Primary Care Provider Office Manager Luncheon September 12, 2017 - - PowerPoint PPT Presentation

Primary Care Provider Office Manager Luncheon

September 12, 2017

Provider Relations

Meet our Provider Relations Team!

Teresa Hebert, Director Christine Owens, Manager Sylvia Carrizales, Analyst Elvia Provencio, Analyst Eric Gustafson, Coordinator Mona Ogas, Coordinator

Provider Enrollment Application related to Children’s Heath Insurance Program

• Patient Protection and Affordable Care Act (PPACA)

requires states to screen and enroll all CHIP providers by December 31, 2017 to continue to receive reimbursement for services

• CHIP only providers must enroll in Texas Medicaid to

continue program participation but are not required to participate in Texas Medicaid

• For more information, call TMHP Contact Center at 1-800-925-9126

Adoption Assistance/Permanency Care Assistance Program

• Effective September 1, 2017, CCHP assumed

management of Utilization Management services for children who belong to the AAPCA program

• CCHP will honor any authorizations for services that are

currently in place on September 1, 2017.

• Please send us a copy of the original authorization.
• CCHP may reach out to Providers for additional

information regarding existing authorizations

If you have questions, contact CCHP at 1-800-964-2247

THSteps Vaccine Sequence

• When billing vaccines, it is critical to bill the

vaccine followed by the appropriate administration code

• Please refer to the Texas Medicaid Children’s

Services Handbook

• http://www.tmhp.com/TMPPM/TMPPM_Living

_Manual_Current/2_Childrens_Services.pdf

THSteps Vaccine Components

THSteps billing

Billing THSTEPS:

 Must have a exam diagnosis (ex Z00129)  If vaccines are given, add diagnosis Z23  Use modifier 25 after the AM modifier if vaccines are given

THSteps Checkup Documentation Improvement Reminder

• Missing documentation is the largest factor and

primary cause of records being reviewed and money being recouped

• HHS provides resources to assist you in

completing THSteps checkup documentation

THSteps Checkup Documentation Improvement Reminder

• THSteps Documentation Improvement Provider Letter
• describes importance of documenting each component and

sub-component

• THSteps Clinical Record Review Tool with Instructions
• Excel workbook assists in self-audits
• THSteps Clinical Record Review Tool
• PDF to use as paper copy

http://dshs.texas.gov/thsteps/providers.shtm

Expansion of Influenza Vaccine Codes 90686 and 90688

• Effective for dates of service August 1, 2017
• Age limitation for 90686 and 90688 expanded
• Will include clients 6 through 35 months of age

Access and Availability

• CCHP is committed to making sure our Members are able to get the

care they need (access) within reasonable timeframes (availability) see 8.1.3.1 of the Uniform Managed Care Contract

https://hhs.texas.gov/sites/default/files/documents/services/health/medicaid-chip/programs/contracts/uniform-managed-care-contract.pdf

• HHSC requires network providers to offer our Members access to

covered services 24 hours a day, 7 days a week.

• In order to ensure our Primary Care Providers and Specialty Care

Providers are meeting these standards, the Quality Department calls all of our network providers on an annual basis during and after regular business hours. PCP surveys will be fielded in September, October and November.

• If issues are identified providers will be mailed a letter via certified

mail with a list of deficiencies.

Access and Availability

• The MCO (CCHP) must provide coverage for Emergency Services to

Members 24 hours a day and seven (7) days a week, without regard to prior authorization or the Emergency Service provider’s contractual relationship with the MCO.

• The MCO (CCHP) must require, and make best efforts to ensure, that

PCPs are accessible to STAR, STAR Kids, CHIP, and CHIP Perinate Newborn Members 24 hours a day, seven (7) days a week and that Network Primary Care Providers (PCPs) have after-hours telephone availability consistent with Section 8.1.4.

• The MCO (CCHP) must ensure that Network Providers offer office hours

to Members that are at least equal to those offered to the MCO’s commercial lines of business or Medicaid fee-for-service participants, if the provider accepts only Medicaid patients.

What does all of this mean?

The Primary Care office will be measured on:

• 1. Average wait time for a Member in the lobby (arrival time to room)
• 2. Preventative Care for a newborn (appt within 14 days of birth/enrollment)
• 3. Preventive THSteps visits for STAR (appt within 90 days)
• 4. Preventive Well Child Checkup for CHIP (appt within 90 days)
• 5. Preventive Care for adult (appt within 90 days)
• 6. Routine Primary Care Non-emergent or Non-urgent (appt within 14 days)
• 7. Urgent Care (Appointment within 24 hours)
• 8. Emergency Care (immediate appointment or referral to ED)
• 9. Routine Specialty Care or non Urgent/Emergency (referral provided within 30

days) 10.After Hours Care or answering service 11.After Hours Recording in English/Spanish 12.After Hours call back from provider (within 30 minutes)

CCHP Provider Website Updates

• Resources
• Provider / Education & Training
• Presentations/Handouts/Updates
• Office Managers Meetings (archive)
• Provider / News Updated regularly
• List of Member Value Added Services can be found on
• ur website Provider / Education & Training / STAR

Kids, STAR, CHIP, CHIP Perinatal

http://www.cookchp.org/English/Providers/Pages/Education-Training.aspx

Hurricane Harvey

• On Thursday, August 31, 2017, the Centers for Medicare and

Medicaid Services (CMS) approved the state's request to waive Children’s Health Insurance Program (CHIP) co-payments for members with a permanent address in one of the Hurricane Harvey Federal Emergency Management Agency (FEMA) declared disaster counties.

• Co-payments are waived for services provided August 25, 2017

through November 30, 2017. Therefore, providers must not require

• r collect co-payments for CHIP members living in or displaced from

a Hurricane Harvey FEMA-declared disaster county.

http://www.cookchp.org/SiteCollectionDocuments/news/news/hurricane-harvey-faq.pdf

Hurricane Harvey

• Will the eligibility certification period for Medicaid, CHIP and Texas Health Women

Program clients be extended for those that have a permanent residence in one of the FEMA-declared disaster counties?

• A: Yes. Due to disruptions to mail delivery and to ensure continuity of services, HHS received federal approval to provide a six

month extension of medical benefits for Medicaid, CHIP and Healthy Texas Women clients whose permanent residence is in one

• f the FEMA-declared disaster counties.
• Clients that were up for renewal of their benefits in August, September, October or

November will have their certification periods automatically extended for six months. Clients do not need to take any action for this extension to be effective.

• Households with certification periods ending in:
• ฀August 2017 will be automatically extended through February 2018;
• ฀September 2017 will be automatically extended through March 2018;
• ฀October 2017 will be automatically extended through April 2018; and
• ฀November 2017 will be automatically extended through May 2018.
• Households will receive a notice when it is time to renew their benefits. Clients are

encouraged to use YourTexasBenefits.com or the Your Texas Benefits mobile app to manage their benefits case and to update HHS of any address changes. When updating their address members should update mailing address, but keep permanent address on file. Clients are also encouraged to sign up for electronic notices to stay informed about their cases.

How to contact CCHP

682-885-2247 or 1-800-964-2247

• Christine Owens 682-885-7049
• Sylvia Carrizales 682-885-7048
• Elvia Provencio 682-885-7189
• Eric Gustafson 682-303-7036
• Mona Ogas 682-303-8804