Tag: Integrated Care

Update 01/23/20
Message from HCA, 01/23/20

The coding subject matter experts missed a crucial error.  Please see below corrected version of the SERI interim guidance document.  The unit duration for the primary or parent codes should be 30 minutes rather than 15 minutes. Corrected or changed areas in the document are in red font so that they are easily seen.  I’ve also attached the crosswalk we received from the APA we received as a reference document. 

If you see any other errors or have questions, please email the hcamcprograms@hca.wa.gov inbox with a cc to Teresa Claycamp (teresa.claycamp@hca.wa.gov). 

HCA Interim SERI Guidance 1-9-2020, Corrections 1-23-2020 – added 01/23/20

Health and Behavior 2020 crosswalk – added 01/23/20

Update 07/12/19
HCA has updated the SERI, NPI, & Taxonomies Q&A document to include many of the new questions received over the last several months around the new 7/1/2019 SERI Guide and the HCA responses to those questions.

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Update 07/05/19
HCA provided answers via email to outstanding provider questions about the new SERI guide. A formal SERI Q&A guide is expected soon.
Answers to provider SERI questions

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Update 03/18/19
HCA has released the IMC Service Encounter Reporting Instructions (SERI), with an effective date of July 1, 2019. Providers will still be able to bill under the old SERI guidelines until that date.

IMC SERI Guide

SERI FAQ

HCA SERI webpage

Note the hyperlinks on the procedure modifiers page are not working at this time. HCA is working to correct these links and plan to get a revised version out soon.

Please send any questions or concerns to Gail Kreiger at Gail.Kreiger@hca.wa.gov  

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Important update! On Nov. 16, BHT received an important update from HCA on taxonomy codes: HCA has received a notification from clearinghouses that they cannot accept the local taxonomy codes created by HCA. See this post for more information and next steps for providers. The NPI Enrollment Fact Sheet below has been revised to reflect this update.

There have been a number of questions about Service Encounter Reporting Instructions (SERI) and enrollment of National Provider Identifiers (NPI). The HCA has created guidance documents in response to these questions from providers, linked below. The documents include appropriate contact information for providers to send questions to the HCA.

Additionally, the HCA hosted a webinar on SERI/NPI Enrollment on Oct. 5. Slides and Q&A from that webinar are below. [Note: Due to technical issues, a recording of this webinar is not available.]

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Update from HCA 12/17/18:
HCA recently released guidance regarding how to code and submit Evidence-Based Practice (EBPs) under the Integrated Managed Care (IMC) program starting January 1, 2019. See EBP Codes FAQ below.

Because HCA is allowing providers and MCOs to use the current SERI Guide for submitting encounters until July 1, 2019, there has been some confusion as to whether implementation of the IMC EBP codes rules will also be delayed until July 1, 2019. 

HCA is reaching out to clarify that the new requirements for coding and submitting EBPs under IMC will become effective January 1, 2019, including the use of 9 digit EBP codes. Please make those necessary changes for January 1.

2019 IMC SERI Guide – new 3/18/19

IMC SERI Fact Sheet 

2019 SERI Modifiers List 

NPI Enrollment Fact Sheet

Step-by-Step NPI Enrollment Instructions

Taxonomy Codes List in Excel Format

Minutes vs. Units FAQ & Code List

EBP Codes FAQ

SERI/NPI Webinar Slides

SERI/NPI Webinar Q&A

American Indian/Alaska Native (AI/AN) Fee-for-Service Checklist

American Indian/Alaska Native (AI/AN) Fee-for-Service FAQ

new! How to update an existing clinician enrollment in ProviderOne
1. Go into www.waproviderone.org as either a file maintenance or super user.
2. Go under Provider.
3. Manage Provider Information.
4. Select Step 14 servicing providers.
5. Select the name of the servicing provider you want to update.
6. Will bring up to the steps for this provider.

 If you want to add a taxonomy select Step 3 and click on the add button and enter your taxonomy. Close out and go back to the steps and submit the last step to submit the modification.

 Yo
u would do the same process to update clinician’s information. If just changing information you could just click on what you need to update and change the information. You do not have to select add if the information is already there.  Make sure you do the last Step and submit the mod.

 You can also call 1 800-562-3022 Ext .16137 and we can help walk you thru the process.

Clarification on NPI Application for Non-Resident and US Resident Aliens
Non Resident and US Resident Aliens are eligible to apply for NPIs, but they must enroll using their IRS Individual Taxpayer Identification Number (ITIN) along with a photocopy of U.S. driver’s license, State issued ID, birth certificate or passport. See the NPPES Application form for more details.

Additional questions regarding applying for the NPI should be directed to the NPPES 1-800-465-3203 or customerservice@npienumerator.com.

Where can I get more information?

• For more information about NPI enrollment, email: provider.enrollment@hca.wa.gov or call 1- 800-562-3022 (extension 16137). You may also visit: www.hca.wa.gov/enroll-as-a-provider

• For questions or comments about the IMC SERI please email Gail Kreiger: gail.kreiger@hca.wa.gov

Resources and contacts received to date:

MCO & BH-ASO Contact List – updated Jan 2020

MCO FAQ compilation

Care Coordination Contacts

Companion Guides

Complaints & Grievances

Prior Authorization resources – updated Jan 2020

Shared Provider Roster template – updated with MCO contacts 4/29/19

Symposium materials

WISe forms & Tracker submission

837 Batch Sample Files

CMS Guidance – Use of Modifier 59

Contracts & Reconciliation Contacts

• Molina – Megan Gillis Megan.Gillis@MolinaHealthCare.Com

• Amerigroup – Kathleen Boyle Kathleen.Boyle2@amerigroup.com

• CHPW – Cathy Neiman Cathy.Neiman@chpw.org

Updating practice demographic data (address, hours, tax ID, etc.)

• Amerigroup – Form is on our website https://providers.amerigroup.com/pages/wa-forms.aspx under Provider Data Update Forms. The best place to send the completed form is waopsrequest@amerigroup.com. You can also use that email address or call 1-800-454-3730 with questions.

• CHPW – “Clinic & Group Change Term” form available on website https://www.chpw.org/for-providers/documents-and-tools/ under Tools & Resources. Ask for 30 days notice thru the form. Contact directly if shorter timeline than that.

• Coordinated Care – reach out to your contract contact.

• Molina – will send specific email box for that.

Forms and resources about the MCO’s authorization processes will be posted below as they are received.

MCOs have shared a Prior Authorization Services reference guide for Behavioral Health providers. This guide shows prior authorization requirements and length of authorization by service type across the different MCOs.

Combined MCO Prior Authorization Reference Guide – updated Jan. 2020

HCA Guidance on Prior Auth Process from Correctional Facility to Residential – added 03/27/29

Amerigroup
SUD Inpatient Prior Auth & Continued Care Form

Coordinated Care
Contact Information and PA Check Tool
Prior Authorization Summary Guide

Molina
Molina BH Auth Request Form
Contact Information – Behavioral Health UM Team information
BH Provider Lists Landing Page on Member Public Website
Spokane BH Provider Grid – In Network Agencies and Community Health Centers

CHPW
Notification – Inpatient notification to CHPW is done one of two ways, fax or via our online portal. 

Prior Auth page – the below link is to our prior auth website which contains the information providers need to know on what requires prior authorization as well as links to the various forms that we provide for submission via fax and information to guide providers how to sign up and start sending authorizations online.
https://www.chpw.org/for-providers/prior-authorization-and-medical-review/

The specific forms (which are on the website above) are:
Inpatient Notification: https://www.chpw.org/resources/Forms_and_Tools/Inpatient_Admission_Form_Updated_9.24.2018.pdf
SUD Request Form: https://www.chpw.org/resources/Providers/Prior_Authorization/IMC_SUD_Service_Request_Form_1.pdf
Mental Health Request Form: https://www.chpw.org/resources/Providers/Prior_Authorization/Mental_Health_Service_Request_Form.pdf

Where to look to identify network providers for CHPW. Our provider directory is located on the website and provides the most accurate and real time information for our network providers and facilities: https://www.chpw.org/provider-search/

Provider Manual Link : https://www.chpw.org/for-providers/provider-manual1/

Integrated Managed Care Providers:

HCA is committed to a successful transition to Integrated Managed Care and supporting providers through this transition. This communication is to remind providers that if you are experiencing challenges, HCA is available to provide assistance. To contact the MCP team for assistance with issues, send your email to HCAMCPROGRAMS@HCA.WA.GOV.

 The HCA Managed Care Programs (MCP) provides direct oversight of the Managed Care Contracts and can assist with finding strategies for resolution. 

When sending an email to the HCA MC Programs mailbox, we will need the following information:

• Overview of your concern:

  • What is the concern?

  • Is your concern specific to a single MCO or multiple MCOs?

  • Have you contacted the MCO with your concern? If so, who did you communication with?

  • What was the MCO response to concerns

• Contact information for who HCA should follow up with from your organization.

• Specific examples that HCA can use to look into issues, including:

  •  The name of the impacted managed care enrollee(s)

  • Enrollee Date of Birth(s) and ProviderOne number(s)

  • Date(s) the service occurred

  • Type of service (SUD, Durable Medical Equipment (DME), pharmacy, Inpatient, physician)

• Any other relevant information or detail you think would be helpful to HCA to assist with problem-solving.

 

Encrypted Emails

All emails with client information should be sent encrypted to ensure confidentiality. If you do not have a secure email system please send an email to HCAMCPROGRAMS@HCA.WA.GOV asking for a secure email to be sent.  We will send a secure email and if you reply to that email the information contained will remain protected.

 Questions? 

If you have any questions, contact us at HCAMCPROGRAMS@HCA.WA.GOV.  We can reach out to you directly by email or schedule a phone call to answer any questions.