Notice Date: November 4, 2024 To: Michigan Medicare-Medicaid Providers From: HAP CareSource MI Health Link (Medicare-Medicaid Plan) Subject: Reminder Prior Authorization Requests and Appeal Process for Part B (Medical Drugs) Effective Date: July 1, 2024 Summary Remember that effective July 1, 2024, there was a change of process when initiating prior authorization (PA) requests for Part B (medical drugs) for HAP CareSource MI Health Link members. Providers must now submit initial PA requests through the ESI Evicore portal or via fax to 1-833-812-0187. Appeals for Part B (medical drugs) must be submitted to HAP CareSource MI Health Link. Impact Medicare providers no longer submit PA requests for Part B (medical drugs) to HAP CareSource MI Health Link . Since July 1, 2024, providers now submit PA requests for Part B (medical drugs) through the ESI Evicore portal or via fax to 1-833-812-0187. A step-by-step guide to submit requests through the ESI Evicore portal is available. Send any appeals related to Part B (medical drug) denials to HAP CareSource MI Health Link via: The provider portal Fax at 937-396-3492 (standard appeals) or 937-396-3507 (expedited appeals) Phone at 1-833-230-2057 Email at MI_MMPHAPG&A@CareSource.comAll service authorization requests for medical services and durable medical equipment (DME) products or devices will continue to be submitted to HAP CareSource MI Health Link. Questions? Please contact HAP CareSource MI Health Link Provider Services at 1-833-230-2159, available Monday through Friday from 8 a.m. to 6 p.m. Eastern Time (ET) if you have questions. H9712_MI-MMP-P-3322997
Notice Date: November 4, 2024To: CareSource PASSE Providers From: CareSource PASSE Subject: Modifiers JZ and JW Summary CareSource PASSE enforces the Single Dose Vial policies approved on July 1, 2023, which define the appropriate billing and coding of Single Dose Vial drug claims. The policy can be reached using the following link: https://www.caresource.com/documents/passe-ar-policy-reimburse-py-pharm-0091-20230701.pdf Impact You may receive a claim line denial for a drug with the remittance advice remark code (RARC) stating Missing Procedure Modifier. Single Dose Vial drugs need to be coded with appropriate modifiers as follows: If you fully administer the contents of the entire vial for the member, you must enter a JZ modifier on the claim line. If you partially administer the contents of the vial for a member, the drug claim must be billed with two separate lines. The first claim line should specify the amount administered to the member and does not require a modifier. The second line would specify the amount discarded, which requires a JW modifier. If responding to a claim denial, simply submit a corrected claim using the instructions above. No need to dispute or appeal for the corrected claim to be reimbursed. Importance Process is necessary to ensure that most efficient vial size has been used for member care and to accurately reflect waste portion of a Single Dose Vial, thus avoiding claims overpayment. Questions? For additional questions, please contact Provider Services at 1-833-230-2100, Monday through Friday, 8 a.m. to 5 p.m. Central Time (CT) . AR-PAS-P- 3387051
WINTER 2024MEMBER Source A Newsletter for HAP CareSource Members We Make it Easy to Find a Doctor Do you need to nd a doctor, hospital, pharmacy or other health care provider? You can use our online tool at any time to search for a provider in our network. Our tool is fast, convenient and updated daily. Go to FindADoctor.CareSource.com to get started. Features Search by name, location, specialty and more. Filter your results to nd what you need quickly. Enable Location Services to get suggested options based on where you are. Sort your results by name, distance or relevancy. If you need help, use the online tutorial. It will show you how simple it is to nd what you need. BIG NEWS: We are Expanding! We are excited to offer our plans to more members than ever as of October 1, 2024! Through the Michigan Department of Health and Human Services (MDHHS) MIHealthyLife initiative, HAP CareSource will proudly serve members in the following counties: Clinton, Eaton, Genesee, Huron, Ingham, Hillsdale, Jackson, Lapeer, Lenawee, Livingston, Macomb, Monroe, Oakland, Sanilac, Shiawassee, St. Clair, Tuscola, Washtenaw, Wayne *New counties are shown in bold. As a HAP CareSource member, your coverage goes beyond basic care and includes: No copays for health care visits Vision and dental care A large network of providers Free rides to health care visits Reward programs for making healthy choices Free help nding a job or nishing your degree And so much more! You can learn more about your benets at HAPCareSource.com or by calling Member Services. We are more than just quality health insurance, we are Medicaid Made for Michigan. MEMBER Source | WINTER 2024 2 Life HACKS: Cold & Flu Season No one plans to get sick. When it happens, it can alter your daily life for up to a week or more. Listen to your doctors treatment plan to help you get better. Here are some home remedies to help you feel better. Stay hydrated. Keeping your body hydrated can help to ght off a cold or u virus. Drink plenty of water. Electrolyte drinks, like Gatorade or Pedialyte, can also help your body absorb the water. Rest and drink warm tea. Give your body time to heal. This helps your body focus on getting better. Warm herbal tea or lemon water can help soothe a sore throat and unblock sinuses. You can also gargle with warm salt water a few times each day. Stay well this winter. Stay well this winter. Whats the best way to protect yourself? Get a u shot! Learn more at CareSource.com/FluShot . If you have questions about your health, the 24-Hour Nurse Advice Line provides around-the-clock access to a caring and experienced staff of registered nurses. Call the 24-Hour Nurse Advice Line at 1-833-687-7370 (833-NURSE-70) 24 hours a day, 7 days a week, 365 days a year. Do you have questions about your medications? Talk to your doctor or pharmacist to make sure you are taking them correctly. These are some questions you can ask to learn more about your medicines. How long will it take to work? Can I take this with other medications? How long do I take this medication? Do I need to eat with this medication? Is there a certain amount of time I should wait between doses? Source: https://medlineplus.gov/ency/ patientinstructions/000535.htm Talk to Your Doctor or Pharmacist About Your Medications 3 For more information, visit HAPCareSource.com 4Protect Your Personal Information Health insurance fraud is a serious issue. Stay safe. Protect your personal information. 1 Be careful when giving out your member ID card number or social security number. 2 Do not let another person use your member ID card. This is illegal. It puts you at risk for identity theft. 3 Report any suspicion of fraud. If you believe someone has used your card to get services, tell us as soon as you can. Call 1-844-415-1272 (TTY: 711) to report fraud. You do not have to give us your name when you write or call. Your report will be kept as condential as allowed by law. Care Management How Can They Help? We want to make sure youre getting the care you need. With our Care Management program, you can get help coordinating your health and non-health care needs. This program is at no cost to you. Our Care Management team has nurses, social workers and community health workers who can work with you one-on one. They are called Care Managers. We offer the program for children and adults. Our Care Managers can work with you, your providers, family and/or caregivers to set up your care. We will work with you to meet your health and wellness goals. How do I get a Care Manager? You may hear from a Care Manager by phone if: Your doctor asks one to contact you. You ask for a phone call. Our staff thinks their services would be helpful to you or your family. You can also call us to learn more about Care Management or join the program. Call the team directly at 1-844-217-1357 from 8 a.m. to 5 p.m., Monday through Friday. MEMBER S | WINTER 2024 988 Suicide and Crisis Lifeline Are you in crisis? If so, call or text 988. You can also open a chat on 988lifeline.org . 988 will reach the Suicide Prevention Hotline. This hotline can be used 24/7 by anyone struggling with their mental health or having thoughts of suicide. Here are some tips for when you call 988: Press 1 if you are a veteran. Press 2 if you need interpretation services. Dial 711 if you are hard of hearing for TTY. Then, dial 1-800-273-8255 or your preferred service. Talk and text is available in English and Spanish. Source: 988 Suicide & Crisis Lifeline. https://988lifeline.org/current-events/the-lifeline-and-988 . When to Get Your Hearing Checked Do you have trouble hearing? Do you or your loved ones notice youre not hearing as well as you used to? It is important to get your hearing checked often. It can be hard to tell if your hearing is getting worse. Here are some early signs of hearing loss to look for:Adults: Hearing worse in one ear Ringing in your ear Turning volume up louder Pressure in the ear Children: Not turning towards sound Delayed speech Turning volume up louder Confused in conversations or when given directions Get your hearing checked! We offer free and important screenings as a part of your benets. Hearing screenings are part of your annual wellness visit. For more information, visit HAPCareSource.com 5 Go Green! Did you know we can send you email or text instead of paper mail? We will send you a text or email when documents or invoices are ready for you in your My CareSource account. Use these steps to update your preferences and go green! 1. Log in to your MyCareSource.com account. If you dont have an account, click Sign Up and follow the prompts. You will need your member ID card. 2. Click Preferences on the top navigation bar. A screen to edit your contact preferences will appear. 3. Make sure your email and phone number are correct. If they are not, change them. Check the boxes for Send me email and/orSend me text. You can pick the types of messages you would like to get electronically. Click the Update button and youre all set! 6 MEMBER S | WINTER 2024 Get Ahead of MigrainesA big step in coping with migraines is to nd out what may be causing them. Causes are not the same for each person. Once you nd them, you may be able to stop migraines before they start. Keep track of your patterns and habits. Some helpful things to track are what you eat or drink and when; when and how long you sleep; the weather; and for those who menstruate, when you have your period. Track when your migraines or headaches start, how long they last and other symptoms you have. Note what medicines and other things help ease the pain. Take these notes to your provider. Together, you can nd what may cause your migraines. This information can also help know the best ways to help ease the symptoms once they start. Sources: Migraine Trust, https://migrainetrust.org/live-with-migraine/self-management/common-triggers/ National Center for Biotechnology Information, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7572189/ Its Important to Drink Water Even in the Winter Our bodies are made up of 60-70% water, so it is important to keep yourself hydrated. As it gets colder, this may seem hard. The dry air from indoor heating can make you dehydrated and you may not even know. Staying hydrated helps keep our immune system strong, which is important during cold and u season. There are simple ways to make sure you are getting enough water during the winter. Carry a water bottle with you. This can help encourage you to drink more water. Add some avor by putting a slice of lemon, lime or other fruit to your water. Drink warm uids. Hot herbal teas, warm water or warm broths are good choices. Eat hydrating foods like oranges, celery or yogurt. Warm soups can also provide the water you need. Plus, its a great meal! 7 For more information, visit HAPCareSource.com Breathe Easier Indoors When we think about air pollution, we often think of it outdoors. But air pollution levels can be just as high indoors! There are several common indoor air pollutants. Radon is a naturally occurring gas that forms in soil. You cannot see or smell radon. Combustion pollutants are gases or particles that come from burning materials. Examples are space heaters, gas stoves and replaces.Volatile Organic Compounds (VOCs)are products like paint and common cleaners that emit chemical gases.There are steps you can take to improve your indoor air quality.3 4 2 1 1 When the weather is nice, open windows to let the breeze through. Check the outdoor air quality where you live at www.AirNow.gov rst. 2 Limit your use of chemical cleaners or products. Or switch to less toxic products that have the Safer Choice label.3 Vent your appliances like heaters and dryers outside. You can also install a carbon monoxide detector in your home. 4 Get your home tested for radon. Most states offer free or low-cost test kits. Find out how to get your kit at www.epa.gov/iaq and choose radon. 8 MEMBER S 4 How to Support a Loved One Through a Difcult Diagnosis It can be hard to get a life changing diagnosis or nd out about a terminal illness. The news can feel overwhelming and difcult. There are no one-size-ts-all solutions, but if you have a loved one facing a difcult diagnosis, there are ways to support them. Many times, we want to offer advice. Try not to say things that are out of your control, even if you think it will make them feel better. Saying that everything will be ne may make your loved one feel like they cannot share when things are not going well. Say, I am here to support you instead. Find out what they need from you. Generally saying, let me know how I can help can be overwhelming. Offer specic kinds of help. Bring them a home cooked meal or do household chores. If you offer help and your loved one does not want it, do not force it. Respect that they may need time and space. Still check in on them because they may want your help eventually. Source: Mayo Clinic, mayoclinichealthsystem.orgChildhood Immunization Schedule Vaccines, or shots, help protect kids from harmful diseases. To get the most benet and protection, make sure your child gets the right shots at the right time. The Centers for Disease Control (CDC) has a list of vaccines children should get and when they should get them. This schedule is based on when vaccines work best with kids immune systems and when kids need the protection the most. Many of the shots happen while they are infants. Often booster shots are needed months or years later. Some shots should be given each year, such as u and COVID-19. If your child misses a vaccine or a booster, they wont need to start over. If you have questions, talk to your childs primary care provider (PCP). Sources: Centers for Disease Control and Prevention, www.cdc.gov/vaccines/ schedules/easy-to-read/child-easyread.html , Centers for Disease Control and Prevention, www.cdc.gov/vaccines/schedules/easy-to-read/adolescent-easyread.html , Healthy Children, www.healthychildren.org/English/safety-prevention/immunizations/ Pages/Recommended-Immunization-Schedules.aspx 9 For more information, visit HAPCareSource.com Managing Food Allergies During the Holiday Season The holidays are a time to celebrate and often involve eating together. This can be challenging for those with food allergies. The more you know about food allergies, the better prepared you can be when planning meals. There are nine foods listed as major food allergens.These include:Milk Eggs Fish Shellsh Tree Nuts Peanuts Wheat Soybeans Sesame While some food allergies are mild, some can be severe or even life threatening. Talk to the people you are spending time with this holiday season. Tell the host if you have a food allergy. Ask questions. Talk through the menu. If you are someone with a child who has a food allergy, talk with them before the celebration. Having a plan can eliminate some of the worry. Consider writing labels for each dish. You can also keep dishes with food allergens separate from the rest of the food. Source: Food and Drug Administration, www.fda.gov/food/buy-store-serve-safe-food/food-allergies-what-you-need-know 10 MEMBER S | WINTER 2024 11 Learn More About Breastfeeding Choosing to breastfeed, formula feed or a combination of both is a hard decision for many new parents. Breastfeeding has benets for moms and babies. For moms, it can reduce the risk for diabetes and some cancers. For babies, it can give them more protection from illnesses. It can also decrease the chance of sudden infant death syndrome (SIDS). Pumping milk to bottle feed later gives your baby the same benets. If you are breastfeeding, make sure you are storing any extra milk safely. Here are some tips: Use freezer milk bags that are designed for storing human milk. Other bags may leak or make the milk unsafe for your baby. HAP CareSource covers 100 bags per month.* Put the date on your milk before storing it. Always use the oldest milk rst. Limit waste by storing milk in 24-ounce (60-120 ml) amounts. Breastfeeding may not be possible for all, or it may not work in your situation. This is okay! Know that formula is a healthy and safe option for babies. Source: La Leche League International. llli.org/breastfeeding-info/storing-human-milk . For more information, visit HAPCareSource.com Talk to Your Teen About Vaping E-cigarettes, or vapes, are the most used tobacco product among United States teens. Most vapes contain addictive substances. Vaping can cause lung damage and impact brain development. Often, teens vape because of peer pressure from friends or social media. A few signs of vaping include mood changes, faint fruity smells or increased thirst. Its important to talk to your teen about vaping. Start by putting yourself in their shoes. Remember what it was like to be a teen. Find a safe, calm place to talk. Express empathy when talking to them. Try not to yell or pass judgement. It is key to be someone to count on and trust. A way to help your teen avoid or stop vaping is to have them focus on something else. Encourage them to join a sport or after school club. They could try exercising, journaling, meditation, listening to music or playing games. Supporting your teen is the best way to help them. Learn more at Teen.SmokeFree.gov Sources: Centers for Disease Control and Prevention, www.cdc.gov/tobacco/e-cigarettes/index.html , American Lung Association, www.lung.org/quit-smoking/helping-teens-quit/talk-about-vaping 12 MEMBER S | WINTER 2024 Your Feedback Is Important to Us!You may receive surveys from us asking about your experiences. These may come by phone, email, text or mail. We want you to be honest in your responses. It will never affect your HAP CareSource coverage. If you receive a survey, please take it! We need your feedback to ensure you are getting the care and support you deserve. If youve had a good experience with us or the providers in our network, you can give scores such as 9 or 10, Excellent or Very Good. You can also tell us how we can better serve you! Call Member Services if there is anything you need help with now. Your voice matters. Thank you for being the best part of HAP CareSource!! Questions About Your Prescriptions? Find out if a drug is covered or how much it will cost at HAPCareSource.com . We have a searchable drug list. Go to Find My Prescriptions under Members then Tools & Resources. It is where the most current drug list can be found. You can also call Member Services. For more information, visit HAPCareSource.com 13 English: We have free interpreter services to answer any questions you may have about our health or drug plan. To get an interpreter, just call us at 1-833-230-2053. Someone who speaks English/Language can help you. This is a free service. Spanish: Tenemos servicios de intrprete sin costo alguno para responder cualquier pregunta que pueda tener sobre nuestro plan de salud o medicamentos. Para hablar con un intrprete, por favor llame al 1-833-230-2053. Alguien que hable espaol le podr ayudar. Este es un servicio gratuito. Chinese Mandarin: 1-833-230-2053Chinese Cantonese: 1-833-230-2053Tagalog: Mayroon kaming libreng serbisyo sa pagsasaling wika upang masagot ang anumang mga katanungan ninyo hinggil sa aming planong pangkalusugan o panggamot. Upang makakuha ng tagasaling-wika, tawagan lamang kami sa 1-833-230-2053. Maaari kayong tulungan ng isang nakakapagsalita ng Tagalog. Ito ay libreng serbisyo. French: Nous proposons des services gratuits dinterprtation pour rpondre toutes vos questions relatives notre rgime de sant ou dassurance mdicaments. Pour accder au service dinterprtation,il vous suft de nous appeler au 1-833-230-2053. Un interlocuteur parlant Franais pourra vous aider. Ce service est gratuit. Vietnamese: Chng ti c dch v thng dch min ph tr li cc cu hi v chng sc khe v chng trnh thuc men. Nu qu v cn thng dch vin xin gi 1-833-230-2053 s c nhn vin ni ting Vit gip qu v. y l dch v min ph. German: Unser kostenloser Dolmetscherservice beantwortet Ihren Fragen zu unserem Gesundheits-undArzneimittelplan. Unsere Dolmetscher erreichen Sie unter 1-833-230-2053. Man wird Ihnen dort auf Deutsch weiterhelfen. Dieser Service ist kostenlos. Korean: . 1-833-230-2053 . . . Russian: , . , 1-833-230-2053. , -p. . Arabic: . 1-833-230-2053.. .Hindi: . , 1-833-230-2053 . . . Italian: disponibile un servizio di interpretariato gratuito per rispondere a eventuali domande sul nostro piano sanitario e farmaceutico. Per un interprete, contattare il numero 1-833-230-2053. Un nostro incaricato che parla Italianovi fornir lassistenza necessaria. un servizio gratuito. Portuguese: Dispomos de servios de interpretao gratuitos para responder a qualquer questo que tenha acerca do nosso plano de sade ou de medicao. Para obter um intrprete, contacte-nos atravs do nmero1-833-230-2053. Ir encontrar algum que fale o idiomaPortugus para o ajudar. Este servio gratuito. French Creole: Nou genyen svis entprt gratis pou reponn tout kesyon ou ta genyen konsnan plan medikal oswa dwg nou an. Pou jwenn yon entprt, jis rele nou nan 1-833-230-2053. Yon moun ki pale Kreyl kapab ede w. Sa a se yon svis ki gratis.Polish: Umoliwiamy bezpatne skorzystanie z usug tumacza ustnego, ktry pomoe w uzyskaniu odpowiedzi na temat planu zdrowotnego lub dawkowania lekw. Aby skorzysta z pomocy tumacza znajcego jzyk polski,naley zadzwoni pod numer 1-833-230-2053. Ta usuga jest bezpatna. Japanese: 1-833230-2053 TTY: 711 MI-MED-M-2240385 MDHHS Approved: 8/7/2023 2023 HAP CareSource. All Rights Reserved Form Approved OMB# 0938-1421 Form CMS-10802 (Expires 12/31/25)MI-MED-M-2240385 MDHHS Approved: 8/7/2023 2023 HAP CareSource. All Rights Reserved Form Approved OMB# 0938-1421 Form CMS-10802 (Expires 12/31/25) Notice of Non-Discrimination HAP CareSource complies with applicable state and federal civil rights laws. We do not discriminate, exclude people, or treat them differently because of age, gender, gender identity, color, race, disability, national origin, ethnicity, marital status, sexual preference, sexual orientation, religious afliation, health status, or public assistance status. HAP CareSource offers free aids and services to people with disabilities or those whose primary language is not English. We can get sign language interpreters or interpreters in other languages so they can communicate effectively with us or their providers. Printed materials are also available in large print, braille or audio at no charge. Please call Member Services at the number on your HAP CareSource ID card if you need any of these services. If you believe we have not provided these services to you or discriminated in another way, you may le a grievance. Mail: HAP CareSource Attn: Civil Rights Coordinator P.O. Box 1947 Dayton, Ohio 45401Email: CivilRightsCoordinator@CareSource.com Phone: 1-800-488-0134 (TTY: 711) Fax: 1-844-417-6254 You may also le a civil rights complaint with the U.S. Department of Health and Human Services, Ofce for Civil Rights: Mail: U.S. Dept of Health and Human Services 200 Independence Ave, SW Room 509F HHH Building Washington, D.C. 20201 Online: ocrportal.hhs.gov/ocr/portal/lobby.jsf Phone: 1-800-368-1019 (TTY: 1-800-537-7697) Complaint forms are found at: http://www.hhs.gov/ocr/ofce/le/index.html . Important Plan Information P.O. Box 1025 Dayton, OH 45401 HAPCareSource.com HOW TO REACH US Member Services Dept: 1-833-230-2053 ( TT Y: 711) 24-Hour Nurse Advice Line:1-833-687-7370 (833-NURSE-70)Join Us Facebook.com/ HAPCareSource X.com/HAPCareSource Tell Us What You Think! We want to know your thoughts about your quarterly newsletter. Tell us what you like, what you dislike, and ideas for improving your newsletters! Take the survey at the link below. It only takes a few minutes. CareSource.com/NewsletterSurvey We want to make your coverage the best youve ever had! We thank you for trusting us with your health coverage needs.MI-MED-M-3062069 | MDHHS Approved: 9/12/2024 2024 HAP CareSource. All Rights Reserved.
Notice Date: November 4, 2024 To: All Georgia D-SNP, Georgia Marketplace, Indiana Marketplace, Kentucky Marketplace, North Carolina Marketplace, Ohio D-SNP, Ohio Marketplace, and West Virginia Marketplace Providers From: CareSource Subject: Modifiers JZ and JW Summary Care Source enforces the Single Dose Vial policies approved on July 1, 2023, which define the appropriate billing and coding of Single Dose Vial drug claims . The policy can be reached using the following applicable links for each plan: Plan Link Georgia D-SNP https://www.caresource.com/documents/dsnp-ga – policy-reimburse-py-pharm-0106-20230701.pdf Ohio D-SNP https://www.caresource.com/documents/dsnp-oh – policy-reimburse-py-pharm-0107-20230701.pdf Georgia Marketplace Indiana Marketplace Kentucky Marketplace Ohio Marketplace West Virginia Marketplace https://www.caresource.com/documents/marketplace – ga-in-ky-oh-wv-policy-reimburse-py-pharm-0104-20230701.pdf North Carolina Marketplace https://www.caresource.com/documents/marketplace – nc-policy-reimburse-py-pharm-0105-20230701.pdf Impact You may receive a claim line denial for a drug with the remittance advice remark code (RARC) stating Missing Procedure Modifier . Single Dose Vial drugs need to be coded with appropriate modifiers as follows: If you fully administer the contents of the entire vial for the member , you must enter a JZ modifier on the claim line. If you partially administer the contents of the vial for a member , the drug claim must be billed with two separate lines. The first claim line should specify the amount administered to the member and does not require a modifier . The second line would specify the amount discarded, which requires a JW modifier. If responding to a claim denial, simply submit a corrected claim using the instructions above. No need to dispute or appeal for the corrected claim to be reimbursed. Importance Process is necessary to ensure that most efficient vial size has been used for member care and to accurately reflect waste portion of a Single Dose Vial, thus avoiding claims overpayment. Questions? For additional questions, please reach out to Provider Services. Youll find the applicable phone number for each plan in the table below. Plan s Provider Services Phone Number Georgia D-SNP Ohio D-SNP 1-833-230-2176 Georgia Marketplace Indiana Marketplace Kentucky Marketplace North Carolina Marketplace Ohio Marketplace West Virginia Marketplace 1-833-230-2101 Multi-Multi-P-3387054 Qualified Health Plans offered in North Carolina by CareSource North Carolina Co., d/b/a
Notice Date: November 4, 2024 To: All Ohio Medicaid, Ohio MyCare, OHW/SRS Providers From: CareSource Subject: Modifiers JZ and JW Summary Care Source enforces the Single Dose Vial policies approved on July 1, 2023, which define the appropriate billing and coding of Single Dose Vial drug claims. The policy can be reached using the following applicable links for each plan: Plan Link Ohio Medicaid https://www.caresource.com/documents/medicaid-oh – policy-reimburse-py-pharm-0100-20230701.pdf Ohio MyCare https://www.caresource.com/documents/mycare-oh – policy-reimburse-py-pharm-0101-20230701.pdf Impact You may receive a claim line denial for a drug with the remittance advice remark code (RARC) stating Missing Procedure Modifier . Single Dose Vial drugs need to be coded with appropriate modifiers as follows: If you fully administer the contents of the entire vial for the member , you must enter a JZ modifier on the claim line. If you partially administer the contents of the vial for a member , the drug claim must be billed with two separate lines. The first claim line should specify the amount administered to the member and does not require a modifier . The second line would specify the amount discarded, which requires a JW modifier. If responding to a claim denial, simply submit a corrected claim using the instructions above. No need to dispute or appeal for the corrected claim to be reimbursed. Importance Process is necessary to ensure that most efficient vial size has been used for member care and to accurately reflect waste portion of a Single Dose Vial, thus avoiding claims overpayment. Questions? For additional questions, please reach out to Provider Services at 1-800-488-0134. OH-Multi-P-3387055
Notice Date: November 1, 2024 To: HAP CareSource Providers From: HAP CareSource Subject: TurningPoint 2024 Annual Policy Updates Summary HAP CareSource has partnered with TurningPoint to cover Cardiac and Musculoskeletal Services for our HAP CareSource members. Our goal is to keep you informed with timely information about our Cardiac and Musculoskeletal Services updates and changes. As changes occur and as needs arise, we issue network notifications to our providers. This notification is intended to provide you notification of changes to the policies listed below. The policies appear on TurningPoints websiteupon their effective dates.Policies Policy Name Plans Effective DateCA-1001.2 4 Automated ImplantableCardioverter Defibrillator HAP CareSource 01/01/2025 CA-1002.23 Leadless Pacemaker HAP CareSource 01/01/2025 CA-1003.24 Pacemaker HAP CareSource 01/01/2025 CA-1004.23 Revision or Replacement of Implanted Cardiac Device HAP CareSource 01/01/2025 CA-1005.24 Coronary Artery Bypass Grafting HAP CareSource 01/01/2025 CA-1006.24 Coronary Angioplasty and Stenting HAP CareSource 01/01/2025 CA-1007.24 Angioplasty and Endovascular Stents HAP CareSource 01/01/2025 CA-1008.24 Implantable Cardiac Monitoring HAP CareSource 01/01/2025 CA-1009.24 Wearable Cardioverter Defibrillator HAP CareSource 01/01/2025 CA-1010.24 Percutaneous Left Atrial Appendage Occluder HAP CareSource 01/01/2025 CA-1011.24 Valve Replacement HAP CareSource 01/01/2025 CA-1012.24 Peripheral Revascularization HAP CareSource 01/01/2025 GN-1001.24 Assistants at Surgery HAP CareSource 01/01/2025GN-1002.23 Medical RecordDocumentation HAP CareSource 01/01/2025 GN-1004.23 Site of Service HAP CareSource 01/01/2025 OR-1001.24 Total Hip Replacement HAP CareSource 01/01/2025 OR-1002.24 Total Knee Replacement HAP CareSource 01/01/2025 OR-1003.24 Lumbar Disc Replacement HAP CareSource 01/01/2025 OR-1004.24 Lumbar Spinal Fusion HAP CareSource 01/01/2025 OR-1005.24 Bone Morphogenetic Protein HAP CareSource 01/01/2025 OR-1006.24 Cervical Disc Replacement HAP CareSource 01/01/2025 OR-1007.24 Cervical Laminectomy and Discectomy HAP CareSource 01/01/2025 OR-1008.24 Lumbar Laminectomy, Discectomy, and Laminotomy HAP CareSource 01/01/2025 OR-1009.24 Sacroiliac Joint Fusion HAP CareSource 01/01/2025 OR-1010.24 Thoracic Laminectomy or Discectomy – HAP CareSource 01/01/2025 OR-1011.24 Thoracic Spinal Fusion HAP CareSource 01/01/2025 OR-1012.24 Cervical Spinal Fusion HAP CareSource 01/01/2025 OR-1013.24 ACL Repair HAP CareSource 01/01/2025 OR-1014.24 Treatment of Osteochondral Defects HAP CareSource 01/01/2025 OR-1015.24 Spinal Cord Neurostimulator HAP CareSource 01/01/2025 OR-1016.23 Revision of Total Hip Replacement HAP CareSource 01/01/2025 OR-1017.23 Revision of Total Knee Replacement HAP CareSource 01/01/2025 OR-1018.24 Acromioplasty and Rotator Cuff Repair HAP CareSource 01/01/2025 OR-1019.24 Shoulder Fusion HAP CareSource 01/01/2025 OR-1020.24 Spinal Fusion for Scoliosis or Kyphosis HAP CareSource 01/01/2025 OR-1021.24 Ankle Replacement and Revision HAP CareSource 01/01/2025 OR-1022.24 Elbow Replacement HAP CareSource 01/01/2025 OR-1023.24 Shoulder Replacement HAP CareSource 01/01/2025 OR-1024.24 Vertebral Augmentation HAP CareSource 01/01/2025 OR-1025.24 Femoroacetabular Arthroscopy HAP CareSource 01/01/2025 OR-1026.24 Hip Resurfacing HAP CareSource 01/01/2025 OR-1027.24 Meniscal Allograft Transplantation HAP CareSource 01/01/2025 OR-1028.24 Partial Knee Replacement HAP CareSource 01/01/2025 OR-1029.24 Knee Arthroscopy HAP CareSource 01/01/2025 OR-1030.24 Ankle Fusion HAP CareSource 01/01/2025 OR-1031.24 Hip Arthroscopy HAP CareSource 01/01/2025 OR-1032.24 Wrist Fusion HAP CareSource 01/01/2025 OR-1033.24 Wrist Replacement HAP CareSource 01/01/2025 OR-1034.24 Implantable Infusion Pumps HAP CareSource 01/01/2025 OR-1035.24 Computer Assisted Navigation HAP CareSource 01/01/2025 OR-1036.24 Shoulder Procedures HAP CareSource 01/01/2025 OR-1037.24 Spinal Devices HAP CareSource 01/01/2025 OR-1038.24 Sacral Decompression HAP CareSource 01/01/2025OR-1039.24 Thermal IntradiscalProcedures HAP CareSource 01/01/2025 OR-1040.24 Manipulation Under Anesthesia HAP CareSource 01/01/2025 OR-1042.24 Hip Osteotomy HAP CareSource 01/01/2025 OR-1043.24 MPFL Reconstruction HAP CareSource 01/01/2025 OR-1045.24 Osteotomies for Spinal Deformity HAP CareSource 01/01/2025 OR-1046.24 Bone Graft Substitutes HAP CareSource 01/01/2025 OR-1047.24 Orthopedic Applications of Stem Cell Therapy HAP CareSource 01/01/2025 OR-1049.24 Percutaneous Tenotomy HAP CareSource 01/01/2025 OR-1050.24 Hip Core Decompression HAP CareSource 01/01/2025 01/01/2025CA-1001.2 4 Automated ImplantableCardioverter Defibrillator HAP CareSource Marketplace 01/01/2025 CA-1002.23 Leadless Pacemaker HAP CareSource Marketplace 01/01/2025 CA-1003.24 Pacemaker HAP CareSource Marketplace 01/01/2025 CA-1004.23 Revision or Replacement of Implanted Cardiac Device HAP CareSource Marketplace 01/01/2025 CA-1005.24 Coronary Artery Bypass Grafting HAP CareSource Marketplace 01/01/2025 CA-1006.24 Coronary Angioplasty and Stenting HAP CareSource Marketplace 01/01/2025 CA-1007.24 Angioplasty and Endovascular Stents HAP CareSource Marketplace 01/01/2025 CA-1008.24 Implantable Cardiac Monitoring HAP CareSource Marketplace 01/01/2025 CA-1009.24 Wearable Cardioverter Defibrillator HAP CareSource Marketplace 01/01/2025 CA-1010.24 Percutaneous Left Atrial Appendage Occluder HAP CareSource Marketplace 01/01/2025 CA-1011.24 Valve Replacement HAP CareSource Marketplace 01/01/2025 CA-1012.24 Peripheral Revascularization HAP CareSource Marketplace 01/01/2025 GN-1001.24 Assistants at Surgery HAP CareSource Marketplace 01/01/2025 GN-1002.23 Medical Record Documentation HAP CareSource Marketplace 01/01/2025 GN-1004.23 Site of Service HAP CareSource Marketplace 01/01/2025 OR-1001.24 Total Hip Replacement HAP CareSource Marketplace 01/01/2025 OR-1002.24 Total Knee Replacement HAP CareSource Marketplace 01/01/2025 OR-1003.24 Lumbar Disc Replacement HAP CareSource Marketplace 01/01/2025 OR-1004.24 Lumbar Spinal Fusion HAP CareSource Marketplace 01/01/2025 OR-1005.24 Bone Morphogenetic Protein HAP CareSource Marketplace 01/01/2025 OR-1006.24 Cervical Disc Replacement HAP CareSource Marketplace 01/01/2025 OR-1007.24 Cervical Laminectomy and Discectomy HAP CareSource Marketplace 01/01/2025 OR-1008.24 Lumbar Laminectomy, Discectomy, and Laminotomy HAP CareSource Marketplace 01/01/2025 OR-1009.24 Sacroiliac Joint Fusion HAP CareSource Marketplace 01/01/2025 OR-1010.24 Thoracic Laminectomy or Discectomy – HAP CareSource Marketplace 01/01/2025 OR-1011.24 Thoracic Spinal Fusion HAP CareSource Marketplace 01/01/2025 OR-1012.24 Cervical Spinal Fusion HAP CareSource Marketplace 01/01/2025OR-1013.24 ACL Repair HAP CareSource Marketplace 01/01/2025OR-1014.24 Treatment of Osteochondral Defects HAP CareSource Marketplace 01/01/2025 OR-1015.24 Spinal Cord Neurostimulator HAP CareSource Marketplace 01/01/2025 OR-1016.23 Revision of Total Hip Replacement HAP CareSource Marketplace 01/01/2025 OR-1017.23 Revision of Total Knee Replacement HAP CareSource Marketplace 01/01/2025 OR-1018.24 Acromioplasty and Rotator Cuff Repair HAP CareSource Marketplace 01/01/2025 OR-1019.24 Shoulder Fusion HAP CareSource Marketplace 01/01/2025 OR-1020.24 Spinal Fusion for Scoliosis or Kyphosis HAP CareSource Marketplace 01/01/2025 OR-1021.24 Ankle Replacement and Revision HAP CareSource Marketplace 01/01/2025 OR-1022.24 Elbow Replacement HAP CareSource Marketplace 01/01/2025 OR-1023.24 Shoulder Replacement HAP CareSource Marketplace 01/01/2025 OR-1024.24 Vertebral Augmentation HAP CareSource Marketplace 01/01/2025 OR-1025.24 Femoroacetabular Arthroscopy HAP CareSource Marketplace 01/01/2025 OR-1026.24 Hip Resurfacing HAP CareSource Marketplace 01/01/2025 OR-1027.24 Meniscal Allograft Transplantation HAP CareSource Marketplace 01/01/2025 OR-1028.24 Partial Knee Replacement HAP CareSource Marketplace 01/01/2025 OR-1029.24 Knee Arthroscopy HAP CareSource Marketplace 01/01/2025 OR-1030.24 Ankle Fusion HAP CareSource Marketplace 01/01/2025 OR-1031.24 Hip Arthroscopy HAP CareSource Marketplace 01/01/2025 OR-1032.24 Wrist Fusion HAP CareSource Marketplace 01/01/2025 OR-1033.24 Wrist Replacement HAP CareSource Marketplace 01/01/2025 OR-1034.24 Implantable Infusion Pumps HAP CareSource Marketplace 01/01/2025 OR-1035.24 Computer Assisted Navigation HAP CareSource Marketplace 01/01/2025 OR-1036.24 Shoulder Procedures HAP CareSource Marketplace 01/01/2025 OR-1037.24 Spinal Devices HAP CareSource Marketplace 01/01/2025 OR-1038.24 Sacral Decompression HAP CareSource Marketplace 01/01/2025 OR-1039.24 Thermal Intradiscal Procedures HAP CareSource Marketplace 01/01/2025 OR-1040.24 Manipulation Under Anesthesia HAP CareSource Marketplace 01/01/2025 OR-1042.24 Hip Osteotomy HAP CareSource Marketplace 01/01/2025 OR-1043.24 MPFL Reconstruction HAP CareSource Marketplace 01/01/2025 OR-1045.24 Osteotomies for Spinal Deformity HAP CareSource Marketplace 01/01/2025 OR-1046.24 Bone Graft Substitutes HAP CareSource Marketplace 01/01/2025 OR-1047.24 Orthopedic Applications of Stem Cell Therapy HAP CareSource Marketplace 01/01/2025 OR-1049.24 Percutaneous Tenotomy HAP CareSource Marketplace 01/01/2025 OR-1050.24 Hip Core Decompression HAP CareSource Marketplace 01/01/2025 MI-Multi-P-3364372
Notice Date: November 1, 2024 To: CareSource North Carolina Co. Providers From: CareSource Subject: TurningPoint 2024 Cardiac and Musculoskeletal Policy Updates North CarolinaSummary CareSource North Carolina Co. has partnered with TurningPoint to cover Cardiac and Musculoskeletal Services for our CareSource North Carolina Co. members. Our goal is to keep you informed with timely information about our Cardiac and Musculoskeletal policy updates and changes. As changes occur and as needs arise, we issue network notifications to our providers. This notification is intended to provide you notification of changes to the policies listed below. The policies appear o n TurningPoint's websiteupon their effective dates.Policies Policy Name Plans Effective DateCA-1001.2 4 Automated ImplantableCardioverter Defibrillator CareSource North Carolina Co. 01/01/2025 CA-1002.23 Leadless Pacemaker CareSource North Carolina Co. 01/01/2025 CA-1003.2 4 Pacemaker CareSource North Carolina Co. 01/01/2025 CA-1004.23 Revision or Replacement of Implanted Cardiac Device CareSource North Carolina Co. 01/01/2025 CA-1005.2 4 Coronary Artery Bypass Grafting CareSource North Carolina Co. 01/01/2025 CA-1006.2 4 Coronary Angioplasty and Stenting CareSource North Carolina Co. 01/01/2025 CA-1007.2 4 Angioplasty and Endovascular Stents CareSource North Carolina Co. 01/01/2025 CA-1008.2 4 Implantable Cardiac Monitoring CareSource North Carolina Co. 01/01/2025 CA-1009.2 4 Wearable Cardioverter Defibrillator CareSource North Carolina Co. 01/01/2025 CA-1010.2 4 Percutaneous Left Atrial Appendage Occluder CareSource North Carolina Co. 01/01/2025 CA-1011.2 4 Valve Replacement CareSource North Carolina Co. 01/01/2025 CA-1012.2 4 Peripheral Revascularization CareSource North Carolina Co. 01/01/2025 GN-1001.2 4 Assistants at Surgery CareSource North Carolina Co. 01/01/2025 GN-1002.23 Medical Record Documentation CareSource North Carolina Co. 01/01/2025 GN-1004.23 Site of Service CareSource North Carolina Co. 01/01/2025OR-1001.2 4 Total Hip Replacement CareSource North Carolina Co. 01/01/2025OR-1002.2 4 Total Knee Replacement CareSource North Carolina Co. 01/01/2025 OR-1003.2 4 Lumbar Disc Replacement CareSource North Carolina Co. 01/01/2025 OR-1004.2 4 Lumbar Spinal Fusion CareSource North Carolina Co. 01/01/2025 OR-1005.2 4 Bone Morphogenetic Protein CareSource North Carolina Co. 01/01/2025 OR-1006.2 4 Cervical Disc Replacement CareSource North Carolina Co. 01/01/2025 OR-1007.2 4 Cervical Laminectomy and Discectomy CareSource North Carolina Co. 01/01/2025 OR-1008.2 4 Lumbar Laminectomy, Discectomy, and Laminotomy CareSource North Carolina Co. 01/01/2025 OR-1009.2 4 Sacroiliac Joint Fusion CareSource North Carolina Co. 01/01/2025 OR-1010.23 Thoracic Laminectomy or Discectomy – CareSource North Carolina Co. 01/01/2025 OR-1011.2 4 Thoracic Spinal Fusion CareSource North Carolina Co. 01/01/2025 OR-1012.2 4 Cervical Spinal Fusion CareSource North Carolina Co. 01/01/2025 OR-1013.2 4 ACL Repair CareSource North Carolina Co. 01/01/2025 OR-1014.2 4 Treatment of Osteochondral Defects CareSource North Carolina Co. 01/01/2025 OR-1015.2 4 Spinal Cord Neurostimulator CareSource North Carolina Co. 01/01/2025 OR-1016.23 Revision of Total Hip Replacement CareSource North Carolina Co. 01/01/2025 OR-1017.23 Revision of Total Knee Replacement CareSource North Carolina Co. 01/01/2025 OR-1018.2 4 Acromioplasty and Rotator Cuff Repair CareSource North Carolina Co. 01/01/2025 OR-1019.2 4 Shoulder Fusion CareSource North Carolina Co. 01/01/2025 OR-1020.2 4 Spinal Fusion for Scoliosis or Kyphosis CareSource North Carolina Co. 01/01/2025 OR-1021.2 4 Ankle Replacement and Revision CareSource North Carolina Co. 01/01/2025 OR-1022.2 4 Elbow Replacement CareSource North Carolina Co. 01/01/2025 OR-1023.2 4 Shoulder Replacement CareSource North Carolina Co. 01/01/2025 OR-1024.2 4 Vertebral Augmentation CareSource North Carolina Co. 01/01/2025 OR-1025.2 4 Femoroacetabular Arthroscopy CareSource North Carolina Co. 01/01/2025 OR-1026.2 4 Hip Resurfacing CareSource North Carolina Co. 01/01/2025 OR-1027.2 4 Meniscal Allograft Transplantation CareSource North Carolina Co. 01/01/2025 OR-1028.2 4 Partial Knee Replacement CareSource North Carolina Co. 01/01/2025 OR-1029.2 4 Knee Arthroscopy CareSource North Carolina Co. 01/01/2025 OR-1030.2 4 Ankle Fusion CareSource North Carolina Co. 01/01/2025 OR-1031.2 4 Hip Arthroscopy CareSource North Carolina Co. 01/01/2025 OR-1032.2 4 Wrist Fusion CareSource North Carolina Co. 01/01/2025 OR-1033.2 4 Wrist Replacement CareSource North Carolina Co. 01/01/2025 OR-1034.2 4 Implantable Infusion Pumps CareSource North Carolina Co. 01/01/2025 OR-1035.2 4 Computer Assisted Navigation CareSource North Carolina Co. 01/01/2025 OR-1036.2 4 Shoulder Procedures CareSource North Carolina Co. 01/01/2025 OR-1037.2 4 Spinal Devices CareSource North Carolina Co. 01/01/2025 OR-1038.2 4 Sacral Decompression CareSource North Carolina Co. 01/01/2025 OR-1039.2 4 Thermal Intradiscal Procedures CareSource North Carolina Co. 01/01/2025 OR-1040.2 4 Manipulation UnderAnesthesiaCareSource North Carolina Co. 01/01/2025 OR-1042.2 4 Hip Osteotomy CareSource North Carolina Co. 01/01/2025 OR-1043.2 4 MPFL Reconstruction CareSource North Carolina Co. 01/01/2025 OR-1045.2 4 Osteotomies for Spinal Deformity CareSource North Carolina Co. 01/01/2025 OR-1046.2 4 Bone Graft Substitutes CareSource North Carolina Co. 01/01/2025 OR-1047.2 4 Orthopedic Applications of Stem Cell Therapy CareSource North Carolina Co. 01/01/2025 OR-1049.2 4 Percutaneous Tenotomy CareSource North Carolina Co. 01/01/2025 OR-1050.2 4 Hip Core Decompression CareSource North Carolina Co. 01/01/2025 NC-EXC-P-3364617Qualified Health Plans offered in North Carolina by CareSource North Carolina Co., d/b/a CareSource
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