roer neeer - amerigroup · 2018-06-01 · a wireless scale and fitbit activity tracker. all of this...
TRANSCRIPT
Provider Newsletter
February 2018MD-NL-0095-18
https://providers.amerigroup.com/MD February 2018
Table of ContentsAmerigroup Community Care announces new weight loss program
Page 2
Effective June 1, 2018, Amerigroup Community Care providers will be required to use ProView for credentialing
Page 3
New pharmacy electronic prior authorization request tool effective January 1, 2018
Page 3
Hepatitis C medications state policy reminders Page 4
Levoleucovorin calcium, elosulfase alfa, histrelin acetate, idursulfase and fulvestrant to require prior authorization
Page 4
Medical Policies and Clinical Utilization Management Guidelines update
Page 5
Reporting address changes Page 6
Behavioral Health Corner Page 6
Updated March 2, 2018
Page 2 of 7
Amerigroup Community Care announces new weight loss program
We are happy to announce that as of November 6, 2017, Amerigroup members have access to a new, no-cost benefit called RetrofitSM.
What is Retrofit?Retrofit is a unique weight loss program that gets results. Eighty-eight percent of the people who have joined the Retrofit program lost weight, and 77 percent kept it off 12 months later. It’s the personal coaching that makes a difference. Retrofit coaches have, on average, 15 years of experience and Master’s level degrees in nutrition, exercise physiology or behavior science.
Each member who enrolls will receive: � Their own personal coach who will meet with them one-on-one. � Weekly, online classes led by a Retrofit coach. � Access to an online community group moderated by an expert. � A wireless scale and Fitbit activity tracker.
All of this is at no cost to eligible Amerigroup members.
Our members look for guidance in their health care decisions. If you have an Amerigroup patient with a BMI greater than or equal to 28, type 2 diabetes, hypertension, or a combination of these conditions, please tell them about Retrofit.
Members can find out more by going to http://bit.ly/amerigroup-wl or calling 443-214-7003 (TTY/TDD: 1-844-224-6191).
We also have brochures for your office. If you would like for us to mail you copies of the Retrofit brochure, contact Bernadette Cosby at [email protected] and 410-981-4000, ext. 44241.
Potential members of the Retrofit program must enroll by March 31, 2018 as membership is limited.
Amerigroup believes that programs like Retrofit will help our members live healthier, more productive lives. Please refer your patients to Retrofit today!MD-NL-0089-17
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Effective June 1, 2018, Amerigroup Community Care providers will be required to use ProView for credentialing
Effective June 1, 2018, use of the Council for Affordable Quality Healthcare’s (CAQH) ProView will be required for initial credentialing and recredentialing with Amerigroup. ProView is a free online service that allows health care providers to fill out one application to meet the credentialing data needs of multiple organizations.
All providers applying for initial or continuing participation will be required to complete and submit their credentialing and recredentialing applications through CAQH ProView by accessing the CAQH website. Below are some helpful hints and things to remember when using ProView.
To join CAQH ProView:1. Go to https://proview.caqh.org/pr.2. Select Register Now on the bottom right and
follow the instructions.
If you already participate with CAQH and have completed your online application, ensure that you authorized Amerigroup access to your credentialing information. This can be completed in four easy steps. (If you have selected Global Authorization, Amerigroup will already have access to your data.)
To authorize Amerigroup:1. Go to https://proview.caqh.org/pr and enter
your username and password.2. Select the cog wheel in the upper right and
then select Authorize.3. Scroll down, locate Amerigroup and check the
box beside Amerigroup.4. Select Save to submit your changes.
For questions about ProView, call the CAQH help desk at 1-888-599-1771 or email [email protected]
New pharmacy electronic prior authorization request tool effective January 1, 2018
Amerigroup Community Care has partnered with CoverMyMeds to offer an electronic prior authorization (ePA) request tool that simplifies the process for requesting medications and checking the status of your submissions.
FeaturesThese new features help simplify the prior authorization process. You will be able to:
� Submit requests for general pharmacy medications (medications dispensed directly to a member from a retail pharmacy or shipped from a specialty pharmacy).
� Check ePA status. � Upload supporting documents and review
appeal status.
AvailabilityThe tool will be available beginning January 1, 2018.
Accessing the tool � Visit https://www.covermymeds.com. � Locate the existing link within your electronic
medical records tool if available.
Support with ePA through CoverMyMeds � For the Support Center, visit
https://www.covermymeds.com/main/help. � For support via chat, locate and activate
the chat window in the bottom right of the webpage.
� For support via phone, call 1-866-452-5017.
Amerigroup is focused on providing new tools to help make your job a little easier. We appreciate the compassion and dedication with which you care for your patients and our members.MDPEC-1401-17
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Levoleucovorin calcium, elosulfase alfa, histrelin acetate, idursulfase and fulvestrant to require prior authorization
Effective April 1, 2018, the injectable medications: levoleucovorin calcium, elosulfase alfa, histrelin acetate, idursulfase and fulvestrant, will require prior authorization (PA) from Amerigroup Community Care. Federal and state law, as well as state contract language (this includes definitions and specific contract provisions/exclusions) take precedence over these PA rules and must be considered first when determining coverage. Noncompliance with the new requirements may result in denied claims.
PA requirements will be added to the following codes:
� J0641 — Injection, levoleucovorin calcium, 0.5 mg � J1322 — Injection, elosulfase alfa, 1mg � J1675 — Injection, histrelin acetate, 10 mcg � J1743 — Injection, idursulfase, 1 mg � J9395 — Injection, fulvestrant, 25 mg
Please note: These drugs may not be covered in all states. Providers must review their specific state for coverage because not all drugs in this update will apply to the state in which you participate.
Please use one of the following methods to request PA:
� Phone: 1-800-454-3730 � Fax: 1-800-964-3627 � Web: https://www.availity.com
Go to https://providers.amerigroup.com/MD > Provider Resources & Documents > Quick Tools > Precertification Lookup Tool.MD-NL-0086-17
Hepatitis C medications state policy reminders
The most up-to-date Prior Authorization (PA) Form for hepatitis C medications can be found on the Amerigroup Community Care website (https://providers.amerigroup.com/MD > Provider Resources & Documents > Pharmacy > State Hepatitis C Therapy Prior Authorization Form).
� All documentation, including lab results, should be dated within 90 days of requesting a PA.
� Viral load should be obtained at treatment weeks two, four, 12 and 24.
� A final viral load should be obtained following treatment completion and faxed within 12 months of initial fill date to Amerigroup at 1-866-495-1977 Attn: Hepatitis C Coordinator.
� Effective November 1, 2017, Mavyret™ was added to the Amerigroup formulary as preferred.
� Mavyret is the first 8-week regimen with an indication as initial therapy in all hepatitis C virus genotypes in patients without cirrhosis.
MD-NL-0092-17
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Medical Policies and Clinical Utilization Management Guidelines update
Medical Policies updateOn December 18, 2017, the Medical Policy and Technology Assessment Committee (MPTAC) approved the following Medical Policies for Amerigroup Community Care. These policies were developed or revised to support clinical coding edits. Several policies were revised to provide clarification only and are not included in the below listing. We made these Medical Policies publicly available on our website on the effective date listed below.
Visit https://medicalpolicies.amerigroup.com to search for specific policies. Existing precertification requirements have not changed. Please share this notice with other members of your practice and office staff.
Medical Policy effective date
Medical Policy number
Medical Policy titleRevised or new
9/27/17 DRUG.00110 Inotuzumab ozogamicin (Besponsa®) New9/27/17 MED.00124 Tisagenlecleucel (Kymriah™) New9/27/17 DRUG.00043 Tocilizumab (Actemra®) Revised
Clinical Utilization Management Guidelines updateOn December 18, 2017, the MPTAC approved the following Clinical Utilization Management (UM) Guidelines for Amerigroup. These guidelines were developed or revised to support clinical coding edits. Several guidelines were revised to provide clarification only and are not included in the below listing.
The Clinical UM Guidelines on this list represent those adopted by the Medical Operations Committee for the Government Business Division on October 19, 2017. We made these guidelines publicly available on the Medical Policy and Clinical UM Guideline subsidiary website on the effective date listed below.
Visit https://medicalpolicies.amerigroup.com to search for specific guidelines. Existing precertification requirements have not changed. Please share this notice with other members of your practice and office staff.
Effective date
Clinical UM Guideline number
Clinical UM Guideline title Revised or new
9/27/17 CG-LAB-11 Screening for Vitamin D Deficiency in Average Risk Individuals New
9/27/17 CG-MED-59Upper Gastrointestinal Endoscopy for Diagnosis, Screening or Surveillance
New
9/27/17 CG-SURG-59 Vena Cava Filter New
9/27/17 CG-DME-31Wheeled Mobility Devices: Wheelchairs —Powered, Motorized, With or Without Power Seating Systems and Power Operated Vehicles (POVs)
Revised
MDPEC-1416-17
Page 6 of 7
Reporting address changes
To ensure Medicaid members do not lose their health insurance benefits, please remind your patients to update their mailing address and phone number with Maryland Health Connection (MHC). Medicaid enrollees whose mail is returned due to an invalid mailing address may be at risk of being disenrolled starting January 2018.
Reporting a change of address and phone number is easy. No documentation is required.
Choose any one of the following four methods:
� Go online: www.MarylandHealthconnection.gov � Use the Change My Information button on
your account home page to update your information.
� Download the free Enroll MHC mobile app. � Get free, in-person help from a local connector
entity, health department or Department of Social Services.
� Call MHC at 1-855-642-8572 (TTY: 1-855-642-8573).
MD-NL-0093-17
Behavioral Health Corner
Welcome to the Behavioral Health Corner of the Provider Newsletter, in collaboration with Beacon Health Options (Beacon).
The Behavioral Health Corner will include updates on topics that impact all providers, no matter what specialty or service they provide. In addition, Beacon will provide brief updates to changes within the Public Behavioral Health System.
The topic of this edition of the Behavioral Health Corner is adolescent suicidality in medical and primary care settings. Suicide rates for adolescents have been rising since 2007. Suicide rates for girls age 15-19 have doubled from 2007-2017. During that same timespan, the suicide rate for boys 15-19 rose by 50 percent. Office-based physicians are often faced with the dilemma of making a judgment call on the seriousness of suicidality presented by an adolescent in their exam room. How do we screen and make clinical decisions regarding the safety of an individual child or adolescent?
A simple, easy-to-use screening tool is the Ask Suicide Screening Questions (ASQ), designed to be used in medical settings. The ASQ employs a three-stage strategy to help clinicians assess risk and make decisions on disposition. Five questions determine whether the individual is a negative screen, a nonacute positive screen or an acute positive screen. Any adolescent screening positive requires a brief suicide safety assessment to determine if a full mental health evaluation is necessary. An acute positive screen requires an immediate safety screen/full mental health evaluation. The ASQ is in the public domain from the National Institutes of Health at: https://www.nimh.nih.gov/news/science-news/ask-suicide-screening-questions-asq.shtml.
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Behavioral Health Corner (cont.)
Recent updates in the Maryland Public Behavioral Health System: � Beacon now manages adult residential treatment services for substance
use disorders (SUDs). For formation on these services or how to refer your patients for SUD assessments, please contact Beacon at 1-800-888-1965.
� Medication Assisted Treatment (including buprenorphine and Vivitrol) for SUD is now available in multiple treatment settings in addition to traditional opioid treatment programs.
� The state has expanded services for the treatment of gambling disorders delivered by SUD treatment programs in January 2018.
� Beginning January 2018, Maryland Medicaid longer reimburses laboratories for definitive urine drug screens greater than 14 substances. The Maryland Department of Health (Department) recommends providers to use the American Society of Addiction Medicine Smart Testing guidelines. The Department also added coverage for providers who have appropriate equipment to perform more extensive presumptive drug testing in their office. Please contact Beacon for questions associated with covered drug testing changes.
� For pregnant patients with substance use or mental health disorders requiring collaboration and coordination of behavioral health and medical care, contact Jay Hensley at Beacon: [email protected].
� Effective January 1, 2018, Medicaid covers applied behavioral analysis (ABA) for children with autism spectrum disorder. Contact [email protected] for information or referrals.
For help with referrals to a mental health provider (or SUD treatment provider), call Beacon at 1-800-888-1965.
For additional information on screening tools and other topics, visit our website at http://maryland.beaconhealthoptions.com/index.html. Select the tab for Non Behavioral Health Provider.
If there are topics you would like to see in future editions of the Behavioral Health Corner of the Provider Newsletter, please email [email protected].
Amerigroup Community Care works with Beacon to provide mental health services to our members.MD-NL-0094-17