Tag: Integrated Care

Changes Coming to Washington Apple Health

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Apple Health is shifting to whole-person care.

What does this mean?

Starting in 2019, Apple Health (Medicaid) Managed Care plans will cover behavioral health treatment services, in addition to the already covered physical health services.*  (You may have heard this referred to as integrated managed care or IMC transition.) This is great news for Apple Health clients because it means that folks can more easily get the help they need, for both physical and behavioral health, which includes mental health and substance use disorder (SUD) treatment.

As part of this transition, the number of managed care plans available in Adams, Ferry, Lincoln, Spokane, Stevens, and Pend Oreille counties will be decreasing. Beginning January 1, 2019, there will be three Apple Health plans in our region: Amerigroup, Community Health Plan of Washington (CHPW), and Molina Healthcare. UnitedHealthcare and Coordinated Care will no longer be available in our region, with the exception that Apple Health Foster Care will continue to be provided by Coordinated Care (Apple Health Core Connections).

It is important to note that this change will not reduce any benefits for Apple Health clients, nor will any clients lose their coverage. Most clients will stay with the same health plan. However, for those whose plan will no longer be an option in our region, the Health Care Authority (HCA) will auto enroll clients to one of the three available plans. There is no open enrollment period for Medicaid—clients may choose to change plans at any time.

What’s the next step?

Some Apple Health clients are already hearing about these changes and—as you can imagine—this news could cause some confusion and angst. Below you will find this information condensed into simple and clear bullet points. We strongly encourage you to share this message with your organization’s staff so they are equipped to handle questions and concerns.

Below you will find the Communication Toolkit which has links to materials for organizations to print and use. There will also be versions created in Spanish later this month. Additionally, the HCA intends to produce an educational webinar for providers and the MCOs are planning a symposium for October. Better Health Together will continue to provide updates and resources via email and on our website as soon as they become available. Click here to add your email address to our distribution list.

Communication Toolkit

Important Dates

October 1, 2018 – HCA sends a letter to Apple Health clients to summarize the changes
November 20, 2018 – HCA begins enrollment process for Jan. 1, 2019
Late November-early December – HCA sends a letter to clients with the name of their health plan, a link to their benefits booklet, and how to change their plan.
December 1, 2018 – HCA’s website and customer service phone lines become available to assist clients

The Facts

  • Clients will not lose coverage

  • Benefits will not be reduced

  • There will be no changes for clients currently on one of three available plans (Amerigroup, CHPW, Molina)

  • Clients on UnitedHealthcare and Coordinated Care will be automatically reassigned

  • Apple Health Foster Care will continue to be provided by Coordinated Care

  • Clients can choose to change their plan anytime

  • This affects Medicaid managed care clients, not Medicare or Medicaid fee-for-service 

Questions?
Health Care Authority • 1-800-562-3022 • askmedicaid@hca.wa.gov
Better Health Together • 509-960-8593 • admin@betterhealthtogether.org

*This change applies to Apple Health managed care programs. This does not apply to individuals receiving Apple Health coverage without a managed care plan (i.e. individuals on a fee-for-service plan, including those dually eligible for Medicaid and Medicare). These individuals will continue to receive physical health services as they do today. For more information about access to behavioral health services for these individuals, view the BHSO fact sheet at www.hca.wa.gov/assets/program/bhso-fact-sheet.pdf

MCO Meet & Greet contacts

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On Sept. 12, the four MCOs in the BHT region – Amerigroup, CHPW, Coordinated Care, and Molina – hosted a Meet & Greet for behavioral health and Tribal providers to get to know their MCO billing and clinical representatives. Slides from that day, which include contact information for those MCO representatives, are below.

Introductory Slides

Amerigroup presentation

CHPW presentation

Coordinated Care presentation

Molina presentation

837 Batch Samples

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837 Batch Sample files from each of the managed care organizations (MCOs) in our region will be housed on this page. They will be listed here in alphabetical order as we receive them. Stay tuned for more updates.

Community Health Plan of Washington (CHPW)
[837 Batch Sample File]

Coordinated Care
[837P Batch Sample File]
[837I Batch Sample File]

Molina Healthcare
[837 Batch Sample File]
*This is a file format for Professional (HCFA 1500) format claims and encounters. There is a different format for Institutional claims and encounters (837I). Some fields may get populated differently depending on how the agency is submitting to Molina. For example, if an agency submits through a clearinghouse that may change how some fields are populated. This file is intended to supplement our EDI companion guide, not replace it. To see the Molina EDI companion guide, click here.

Companion Guides

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For easy reference BHT is collecting Companion Guides from each of the managed care organizations (MCOs) in our region onto this page. They will be listed here in aphabetical order as we receive them. Stay tuned for more updates.

Amerigroup

Click here to view the most recent version of Amerigroup’s EDI Companion Guide.

Community Health Plan of Washington (CHPW)

For Providers (not the BHASO’s), CHPW strictly follows the 837 Healthcare Claim Professional and Institutional Guide (IG) version 5010, SERI for substance use disorder providers, and the HCA guidelines. Because we follow these we do not have CHPW specific companion guides.

  1. The 837 Healthcare Claim Professional Guide (IG) version 5010 can be found at www.wpc-edi.com or by calling (425) 562-2245.
  2. Service Encounter Reporting Instructions (SERI) https://www.hca.wa.gov/billers-providers-partners/behavioral-health-recovery/service-encounter-reporting-instructions-seri
  3. The HCA guidelines are at https://www.hca.wa.gov/billers-providers-partners/prior-authorization-claims-and-billing/hipaa-electronic-data-interchange-edi.

The acknowledgement files (999/277CA) are discussed in the 837 transaction companion guide.

For the BHASO’s we also have the below encounter information in addition to the above:

Molina Healthcare

Click here to view the most recent version of Molina’s EDI Companion Guide, which can also be found on their website along with other useful information under the EDI ERA/EFT link.