November 2021 MedicAide
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In This Issue COVID-19 Vaccinations & Crisis Standards of Care ....................................................................... 2 The Global Surgery Package Includes Postoperative Pain Management ........................................... 2 Secure Message Inquiries.......................................................................................................... 3 New Idaho Healthcare Directive Registry System ......................................................................... 4 Health Information Technology Survey ....................................................................................... 4 November MCAC Meeting moved to December; topic chiropractic care............................................ 4 Letter from Medicaid Medical Director ......................................................................................... 6 ECHO Idaho’s CE/CME-eligible Podcast ....................................................................................... 8 Provider Training Opportunities in 2021 .....................................................................................25 DHW Resource and Contact Information ....................................................................................26 Insurance Verification ..............................................................................................................26 Gainwell Technologies Provider and Participant Services Contact Information .................................27 Gainwell Technologies Provider Services Fax Numbers .................................................................27 Provider Relations Consultant (PRC) Information.........................................................................28 Information Releases MA21-20 - COVID19 CFAC Medicaid Provider Stabilization Fund - AMENDED .......................................... 11 MA21-24 - Hospice Rates 2022 ......................................................................................................... 14 MA21-25 - COVID19 Vaccine And Idaho Medicaid................................................................................ 19 The content of this guidance document is not new law, but is an interpretation of existing law prepared by the Idaho Department of Health and Welfare to provide clarity to the public regarding existing requirements under the law. This document does not bind the public, except as authorized by law or as incorporated into a contract. For additional information or to provide input on this document, contact the Idaho Division of Medicaid by emailing [email protected] or by calling (208)334-5747. An Informational Newsletter for Idaho Medicaid Providers From the Idaho Department of Health and Welfare, November 2021 Division of Medicaid
Transcript of November 2021 MedicAide
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In This Issue
COVID-19 Vaccinations & Crisis Standards of Care ....................................................................... 2 The Global Surgery Package Includes Postoperative Pain Management ........................................... 2 Secure Message Inquiries .......................................................................................................... 3 New Idaho Healthcare Directive Registry System ......................................................................... 4 Health Information Technology Survey ....................................................................................... 4 November MCAC Meeting moved to December; topic chiropractic care ............................................ 4 Letter from Medicaid Medical Director ......................................................................................... 6 ECHO Idaho’s CE/CME-eligible Podcast ....................................................................................... 8 Provider Training Opportunities in 2021 .....................................................................................25 DHW Resource and Contact Information ....................................................................................26 Insurance Verification ..............................................................................................................26 Gainwell Technologies Provider and Participant Services Contact Information .................................27 Gainwell Technologies Provider Services Fax Numbers .................................................................27 Provider Relations Consultant (PRC) Information .........................................................................28
Information Releases MA21-20 - COVID19 CFAC Medicaid Provider Stabilization Fund - AMENDED .......................................... 11 MA21-24 - Hospice Rates 2022 ......................................................................................................... 14 MA21-25 - COVID19 Vaccine And Idaho Medicaid ................................................................................ 19
The content of this guidance document is not new law, but is an interpretation of existing law prepared by the Idaho Department of Health and Welfare to provide clarity to the public regarding existing requirements under the law. This document does not bind the public, except as authorized by law or as incorporated into a contract. For additional information or to provide input on this document, contact the Idaho Division of Medicaid by emailing [email protected] or by calling (208)334-5747.
An Informational Newsletter for Idaho Medicaid Providers
From the Idaho Department of Health and Welfare, November 2021
Division of Medicaid
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COVID-19 Vaccinations & Crisis Standards of Care COVID-19 case rates remain high in Idaho and hospitals continue to be stretched to their limits. Crisis Standards of Care were activated in Idaho on September 16, 2021, and remain in effect. We can turn this around by practicing social distancing, wearing masks when indoors with individuals outside our households, staying home and getting tested when sick, and getting vaccinated against COVID-19. Idaho COVID-19 vaccination rates continue to remain well below the national average, and they are even lower among Idaho Medicaid participants. Even with an increase over the last month, only about 19 percent of Idaho Medicaid participants ages 12-64 have been fully vaccinated against COVID-19. COVID-19 vaccines are safe and effective and are the best defense we have against COVID-19. Idaho Medicaid strongly encourages providers to continue to talk to all eligible participants (soon to include children ages 5-11 as well as all individuals over age 12) about getting vaccinated to protect themselves, their families, and their communities against COVID-19. More than 91 percent of people hospitalized for COVID-19 in Idaho are not fully vaccinated. Pregnant women are at especially high risk of becoming severely ill from COVID-19 and experiencing negative pregnancy outcomes, and the CDC recently issued a health advisory encouraging all women who are pregnant, recently pregnant (including those who are breastfeeding) or trying to become pregnant to choose to become vaccinated against COVID-19. Please see the updated Information Release MA21-25 on vaccinations included with this MedicAide newsletter for more information. Please also see the copy of the letter sent to Healthy Connections Organizations about COVID-19 vaccinations. For additional information about COVID-19 in Idaho, visit https://coronavirus.idaho.gov.
The Global Surgery Package Includes Postoperative Pain Management
The Medicaid Program Integrity Unit has identified instances when providers have unbundled and billed separately for postoperative pain management services when such services are included in the global payment of a surgical procedure. Idaho Medicaid is federally mandated to implement the National Correct Coding Initiative (NCCI). NCCI applies to all practitioners (including dentists), hospitals, or providers eligible to bill the relevant HCPCS/CPT codes pursuant to Medicaid program rules. Under the NCCI program, postoperative pain management is not separately reportable when provided by the physician performing an operative procedure. The Idaho Medicaid Provider Handbook: General Billing Instructions, Section 3.5, effective March 2, 2021 and subsequent versions, explains that implementation of NCCI is federally mandated. It specifically states, the following:
“The National Correct Coding Initiative (NCCI) is a program developed by CMS that uses correct coding methodologies to reduce overpayments to providers due to incorrect coding on claims. NCCI edits are comprised of Procedure-to-Procedure Edits and Medically Unlikely Edits. Section 6507 of the Affordable Care Act directed all State Medicaid programs to implement use of NCCI methodologies that are “compatible” with claims filed with Medicaid. This is to promote correct coding and control improper coding leading to inappropriate payment of claims under Medicaid.”
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Chapter 1, Introduction, of NCCI Policy Manual, effective January 1, 2021, as well as subsequent versions, explains the usage of the term “physician” and states, in pertinent part:
In this Manual, many policies are described using the term “physician.” Unless indicated differently, the use of this term does not restrict the policies to physicians only but applies to all practitioners (including dentists), hospitals, or providers eligible to bill the relevant HCPCS/CPT codes pursuant to Medicaid program rules in each state.
Chapter 8, General Policy Statements, of the NCCI Policy Manual, addresses postoperative pain management as not separately reportable by the same physician performing the operative procedure. It states, in pertinent part:
Under the NCCI program, postoperative pain management is not separately reportable when it is provided by the physician performing an operative procedure. The CPT codes 36000, 36410, 62320-62327, 64400-64489, and 96360-96377 describe some services that may be utilized for postoperative pain management. The services described by these codes may be reported by the physician performing the operative procedure only if provided for purposes unrelated to the postoperative pain management, the operative procedure, or anesthesia for the procedure.
Improper billing of services to Medicaid will be subject to recoupment and civil monetary penalties.
Secure Message Inquiries To increase efficiency and prompt resolution to your inquiries we are asking the Provider community to include the following information when communicating with Gainwell through your secure message feature on your Trading Partner Account: For claim inquiries:
• Pay to NPI • Pay to Name • Member name • Claim number
For Prior Authorization (PA) status inquiries:
• Pay to NPI • Pay to Name • MID • Member name • Date submitted
For a request to update the Administrator on your Trading Partner Account:
• All information must be included on company letterhead, signed and o NPI/Provider ID to specific account o Explanation of Admin Change o First and Last Name of Previous or Username on file o Current Email on file o First and Last Name of New Admin
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New Idaho Healthcare Directive Registry System On October 12, 2021, the Department of Health and Welfare established a new Idaho Healthcare Directive Registry (IHDR) and existing advance directives were transferred from the Secretary of State to the new system. IHDR is a secure web-based system where Idahoans can safely create, store, and share their healthcare advance directive. Idaho healthcare professionals can access the IHDR to view existing directives 24/7 at no charge. Licensed physicians, advance practice professional nurses, and physician assistants can create an electronic POST (Physician Orders for Scope of Treatment) that can be digitally signed by the provider and patient. For more information, visit the healthcare provider FAQs and IHDR website, email [email protected], or call 208-334-5501.
Health Information Technology Survey
Some of you may have received an email from Health and Welfare inviting you to participate in a Health Information Technology survey. We are conducting a survey on the adoption and use of electronic health records, participation in health information exchange, and overall health information technology. Your participation in the survey is very valuable. The assessments of Health Information Technology usage will allow us to understand the current provider landscape and opportunities for improved interoperability of health information, leading to better coordination of care and improved health outcomes. A copy of the health information technology report, detailing the survey results, will be made available by February 2022.
Thank you for your participation.
November MCAC Meeting moved to December; topic chiropractic care
The Medical Care Advisory Committee (MCAC) typically meets on the fourth Wednesday of every month from 1:30-2:30pm MST via Webex. Because of the holidays in November and December, MCAC will instead have one longer meeting on Wednesday, Dec 1st from 1:30-3pm MST. MCAC serves as a sounding board for Medicaid, providing advice on programming, coverage policies, and managed care organization activities. The November MCAC meeting will focus on potential changes to Idaho Medicaid’s chiropractic manipulation therapy (CMT) coverage policy. Idaho Medicaid covers CMT for the treatment of acute back pain due to subluxation of the spine, subacute back pain due to subluxation of the spine, or an exacerbation of chronic back pain due to subluxation of the spine. Medicaid is considering taking this service off prior authorization to reduce administrative work for chiropractors and add a Healthy Connections referral requirement to facilitate care coordination. Chiropractors, primary care providers, Medicaid participants, and other interested parties are encouraged to join the November MCAC meeting to provide input. MCAC is seeking new members, especially from among medical, dental, and behavioral health providers. If you or your organization are interested in participating in MCAC, please email Sabine Tordjman at [email protected] . For more information about MCAC, please go to https://healthandwelfare.idaho.gov/about-dhw/boards-councilscommittees/medical-care-advisory-committee.
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Next meeting: Wednesday, December 1, 1:30-3:00PM MST Join from the meeting link https://idhw.webex.com/idhw/j.php?MTID=m3810c82312df3bff85831038e29f0f24 Join by meeting number Meeting number (access code): 2455 191 2375 Meeting password: psPEyZqJ635 (77739975 from phones and video systems) Tap to join from a mobile device (attendees only) +1-415-655-0003,,24551912375#77739975# US Toll +1-720-650-7664,,24551912375#77739975# United States Toll (Denver) Some mobile devices may ask attendees to enter a numeric meeting password. Join by phone +1-415-655-0003 US Toll +1-720-650-7664 United States Toll (Denver)
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Letter from Med icaid Med ical Di rector
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ECHO Idaho’s CE/CME-eligib le Podcastligible Podcast
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Provider Training Opportunities in 2021 You are invited to attend the following webinars offered by Gainwell Technologies Regional Provider Relations Consultants.
November: Coordination of Benefits The Coordination of Benefits training will review COB pricing calculations, entering COB in your Trading Partner Account, and attaching EOBs. Training is delivered at the times shown in the table below. Each session is open to any region, but space is limited to 25 participants per session, so please choose the session that works best with your schedule. To register for training, or to learn how to register, visit www.idmedicaid.com.
November December January
Coordination of Benefits
Claims Eligibility
10-11:00 AM MT
11/16/2021 12/15/2021 1/19/2022 11/17/2021 12/16/2021 1/20/2022 11/18/2021 12/21/2021 1/18/2022
2-3:00 PM MT
11/9/2021 12/8/2021 1/12/2022 11/10/2021 12/9/2021 1/13/2022 11/16/2021 12/16/2021 1/20/2022 11/18/2021 12/21/2021 1/18/2022
If you would prefer one-on-one training in your office with your Regional Provider Relations Consultant, please feel free to contact them directly. Provider Relations Consultant contact information can be found on page 28 of this newsletter.
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DHW Resource and Contact Information DHW Website https://healthandwelfare.idaho.gov/
Idaho CareLine 2-1-1 1 (800) 926-2588
Medicaid Program Integrity Unit P.O. Box 83720 Boise, ID 83720-0036 [email protected] Fax: 1 (208) 334-2026
Telligen 1 (866) 538-9510 Fax: 1 (866) 539-0365 http://IDMedicaid.Telligen.com
Healthy Connections Regional Health Resource Coordinators Region I Coeur d'Alene
1 (208) 666-6766 1 (800) 299-6766
Region II Lewiston
1 (208) 799-5088 1 (800) 799-5088
Region III Caldwell
1 (208)-334-4676 1 (800) 494-4133
Region IV Boise
1 (208) 334-4676 1 (800) 354-2574
Region V Twin Falls
1 (208) 736-4793 1 (800) 897-4929
Region VI Pocatello
1 (208) 235-2927 1 (800) 284-7857
Region VII Idaho Falls
1 (208) 528-5786 1 (800) 919-9945
In Spanish (en Español)
1 (800) 378-3385
Insurance Verification HMS PO Box 2894 Boise, ID 83701
1 (800) 873-5875 1 (208) 375-1132 Fax: 1 (208) 375-1134
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Gainwell Technologies Provider and Participant Services Contact Information
Provider Services MACS (Medicaid Automated Customer Service)
1 (866) 686-4272 1 (208) 373-1424
Provider Service Representatives Monday through Friday, 7 a.m. to 7 p.m. MT
1 (866) 686-4272 1 (208) 373-1424
E-mail [email protected] [email protected]
Mail P.O. Box 70082 Boise, ID 83707
Participant Services MACS (Medicaid Automated Customer Service)
1 (866) 686-4752 1 (208) 373-1432
Participant Service Representatives Monday through Friday, 7 a.m. to 7 p.m. MT
1 (866) 686-4752 1 (208) 373-1424
E-mail [email protected]
Mail – Participant Correspondence P.O. Box 70081 Boise, ID 83707
Medicaid Claims
Utilization Management/Case Management P.O. Box 70084 Boise, ID 83707
CMS 1500 Professional P.O. Box 70084 Boise, ID 83707
UB-04 Institutional P.O. Box 70084 Boise, ID 83707
UB-04 Institutional Crossover/CMS 1500/Third-Party Recovery (TPR)
P.O. Box 70084 Boise, ID 83707
Financial/ADA 2006 Dental P.O. Box 70087 Boise, ID 83707
Gainwell Technologies Provider Services Fax Numbers Provider Enrollment 1 (877) 517-2041 Provider and Participant Services 1 (877) 661-0974
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Provider Relations Consultant (PRC) Information
Region 1 and the state of Washington 1 (208) 373-1309 [email protected]
Region 2 and the state of Montana 1 (208) 373-1326 [email protected]
Region 3 and the state of Oregon 1 (208) 373-1475 [email protected]
Region 4 and all other states 1 (208) 373-1351 [email protected]
Region 5 and the state of Nevada 1 (208) 373-1357 [email protected]
Region 6 and the state of Utah 1 (208) 373-1325 [email protected]
Region 7 and the state of Wyoming 1 (208) 373-1408 [email protected]
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Digital Edition MedicAide is available online by the fifth of each month at www.idmedicaid.com. There may be occasional exceptions to the availability date as a result of special circumstances. The electronic edition reduces costs and provides links to important forms and websites. To request a paper copy, please call 1 (866) 686-4272.
Gainwell Technologies PO Box 70082 Boise, Idaho 83707
MedicAide is the monthly informational newsletter for Idaho Medicaid providers. Editor: Shannon Tolman
If you have any comments or suggestions,
please send them to: Shannon Tolman,
[email protected] Medicaid – Communications Team
P.O. Box 83720 Boise, ID 83720-0009 Fax: 1 (208) 364-1811
