May Provider Digest

AmeriHealth Caritas North Carolina (ACNC) is shining a light on mental health this month with content and updates focused on behavioral health. You will find the following topics in this May digest:

• Mental Health Provider Resources
• Remittance Advice Payment Recovery Details Now Available!
• Virtual Self-Care and Burnout Prevention Workshop for Providers

QUALITY CORNER

• Depression Screening and Follow-Up for Adolescents and Adults (CDF)
• Upcoming ACNC Baby Shower Events
• Screening for Mental Health or Substance Use Disorder Service Available

PHARMACY

• Behavioral Health Medications Reminder

MEMBER BENEFIT SPOTLIGHT

• Behavioral Health Benefits Webpage

REMINDERS

• Personal Care Service (PCS) Providers: How to Avoid Claim Denials for Overnight Shifts
• No Outpatient Behavioral Health Prior Authorizations Limitations
• Tobacco-Related Policy Requirements Go into Effect on July 1, 2024
• Substance Use Disorder Services Are Part of the Standard Plan Service Array
• Post-Appointment Survey Provider Scorecard Available in NaviNet

TRAININGS AND FORUMS

• Support in Navigating Electronic Visit Verification
• Intensive Behavioral Health Approaches to Tobacco Treatment (9.5 CE hours)
• Foundations of Client-Centered Tobacco Treatment: A Training for Maternal Health Providers (1.25 CE hours)
• Registering for and Using NaviNet, Our Provider Portal
• Let’s Work Together: Provider Orientation
• 2024 Clinical Leadership Forums

Mental Health Provider Resources

ACNC has added behavioral health resources and information to our website to support providers in meeting the needs of our members.

1. New! A Behavioral Health Care page has been added that includes information and links to resources to support providers and administration teams. A new Behavioral Health Services Crisis Guide is available to download from listed resources. All prepaid health plans contributed to the creation of this guide through the Administrative Simplification workgroup.

2. The Service-Specific Guidance section of our Prior Authorization webpage now includes information about behavioral health authorizations.

Remittance Advice Payment Recovery Details Now Available!

Due to the Change Healthcare security incident, remittance advices generated after February 21, 2024, have not included certain claim recovery information. AmeriHealth Caritas North Carolina (ACNC) is pleased to inform you that a solution has been developed in collaboration with Change Healthcare to provide the detailed payment recovery information missing from the provider remittance advice. This solution will provide payment recovery details on the remittance advice or 835 you receive with your payments for claims processed on and after May 6, 2024.

For claims processed February 21, 2024, through May 5, 2024, ACNC has generated a comprehensive claims recovery report available in the NaviNet provider portal. The claims recovery report provides payment recovery details by your provider internal account number, claim number, provider tax ID, payee/group ID, and NPI.

To access the claims recovery report:

• Log in to the NaviNet provider portal.
• Select applicable health plan.
• Go to Report Inquiry, under Workflows for this Plan.
• Click on Administrative Reports > Claim Recovery Report.

If you do not have access to the NaviNet provider portal, please visit: https://register.navinet.net/ to sign up.

Questions?

For questions, please contact Provider Services at 1-888-738-0004 or your Provider Network Management Account Executive.

We appreciate your partnership and patience as we work to re-establish services and will continue to share additional information as it becomes available.

Virtual Self-Care and Burnout Prevention Workshop for Providers

In recognition of Mental Health Awareness month¹, our Behavioral Health Medical Director is presenting an important workshop just for providers and office staff. If you believe that life in medicine seems to have gotten harder, it’s not your imagination. Chronic imbalance between work pressures and our ability to manage them can lead to burnout. Burnout is a serious occupational phenomenon that has dramatically increased in our world². However, fortunately, burnout can be mitigated with intentional strategies. This no-cost, virtual workshop will help you identify the causes of burnout, recognize the risks, and discuss practical individual and organizational strategies for prevention and management.

Presenter: Dr. Nerissa Price, ACNC Behavioral Health Medical Director
Date: May 22, 2024
Time: Noon – 1:00 p.m. ET

Register for workshop

Depression Screening and Follow-Up for Adolescents and Adults (CDF)

Measure Steward: Centers for Medicare & Medicaid Services (CMS)

The Depression Screening and Follow-Up for Adolescents and Adults (CDF) measure is used with patients 12 years of age and older who have never been diagnosed with depression or bipolar disorder. This measure evaluates the percentage of patients who were screened for depression on the date of the encounter (or up to 14 days prior) using an age-appropriate standardized depression screening tool. If the patient screens positive, a follow-up plan is documented on the date of or up to two days after the encounter.¹

Examples of adult and adolescent screening tools² can also be found on page 32 of Behavioral Health Toolkit (PDF).

CDF Coding/Documentation³

Patient outcomes improve when there is care coordination and collaboration between the primary care provider, case manager, and mental health specialist to screen for depression, monitor symptoms, provide treatment, and refer to specialty care as needed. Some additional best practices⁴ are:

• Complete screening annually.
  
  
• If the screening is positive, make sure there is documented evidence of follow-up care such as a referral to a provider for additional evaluation and assessment or pharmacological interventions.
  
  
• Use “collaborative care interventions involving multifaceted care team approaches” (e.g. primary care physician, case manager with mental health background, psychiatrist, etc.).⁴
  
  
• Make sure there is documentation of a referral or the need for further evaluation on the encounter date.

If your practice is interested in partnering with ACNC on screening events, please contact ACNC quality management by email at ACNCQualityManagement@amerihealthcaritas.com.

Upcoming ACNC Baby Shower Events

Behavioral Health Medications Reminder

Most behavioral health medications do not require prior authorization in NC. We recommend providers check the NC Medicaid Preferred Drug List (PDL) before prescribing medications.

Personal Care Service (PCS) Providers: How to Avoid Claim Denials for Overnight Shifts

In accordance with the North Carolina Department of Health and Human Services (NCDHHS) EVV Guidance Documentation, overnight shifts must be split at the time of scheduling and confirming a member’s visit. Please refer to page 9, “Span of Dates” for more information regarding this requirement.

When scheduling a shift that spans overnight, providers should create two separate visits for the member.

See example below:

• Visit starts on 11/1 at 6 p.m. EST and ends at 11/2 at 3 a.m. EST
• Visits should be scheduled as 6 p.m.  – 11:59 p.m. EST on 11/1 and 12:01 a.m. – 3 a.m. EST on 11/2

Incorrect billing of shifts could cause an encounter and claim denial and will require the visits to be unbilled, rescheduled, and rebilled.

For any questions surrounding this policy, please contact your Provider Network Account Executive. For questions related to scheduling and/or correcting visits, please submit a request via HHAeXchange Client Support [hhaxsupport.atlassian.net].

No Outpatient Behavioral Health Prior Authorizations Limitations

In 2022, ACNC removed the prior authorization limitations for the outpatient behavioral health psychotherapy codes listed below. ACNC continues to monitor over- or underutilization of behavioral health psychotherapy services for our members.

Tobacco-Related Policy Requirements Go into Effect on July 1, 2024

Tobacco-related policy requirements will be effective July 1, 2024, for NC Medicaid Managed Care Standard Plans, Behavioral Health and Intellectual/Developmental Disabilities (I/DD) Tailored Plans, and Local Management Entity/Managed Care Organizations (LME/MCOs) contracted medical, behavioral health, I/DD and traumatic brain injury (TBI) service providers. Two new items have been added to the policy: a provider monitoring process and additional technical assistance through Breathe Easy, North Carolina.

Find additional information in the March 21, 2024 North Carolina Department of Health and Human Services (NCDHHS) Bulletin.

Substance Use Disorder Services Are Part of the Standard Plan Service Array

To further improve rapid access and reduce barriers to substance use disorder (SUD) services for members enrolled in a Standard Plan, NC Medicaid added the Substance Abuse Intensive Outpatient Program (SAIOP), Substance Abuse Comprehensive Outpatient Treatment (SACOT) and social setting detox to the NC Medicaid Standard Plan service array, effective October 3, 2023. Read more by visiting this North Carolina Department of Health and Human Services (NCDHHS) blog post.

Post-Appointment Survey Provider Scorecard Available in NaviNet

ACNC works in collaboration with our providers to help ensure that our members receive comprehensive, quality, and culturally responsive care. One of the tools we use to evaluate the member care experience is our Post-Appointment Member Satisfaction Survey.

We are pleased to announce that providers will now be able to view their member satisfaction ratings through a new Post-Appointment Survey Provider Scorecard, available in the NaviNet provider portal. To access this new feature, login to NaviNet, and navigate to Clinical Reports Inquiry > Report Selection > Post-Appointment Survey Provider Scorecard.

Support in Navigating Electronic Visit Verification

To support home health providers in the transition to the Electronic Visit Verification (EVV) process, ACNC is offering a new weekly series titled Navigating Electronic Visit Verification, Crosswalks and More. During these sessions, offered each Wednesday at 5 p.m., ACNC will share a crosswalk developed to simplify the verification and billing process, including the necessary steps to establish a connection with the vendor, HHAExChange, and cover how to bill claims. Our team also will be prepared to address specific concerns and obstacles facing providers in this transition.

Register for a weekly session date through the end of May. Sign up at least a week in advance AND complete the survey, answering all the necessary questions so we can better support you.

Register for Navigating Electronic Visit Verification

Intensive Behavioral Health Approaches to Tobacco Treatment (9.5 CE hours)

This training will assist clinicians with acquiring improved skills in behavioral interventions for tobacco use treatment. Through experiential training methods, participants will be able to demonstrate how to use a variety of behavioral interventions, from motivational interviewing to cognitive behavior therapy to mindfulness practice. The training will also practice how understanding cultural differences can improve behavioral counseling outcomes.

This training will be held May 21, 2024, 11:00 am-5:00 pm ET.

Register to learn more

(Reprinted with permission from NCDHHS Tobacco Prevention and Control Branch.)

Foundations of Client-Centered Tobacco Treatment: A Training for Maternal Health Providers (1.25 CE hours)

This training is free and open to all health professionals, prevention professionals, and community members who are interested in learning more about the burden of tobacco and strategies for intervention and treatment with pregnant and post-partum individuals.

In this training, NCDHHS will share an overview of smoking & vaping prevalence in the pregnant population. Presenters will identify health implications of smoking & vaping during pregnancy and postpartum, as well as the health effects of second & thirdhand smoke. Participants will learn effective treatment interventions, including screening methods and various counseling approaches (motivational interviewing, cognitive behavioral therapy), and get additional resources to utilize while helping their patients quit smoking and vaping, during and after pregnancy. This training will be held May 29, 2024, 12:00 pm-1:30 pm ET.

Register to learn more.

(Reprinted with permission from NCDHHS Tobacco Prevention and Control Branch.)

Registering for and Using NaviNet, Our Provider Portal

Are you a provider or clearinghouse looking to save time and move away from paper prior authorizations? If you’ve signed up for NaviNet, the provider portal, are you using all its functionality? Maybe you have multiple claims needing attention and didn’t realize you can save up to 16 minutes per submission using NaviNet instead of fax.

Sign up for our newest live webinar: Registering for and Using NaviNet. This training helps providers understand how efficient the provider portal, NaviNet, is for member eligibility and benefits, locating care gap reports, filing a grievance or appeal, inquiring about claims status, and handling our plan’s prior authorizations — all online. This training is being offered the fourth Tuesday of each month through November. Register below to learn more.

Register for Using NaviNet

Let’s Work Together: Provider Orientation

Our provider orientation sessions are presented on the 2nd Tuesday of each month from noon to 1 p.m. ET. Our Account Executives host each Let’s Work Together session, sharing tools and information to support provider success as part of our network. Find the registration link on our Provider Training page.

2024 Clinical Leadership Forums

ACNC is pleased to provide opportunities for providers to engage with our team to discuss quality improvement activities and associated challenges related to quality and population health outcomes. Each lunchtime session includes a Provider Spotlight to highlight best practices, as well as open discussion with participants.

Register for 2024 Forums