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OFFICE VISIT

Your source for important provider news and updates.

March 2022 Issue

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March 2022 Issue

IN THIS ISSUE

Provider Portal Updates

Here are some helpful tips:
Adding documentation to a preauthorization request: Need to provide documentation in support of an initial request for services, a concurrent review update, or a discharge plan? Simply look up the original preauthorization request, use the “Add Supporting Documentation” button, and add up to five attachments. For step-by-step instructions, see our Search and View Preauthorizations Quick Reference Guides for EmblemHealth and ConnectiCare.

PCP Member Panel Reports: This useful resource is relatively new for our ConnectiCare primary care providers (PCPs). To effectively use this report, we recommend that you check in regularly to see:

A complete list of the patients in your panel.
A list of newly assigned patients who are ready to be invited for a new patient visit.
For EmblemHealth, which New York Medicaid members are homeless, restricted recipients, and/or are HARP eligible to determine if special rules apply.
Members with coverage up for recertification. Remind your patients to submit their renewal documents on time.

You can see the report on-screen or download it to Excel. Once in Excel, you can add your own columns to track patient visits, preventive care, immunizations, and more. Review the following to see how to view the PCP Member Panel Report:

Read this guide (EmblemHealth/ConnectiCare), and/or
Watch this short video (EmblemHealth/ConnectiCare).

City of New York Medicare Advantage Option Postponed

We previously announced the City of New York awarded their group retiree business to an alliance between Empire BlueCross BlueShield and EmblemHealth. Now we want to inform you the NYC Medicare Advantage Plus plan is not being implemented on April 1, 2022.

All retirees will remain on their current health plans until further notice.

As more information becomes available, we'll continue to provide you with updates.

Note: The NYC Office of Labor Relations has provided member updates here should your CNY retiree patients have more questions.

Provider Satisfaction Survey

During the week of March 21, we will send you an email with a link to our 2022 provider survey. We want your feedback on how we can improve your experience as a provider working with EmblemHealth and ConnectiCare. Participation is voluntary and will only take a few minutes of your time but will go a long way toward helping us serve your practice better. Look for the survey coming soon.

Keep Children Healthy and Spread Awareness About Immunizations

Along with the Centers for Disease Control and Prevention (CDC) and Action for Healthy Kids, we’re spreading awareness about Every Kid Healthy Week (April 25-29), World Immunization Week (April 24-30), and National Infant Immunization Week (April 26-May 3).

A few strategies to engage with parents and improve immunization rates include:

Talking to parents to schedule their child’s vaccination appointments.
Educating your team about scheduling visits within the guideline time frames.
Administering vaccinations during already scheduled appointments.
Reviewing immunization records at each appointment and encouraging the opportunity to catch up on missing immunizations.
Advising parents on the importance of completing each vaccine series.
Providing handouts on the diseases that the vaccines prevent.

Your influence is key in the development, health, and well-being of children. Follow the hyperlinks above for more information and resources on childhood immunizations and health activities.

Resources Available for STI Awareness Month in April

The Health Is Power toolkit is designed to educate young Black men (ages 18-30) through a multi-phased campaign. The Yes Means Test campaign aims to reduce the stigma around sexually transmitted disease or infection (STD or STI) tests, with a specific focus on promoting recommended chlamydia screening for women under 25. Campaign materials can be found on the website of the National Chlamydia Coalition, that also offers resources on improving chlamydia screening rates through an opt-out strategy.

Helpful tips to close gaps in care:

Perform chlamydia screening yearly on every 16- to 24-year-old sexually active female.
Offer to do the screening as a urine test.
Place chlamydia swab next to Pap test or pregnancy detection materials.

Medicare Updates

Do Not Bill Members with Full Medicaid or QMB

If Medicare-Medicaid dual eligible individuals have their Part A and Part B cost-share fully covered by their Medicaid plan or are Qualified Medicare Beneficiaries (QMB), they are not responsible for their Medicare Advantage cost-share for covered services. Do not balance bill these members for any other costs. Any Medicare and Medicaid payments for services given to these members must be accepted as payment in full.

For EmblemHealth members, you can use ePaces to check whether the member has full or partial Medicaid benefits. For more detail, see EmblemHealth Medicare Advantage Plans.

For ConnectiCare members, you can visit CT Department of Social Services or call 800-842-8440. For more detail, see ConnectiCare Medicare Advantage Plans.

NY Medicaid, HARP, and Child Health Plus Updates

COVID-19 Vaccination Counseling for Medicaid & HARP Members Is Available

Effective Dec. 1, 2021, EmblemHealth provides reimbursement for COVID-19 vaccination counseling to unvaccinated Medicaid and Health and Recovery Plan (HARP) members to encourage the administration of the COVID-19 vaccine. For more information, visit EmblemHealth’s COVID-19 Update page.

Regulatory Changes Impacting Medicaid PCS

As of Nov. 8, 2021, several New York State Department of Health (NYDOH) regulations were amended to clarify supervision and cueing (cognitive prompts) as forms of assistance with personal care services (PCS). This change expands allowable supervision and cueing to include assistance with nutritional and environmental support functions (Level 1 services) and supersedes the NYSDOH document GIS 03 MA/003, which addresses Level 2 services.

Further information on the regulatory changes impacting Consumer Directed Personal Assistance Program (CDPAP) and PCS is available on the NYSDOH website.

Change of Address (and Contact) Notification

Providers must notify Medicaid of any change of address, telephone number, or other pertinent information within 15 days of the change. For more information on this requirement and how to submit changes, see Reminder: Keep Your Directory Data Current.

Medicaid: New York State Medicaid Update

View the latest Medicaid Updates from the New York State Department of Health.

Claims Corner (Reimbursement Policy Updates)

Correctly Billing ConnectiCare Medical vs. Behavioral Claims

ConnectiCare partners with Optum Health to provide behavioral health care to its members. We’ve learned that Optum Health has been receiving an excessive number of medical claims. Optum should NOT receive medical claims for ConnectiCare members. These claims are being denied and providers must then resubmit the claims to ConnectiCare. To avoid claim processing delays and help you get paid faster, we ask that you bill the correct company. Behavioral health (mental health and substance abuse) claims should be sent to Optum Health and medical claims should be sent to ConnectiCare.

Reimbursement Policy Updates

We are introducing a new reimbursement policy, Prolonged Services, for our Medicaid members that has been in effect for our other benefit plans. The policy applies to all EmblemHealth and ConnectiCare members.

For EmblemHealth, we have formalized and moved the information formerly in Claims Corner to a Reimbursement Policy, In-Office Laboratory Services, which has been aligned with the Medicaid Physician Fee Schedule effective July 1, 2022.

In addition, updates have been made to the following policies:

COVID-19 Vaccine and Monoclonal Antibody Infusions Policy (EmblemHealth/ConnectiCare)
Modifier Reference Policy (Commercial) (EmblemHealth/ConnectiCare)
Preventive Care Services (Medicare) (EmblemHealth/ConnectiCare)
Multiple Diagnostic Imaging Payment Reduction Policy (Commercial) (EmblemHealth/ConnectiCare)

Clinical Corner

There’s Still Time to Recommend the Flu Vaccine!

As a health care provider, you play a vital role in helping protect your patients against the flu. Your recommendation to get the flu vaccine, even now, is one of the most important factors in their decision to safeguard against this flu season. While it is March, influenza is still widespread across New York State (NYSDOH Influenza Activity page), and considered a “regional” issue in Connecticut. Asking patients if they’ve received a flu vaccine can better ensure a more accurate response to this question in the upcoming 2022 CAHPS survey. Remember to:

Use each office visit to talk with your patients about the importance of the flu vaccine.
Share these resources with your patients who want additional information, have questions, or decline the flu vaccine:
- Seasonal Influenza Vaccination Resources for Health Professionals
- Flu Shot Information for Medicare Members

Give Your Patients a Choice for Their Infusion Care

New York Cancer and Blood Specialists (NYCBS) has collaborated with EmblemHealth on a concierge program option for EmblemHealth members and physicians. Members can receive their specialty office infusion services for benign and malignant conditions in NYCBS’ quiet, comfortable, spacious suites in convenient locations throughout the five boroughs and Long Island.

There are added benefits for EmblemHealth members, such as quick scheduling, extended hours including weekends at some locations, and amenities such as blankets and iPads.

For EmblemHealth-contracted providers and their office staff, NYCBS can offer:

Direct communication with NYCBS physicians to get up-to-date information on their patients’ treatment.
Access to the NYCBS coordinator who will obtain any required preauthorizations from EmblemHealth, significantly decreasing the administrative burden on your staff.
- Coordinator: Michelle Sta. Cruz
- Phone Number: 631-574-8303
- Email Address: EmblemTreatments@nycancer.com
A more cost-effective referral option than receiving the same infusion treatment at a hospital.

Members Who Do Not Need Referrals

We would like to remind our EmblemHealth providers that members managed by SOMOS do not need referrals to access specialists. This is true whether the specialist is or is not affiliated with SOMOS. SOMOS-managed members are limited to Medicaid, HARP, Child Health Plus, and Essential Plan.

To see whether a referral is needed for an EmblemHealth member, see our updated video and materials in our "Do I need a referral?” - A Quick Guide and our updated quick reference 2022 Benefit Plans That Do Not Require A Referral.

Both EmblemHealth and ConnectiCare Medicare Advantage Members continue to have their referrals waived during the COVID-19 State of Emergency.

Our Care Management Programs Help Our Providers, Too!

Does any of this sound familiar?

A patient needs help understanding a new diagnosis.
A patient needs support learning self-management and establishing new habits.
Your patient faces transportation barriers and needs help getting to their appointments.
A Medicare patient needs a well visit and/or preventive screenings but your office has challenges engaging them.

If so, we can help! We have a team of social workers, nurses, pharmacists, who can:

Partner with you and your office to help educate members about chronic diseases, care plans, and medication adherence.
Help your office with coordination of care, conduct specialist searches, schedule appointments, and help members with transportation.*
We can connect your EmblemHealth patients to resources who can help with the social determinants of health.

See our full suite of Care Management Programs designed to help your patients with chronic or complex conditions. Each flyer describes member eligibility, the enrollment process, benefits to the member, how you can partner with us, and who you can contact to enroll a member. Review the flyers, identify qualifying members, and contact us so we can start helping you.

For general information, contact 800-447-0768.

*Subject to the member’s benefits.

Medical Policies

New Medical Policy

There is a new Penile Implants medical policy for EmblemHealth and ConnectiCare.

Training Opportunities

Provider Portal Videos and Guides

If you need help navigating our provider portals, see our videos, quick guides, and Frequently Asked Questions pages:

EmblemHealth Videos and Guides
EmblemHealth FAQs
ConnectiCare Videos and Guides
ConnectiCare FAQs

If you still have questions or need additional support, you may contact Provider Customer Service:

EmblemHealth: 866-447-9717

ConnectiCare: Commercial: 860-674-5850, Medicare: 877-224-8230

Free Pulse8 Webinars: Patient Management & ICD-10 Coding for the 2022 EmblemHealth Risk Adjustment Program

EmblemHealth continues to partner with Pulse8™ to promote risk adjustment and gap-closure education for primary care providers (PCPs) caring for EmblemHealth members enrolled in these products:

New York State of Health (NYSOH) Marketplace
Medicare HMO
Medicaid

Pulse8 offers free monthly webinars to help educate providers on best practices regarding the risk adjustment process, including accurate medical record documentation and claims coding to capture the complete health status of each patient. We encourage PCPs and/or their support staff to register for Pulse8’s monthly webinars. Go to Pulse8’s Public Event List and search by webinar date or title.

These Pulse8 webinars are generally held on Tuesdays and Thursdays at 8:30 a.m. and 12:30 p.m. Here are the March and April topics:

Mar. 29/31– Consider the Landscape: Social Determinants of Health that May Impact your Patients
Apr. 26/28 – Breaking Down the Specifics of Coding for Orthopedic Conditions

If you are interested in learning more about how you can access Pulse8’s provider resources and webinars, please contact Pulse8’s Customer Support team Monday through Friday, 8 a.m. to 8 p.m. at 844-8PULSE8 (844-878-5738) or mail to ProviderEngagement@Pulse8.com.

Valuable Training Available

We recommend that you take advantage of the training opportunities offered by CMS’s Medicare Learning Network and eMedNY.

In Every Issue

Keep Your Directory and Other Information Current

Let Us Know When Directory Information Changes (Provider Data Validation)

The Centers for Medicare & Medicaid Services (CMS) requires EmblemHealth and ConnectiCare to perform provider data validations to ensure that our Provider Directories maintain current and accurate information. Beginning March 2022, Atlas Systems, EmblemHealth’s partner and third-party vendor, will also manage the process for ConnectiCare by:

Contacting directory-listed providers semi-annually by fax, email, or telephone.
Conducting a review of their directory-listing data.
Obtaining attestation to the accuracy of data and submitting changes to correct inaccuracies.

We ask for your cooperation when someone from Atlas contacts you. As a reminder, you can update your directory information any time on our secure provider portals EmblemHealth*/ConnectiCare. For ConnectiCare, you can use the Provider Demographic Change Form to submit timely notification of changes. If a provider in your practice is leaving, inform us as soon as possible. See more on how to submit changes for EmblemHealth and ConnectiCare.

Also, remember toreview your Council for Affordable Quality Healthcare (CAQH)application every 120 days for continued accuracy and ensure you have authorizedEmblemHealthas an eligible plan to access your CAQH information.

*If you participate with us under a delegated credentialing agreement for EmblemHealth, have your administrator submit these changes.

Consult EmblemHealth’s Online Provider Manual for Important Information

The EmblemHealth Provider Manual is a valuable online resource and an extension of your Provider Agreement. It applies to all EmblemHealth plans and includes details about your administrative responsibilities and contractual and regulatory obligations. You can also find information about best practices for interacting with our plans and how to help our members navigate their health care. The manual is updated regularly, so be sure to download a current PDF when looking for information. You can find the EmblemHealth Provider Manual on the top right side of our website.

EmblemHealth Neighborhood Care & ConnectiCare Centers

Our EmblemHealth Neighborhood Care and ConnectiCare Centers provide one-on-one customer support to help members understand their health plan, get access to community resources, and learn about free health and wellness events we offer to help the entire community learn healthy behaviors. Virtual and on-demand events are available to you and all your patients. View our locations and upcoming events for EmblemHealth Neighborhood Care and ConnectiCare Centers.

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