August Managed Care Plan Updates
This past month, CareSource and Molina have published updates on events and policy changes impacting their organizations.
- New Policy – Molecular Diagnostic Testing: CareSource considers conventional testing such as rapid antigen direct tests, direct fluorescent antibody testing and cultures lower cost options. They should be utilized before molecular diagnostic testing by PCR. The new policy states that providers should utilize conventional testing first. If initial testing is negative but the patient is presenting symptoms that support the diagnosis, then a PCR test can be ordered. Click here to read the policy in detail.
- Next Generation of Managed Care – FQHC/RHC Prior Authorizations and Claims: In alignment with the Next Generation Managed Care Initiative, CareSource is required to change its Payer ID. The CareSource Payer ID is changing from 31114 to 0003150 for Ohio Medicaid providers only. Providers must reflect the CareSource Payer ID change when submitting Ohio Medicaid claims with a Date of Service on or after Dec. 1, 2022. Click here to read the update in detail.
- Change Healthcare ProviderNet: Change Healthcare’s service portal, ProviderNet, is experiencing an outage and there is currently no estimated time of restoration. Click here to see how this will impact payments, changes to banking information for Electronic Funds Transfer (EFT), and new provider registration.
- Readmission Payment Policies: Effective August 1, 2022, Molina will begin reviewing admissions within 30 days of an anchor admission for both inpatient behavioral health and detox stays. The readmission will be reviewed based on Molina’s published policy to identify if the stay was potentially preventable. If the admission is identified as potentially preventable, providers will have the right to file a reconsideration with supporting clinical information. Click here and go to the top of page 3 to review the update in detail and view additional resources.
- Expansion of Telehealth Services: Effective July 1, 2022, Ohio Administrative Code (OAC) 5160-1-18 Telehealth will expand to include the services listed below. If you would like to read the updated posted on Molina’s bulletin click here.
Services Being Expanded:
- Individual diabetes management training
- Group setting diabetes management training
- Childbirth prep/Lamaze classes
- Childbirth refresher classes
- Baby parenting classes
- Infant safety training
- Prenatal nutrition classes
- Smoking cessation classes
- Preventive medicine counseling
- Child Adolescent Needs and Strengths (CANS) assessments
Behavioral health services eligible for payment when provided through telehealth by Ohio Department of Mental Health and Addiction Services (OhioMHAS) certified providers expand to include the following:
- Mobile Response Stabilization Services, initial response
- Mobile Response Stabilization Services, stabilization
- Mobile Response Stabilization Services, follow-up
- Prolonged Evaluation and Management (E&M) visits
Published August 2022