This past month, the managed care plans have published updates on events and policy changes impacting their organizations.
Ohio Department of Medicaid:
The Ohio Department of Medicaid (ODM) will be hosting an upcoming navigation training for their new Alternative Payment Model (APM) System. This new system will impact those working closely with the Comprehensive Primary Care (CPC) and Comprehensive Maternal Care (CMC) programs. This new APM system will be replacing HAVEN, which is where all CPC and CMC reports and files are located today. This training session will be taking place on Thursday, September 12, from 10-11 a.m. Register for the training here.
The Managed Care Organizations (MCO) will be conducting CPT-II billing trainings at no additional cost. The opportunity for CEU’s is available. This coding workshop is offering a beginner-level virtual training aimed at identifying best practices related to how clinical providers accurately document their care and diagnoses. Tw0, 90-minute options are available for attendance. Tuesday, September 24 at 10 a.m. and Wednesday, September 25 at 2 p.m. Register for a training session here. Placeholder invites will be sent and then updated once a Zoom link is available. If you have questions or would like to be added to the communication list for this training, please email MHOVBR@molinahealthcare.com.
AmeriHealth Caritas:
Changes to prior authorization requirements and medical necessity review for various services is a part of AmeriHealth Cartitas’ continued dedication to supporting providers in their shared commitment to high quality health care for their participants. Q3 Procedure code authorization updates can be found here.
Buckeye Health:
Buckeye Health is pleased to announce that they recently added a new form on their website to allow providers to indicate on their profile that they offer Telehealth services. If you have not added that to your provider profile, please complete the form on the Demographics section of their website.
Buckeye Health has chosen SafeRide Health to serve as their transportation vendor. To schedule rides for members please call (866) 531-0615. To learn more about SafeRide Health, click here.
CareSource:
Caresource has enhanced their Provider Portal to show redetermination dates for Medicaid and MyCare members. When providers perform a member search, they will now see the member’s redetermination date in the results. This is a great opportunity to remind the member to complete the renewal packet if their redetermination data is coming up soon and will help the member remain eligible for Medicaid. To learn more, click here.
Humana Healthy Horizons:
Humana has a new search tool to help providers streamline prior authorizations! Providers can now search by CPT code, procedure, or drug name to determine if authorization is required. Providers can also find guidance on how to submit medical and pharmacy authorizations. Access the tool here.
Molina Healthcare:
Molina would like providers to remind their patients or their patents/guardians when it is time to get important Healthchek Early and Periodic Screenings, Diagnostic, and Treatment (EPSDT) services. Molina covers Healthchek services at no cost to their members. Physicians and Adanced Practice Nurses are eligible to provide Healthchek services. For addition information, visit here.
United Healthcare Community:
On October 1, 2024, United Healthcare will be removing email as an intake option to maintain demographic data for groups and practitioners. UHC will be no longer be accepting email as a method to update your information. Moving forward, groups and practitioners can submit their demographic updates through one of the following methods listed here to ensure timely and accurate updates of your data.