Provider Matters - September 2016

 

 

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Monthly updates about claim processing, policy and resources for Oregon Medicaid providers
 
September 2016

In this issue:

 

Health System Transformation

  • Medicaid Electronic Health Records (EHR) Incentive Program

Other provider updates

  • Oct. 1, 2016 Prioritized List changes and other updates
  • Coming soon: Changes to Provider Web Portal Benefits and Prioritized List inquiry
  • Version 34 Medicare Severity-Diagnosis Related Group (MS-DRG) grouper delayed
  • Free October 17 webinar: Trans* Health 101
  • Free October 26 webinar: Buprenorphine waiver training
  • Reminder: APM plan type on Provider Web Portal eligibility screen
  • Reminder: Monthly payment recovery for Oregon Health Plan newborn claims

Medicaid Electronic Health Records (EHR) Incentive Program

Program Year 2016 updates for eligible professionals
Eligible professionals can submit their 2016 adopt, implement or upgrade (AIU) and meaningful use (MU) first year attestations until March 31, 2017. Please include the following documents as part of your attestation:

  • Copy of meaningful use summary report;
  • Security risk assessment (SRA). HealthIT.gov offers an SRA tool to help providers complete this assessment;
  • Inventory list;
  • Deficiencies noted and the corrective action plan(s), including target dates for implementation; and
  • Documentation of who completed the SRA.

This is the last year to begin the program (coming in under AIU or MU payment year one).

  • Eligible professionals can receive an incentive payment for adopting, implementing or upgrading certified electronic health record technology (CEHRT) in their first year of participation.
  • Eligible professionals must choose to participate in either the Medicare or Medicaid EHR Incentive Program.

For more information


Oct. 1, 2016 Prioritized List changes and other updates

The Health Evidence Review Commission (HERC) has published the pending 10-1-2016 Prioritized List of Health Services (The List). The List takes effect Oct. 1, 2016.
Other recent updates
HERC updated its technical changes document and fact sheet about back and spine line policy changes. You can find these resources on HERC’s News and Information page.

Approved coverage guidance on tobacco cessation during pregnancy is now posted on the HERC Blog.

Questions?
Email HERC.Info@state.or.us.

Also try HERC’s Searchable List tool and sign up to get HERC email updates to keep informed about Prioritized List changes.

Coming soon: Changes to Provider Web Portal Benefits and Prioritized List inquiry

Starting Sunday, October 9, the Provider Web Portal Benefits and Prioritized List Inquiry will require entering the claim type when making a combined “Client Inquiry” and “HSC List Inquiry.”

  • If you do not enter a claim type, you will see an error message asking you to enter the claim type.
  • To learn more about using the Benefits and Prioritized List inquiry, view our self-paced guide and quick reference.

DRG hospitals: Version 34 Medicare Severity-Diagnosis Related Group (MS-DRG) grouper delayed

The Version 34 MS-DRG grouper becomes effective Oct. 1, 2016. Unfortunately, we will not be able to update our system effective October 1. When we make this update, we will let you know.


Free October 17 webinar: Trans* Health 101

A 90-minute webinar presented by the Health Resources and Services Administration (HRSA), Trans* Health 201: A Deeper Dive Into Providing Culturally Appropriate Care from Patient and Provider Perspectives will discuss the health care needs of the trans* community from both the patient and provider perspectives.

The webinar will highlight the special obstacles faced by trans* patients within the health care setting; opportunities to improve cultural competency within your organization; and best practices to integrate trans* friendly care into the primary care setting.

The target audience includes HRSA grantees, health care providers, public health officials, and advocates wanting to better serve trans* patients in their practices.

Agenda

  • How HRSA Is Improving the Lives of the LGBTQ Community: Valerie Gallo, M.P.H., public health analyst, HRSA Office of Regional Operations, San Francisco
  • Patient Perspectives: Reed Milliard, B.A., program specialist, Asian and Pacific Islander Wellness Center, Behavioral Health & Community Programs, Trans: Thrive,  San Francisco
  • Provider Perspectives: Tri D. Do, M.D., M.P.H., chief medical officer, and Blair M. Turner, D.N.P., F.N.P.-B.C., nurse practitioner, Asian and Pacific Islander Wellness Center, San Francisco.

Free October 26 webinar: Buprenorphine waiver training

The Providers’ Clinical Support System for Medication Assisted Treatment (PCSS-MAT) holds two free online buprenorphine waiver trainings per month. The next scheduled West Coast training is coming soon:

About buprenorphine and buprenorphine waiver training
The latest advance in medication-assisted treatment, buprenorphine provides a whole-patient approach to the treatment of opioid dependency. When taken as prescribed, in combination with counseling and behavioral therapies, buprenorphine is safe and effective.

Under the Drug Addiction Treatment Act of 2000 (DATA 2000), physicians are required to complete an eight-hour training to qualify for a waiver to prescribe and dispense buprenorphine. This free webinar is one of three continuing medical education courses that can help physicians qualify to prescribe buprenorphine in an office setting.

About PCSS-MAT
A three-year grant funded by the Substance Abuse and Mental Health Services Administration, PCSS-MAT promotes high-quality, evidence-based screening, assessment and treatment for substance use and co-occurring mental disorders.

The American Academy of Addiction Psychiatry leads PCSS-MAT project efforts in partnership with other professional organizations of physicians involved in care of patients with addiction: the American Osteopathic Academy of Addiction Medicine, American Psychiatric Association and American Society of Addiction Medicine.


Reminder: Alternate Payment Methodology (APM) plan type on Provider Web Portal eligibility screen

Oregon Health Plan members who are enrolled with a federally qualified health center (FQHC) or rural health clinic (RHC) as their primary care home will have their FQHC/RHC listed as plan type “APM” on the Provider Web Portal eligibility verification screen.

  • APM is not a managed care plan. You cannot bill this plan type.
  • APM does not indicate the primary care provider for managed care plan members.
  • If a client has the APM plan type and no coordinated care organization (CCO), mental health organization (MHO) or dental care organization (DCO) plan types, this means you should bill the Oregon Health Authority (OHA) on a fee-for-service basis.

For more reminders about the APM plan type and verifying OHP eligibility and enrollment, please read our January letter about the APM plan type. You can also review our Eligibility Verification screen quick reference.


Reminder: Monthly payment recovery for OHP newborn claims

Every month OHA recovers a small number of payments made in the preceding month for services to newborns who are now enrolled in a CCO.

  • Once the birth is reported, we enroll children born to CCO members in the mother’s plan.
  • Depending on when the birth is reported to us, this process may take three or more weeks to complete.

To avoid future recoveries for newborn services:

What you will see on the paper remittance advice (RA), electronic remittance advice (ERA) or Provider Web Portal (PWP):

  • On the paper RA: Adjusted claims will have an Internal Claim Number (ICN) beginning with “52.” The “Detail EOBs” for these ICNs will list Explanation of Benefits (EOB) code EOB 0090 – Service is covered by a managed care plan. Claim must be billed to the appropriate managed care plan.
  • On the ERA or PWP: The ERA should list these adjustments as overpayment recoveries. PWP will show the adjustment ICN as a denied claim. In both ERA and PWP, the reason for recovery will be Adjustment Reason Code 24 - Charges are covered under a capitation agreement/managed care plan.
To learn more about recovery of overpayments or appeals, please see Oregon Administrative Rules 410-120-1397(7), 410-120-1560 and 410-120-1580 in the General Rules guidelines.

Need help?

Find more phone numbers, email addresses and other resources in our Provider Contacts List.
•  Client calls: CCO members should call their CCO. Other clients should call OHP Client Services at
800-273-0557.
•  Claim resolution:
Contact Provider Services (800-336-6016).
•  Direct deposit questions: Contact the DHS/OHA EFT Coordinator (503-945-6872).
•  Electronic Data Interchange (EDI), the EDI Trading Partner Agreement, EDI mailbox help, and the 835 ERA: Contact EDI Support Services (888-690-9888).
•  ICD-10 transition questions: OHAICD10.help@state.or.us
•  Pharmacy and prescriber questions (for technical help and fee-for-service prescription PAs): Contact the Oregon Pharmacy Call Center at 888-202-2126. You can also fax PA requests to 888-346-0178.
•  Prior authorization status: Call the PA Line at 800-642-8635 or 503-945-6821 (outside Oregon).
•  Provider enrollment updates: Contact Provider Enrollment (800-422-5047).
•  Provider training videos and past Provider Collaborative webinars: Visit the OHA YouTube channel.
•  Provider Web Portal help: Visit our Provider Web Portal page. If you need a password reset, contact Provider Services (800-336-6016).