for E/M and full BH Evaluation, providers have the option to bill for a higher level E/M code or utilize 90792, in accordance with CMS guidance: “When a patient is referred with an organic diagnosis and a mental health diagnosis is established, the mental health diagnosis should be billed. If a psychiatric diagnostic evaluation with medical assessment is performed, the physician or NPP may use CPT code 90792 or an evaluation and management (E/M) code.”
|
|
|---|
|
Claims dispute FAQs
- Claim disputes are typically related to a claim payment/denial that requires supporting documents
- Disputes are sent by the provider verbally (provider services claims call center), written, or via our provider portal NaviNet
- Timeframes to submit is 30/60 days from the denial/incorrect payment
- Any disputes that are faxed should receive a tracking number along with a letter confirming the receipt of the fax within five days. You can fax forms to 1-833-216-2272
- A letter will be sent to the provider notifying them whether the claim decision was upheld or overturned
- If a dispute is filed and determined to be a system issue, the provider will NOT have to resubmit claims or dispute any additional claims. The claims will be pulled and reprocessed for the provider
- Provider will receive a fax confirmation receipt with tracking number
|
|
Join us at a new provider orientation session
AmeriHealth Caritas Ohio has added provider orientation sessions through the end of the year. Please see the dates below and join your personal account executives online via Zoom from 10 a.m. - 11 a.m.
New provider orientations inform our providers about Next Generation and Plan updates, claims and billing resources, prior authorizations resources, EFT information, and member and provider resources.
June 20 - click here to register
July 18 - click here to register
August 15 - click here to register
September 19 - click here to register
October 17 - click here to register
November 14 - click here to register
December 19 - click here to register
Have you attended an orientation session and need to complete the attestation? Click here to get started.
|
|
|---|
|
Tell us a little bit about where you’re from.
I grew up in a small town named Leesburg, an hour east of Cincinnati. I attended Ohio University and have a BS in Health Administration.
Everyone at AmeriHealth Caritas Ohio (ACOH) has a story about why they joined the team. What’s yours?
I had been working in Provider Relations for another Medicaid MCO for the past 21 years, needless to say I was comfortable and wasn’t necessarily looking to move. I previously worked with some of the AmeriHealth Caritas Ohio leadership and a number the AE’s and felt that it was a great opportunity to join a team of individuals who I knew would bring a lot of experience and knowledge to the team. Change can be hard but knowing that you are joining a team with people you know and respect can sure make the transition to a new job a lot easier. I felt that being part of a startup plan was an exciting opportunity, it would allow us all to bring our different experiences and think of different and creative ways to collaborate with our provider partners to ensure great member care and experiences.
What drew you to this profession?
In college I knew I wanted to be in the healthcare sector but knew I couldn’t be a hands-on clinician, so by studying health administration it allowed me to be in healthcare and still have an impact on the wellness of those in our community. Working in provider relations has allowed me to collaborate with the providers in our community to help the underserved get access to the care they need. |
|
|
Nicki and her family
What do you like to do in your free time? I love to travel but don’t do it nearly enough. I enjoy spending time with my family. I have a daughter who is going off to college in the fall so I try to enjoy as much time with her as she will allow. I love to read, so you will find me reading most evenings.
If you could have dinner with anyone in the world, dead or alive, who would it be? Why?
My mother, whom I lost unexpectedly in October 2022. My parents owned a restaurant for 22 years so food and cooking was always part of our family. To have the opportunity to have another dinner with her and share with her all the celebrations our family has had in the past seven months would be wonderful.
What are two apps on your phone you CANNOT live without?
My camera and Libby, which is an app for downloading and reading e-books.
Any interesting facts about yourself that you’d like to share?
As I mentioned above, I grew up in the restaurant business but I honestly do not really enjoy cooking.
|
|
|---|
|
|
|
Throughout June, Men’s Health Month aims to encourage boys and men to take charge of their physical and mental health. The goal is to heighten the awareness of preventable health problems and encourage early detection and treatment of diseases including cancer, heart disease, and depression.The official symbol for the month is a blue ribbon and Wear BLUE Day will be held on Friday, June 16 to raise awareness.
To view resources and statistics, visit Office of Minority Health's website.
|
|
|---|
|
Improving Outcomes for People with Disabilities 2023 virtual roundtable
Ohio Association of Health Plans and Ohio Center for Autism and Low Incidence (OCALI) are hosting a series of virtual roundtables. This series provides attendees the opportunity to hear from and engage with national experts and local leaders and deepen their understanding of people with disabilities as a focus of population health. The one-hour roundtables include lived experience, didactic presentation, and opportunity for interaction. Each session is designed to both challenge your thinking and change your practice, providing you with tools and resources you can use immediately. Click here to register. |
|
Provider Services Team Update
Our Ohio-based provider services account executive team was able to come together for two days of team-building and goal setting. We had a fun dinner at one of our favorite Hibachi restaurants!
|
|
|
|
|
|
|
 |
|  |
|
|
|
|
