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PO Box 723308, Atlanta, GA 31139-1308 | www.caresource.comAsunto: Re sume n de cambios e n la PDL a partir de l July 1, 2022 Es ti mado afiliado a CareSourc e: Su atenc in mdic a es nues tra prioridad. Por es o, le es c ribimos para informarle que la Lis ta de medic amentos preferidos (Preferred Drug Lis t, PDL) de CareSourc e c ambiar el July 1, 2022. Una PDL es una lis ta de medic amentos preferidos . LOS SIG UIENT ES MEDICAMENT OS SERN PREFERIDOS EN LA PDL A PART IR DEL JULY 1, 2022 Nombre de marca Notas De xcom G6 Continuous Glucose Monitor Corres ponding S ens or, Reader and Trans mitter A dded to the Lis t Requires Clinic al Prior Authoriz ation Qu debe hace r? En primer lugar, hable c on s u prov eedor de atenc in mdic a. Es pos ible que hay a otros medic amentos en la PDL de CareSourc e que us ted pueda us ar en s u lugar . Hay v arias formas para que us ted o la pers ona que s e los rec eta puedan enc ontrar medic amentos :Puede bus c ar en nues tro s itio web, en Care Source .com. En la pgina Members (Afiliados ), v ay a a Tools & Res ourc es (Herramientas y Rec urs os ) y haga c lic en Find My Pres c riptions (Enc ontrar mis medic amentos c on rec eta). Ollame a nues tro Departamento de Serv ic ios para Afiliados al 1-855-202-0729 (TTY: 1-800-255-0056 o 711). Es tamos aqu para ay udarlo. El Departamento de Serv ic ios para Afiliados a CareSour c e es t abierto de lunes a v iernes , de 7 a. m. a 7 p. m. Atentam ente, Departam ento de Farmac ia de CareSourc e CareSour c e c umple las ley es s obre derec ho c iv il es tatales y federales y no dis c rimina por motiv os de edad, s ex o, identidad de gnero, c olor, raz a, inc apac idad, origen nac ional, es tado c iv il, preferenc ia s ex ual, filiac in religios a, es tado de s alud o es tado de as is tenc ia pblic a. Si us ted o alguien a quien ay uda tienen preguntas s obre CareSourc e, tiene derec ho a rec ibir es ta informac in y ay uda en s u propio idioma s in c os to. Para hablar c on un intrprete, Por fav or, llame al nmero de Serv ic ios para Afiliados que figura en s u tarjeta de identific ac in. GA-MM ED-2705-V. 17 Aprobado por DCH: 7/23/2019
Seguimiento despus de una visita al departamento de emergencias por una enfermedad mental (FUM) Por qu el seguimiento es importante La enfermedad mental puede afectar a personas de todas las edades. La Alianza Nacional de Enfermedades Mentales (National Alliance on Mental Illness, NAMI) indica que una de cinco personas en los Estados Unidos vive con una afeccin de salud mental. Muchas terminan en el departamento de emergencias (ED, por sus siglas en ingls) para recibir atencin bsica. Y, a menudo, muchas nunca hacen seguimiento con su proveedor mdico primario (PMP) o proveedor de salud conductual para recibir atencin continua. Conectarse con un proveedor puede ayudarle a encaminarse hacia una mejor salud. Un PMP o proveedor de atencin conductual pueden ayudarle a abordar las inquietudes subyacentes que condujeron a su visita al ED. La investigacin sugiere que la atencin de seguimiento para personas con enfermedades mentales: Disminuye los incidentes de pensamientos suicidas,intentos de suicidio y muerte por suicidio. Disminuye el uso del ED y las admisioneshospitalarias, adems de la duracin de las estadas. Conduce a una mejor identicacin y tratamiento de problemas de salud mental y fsica. Estamos aqu para usted! Servicios para Aliados 1-844-607-2829 (1-800-743-3333 o 711) Llame de lunes a viernes, de 8:00a.m. a 8:00p.m. Hora estndar del Este.Lnea de crisis de salud conductual 1-833-227-3464 Llame las 24 horas del da, los 7 das de la semana. Cmo podemos ayudar? En CareSource, nos preocupamos por usted. Podemos ayudarle a ver a su PMP o proveedor de salud conductual en un plazo de siete das despus de su visita al ED. Estas son algunas formas en las que tambin puede ayudarle: Revisar el plan que recibi cuando fue dado de altadel ED. Ayudarle a conseguir transporte para su visita deseguimiento. Asegurarse de que tenga una segunda visita en unplazo de 30 das. Ayudarle a encontrar un proveedor de tratamiento local. Hablar y resolver problemas que le impidenconcentrarse en su salud (p. ej., empleo, vivienda,opciones de alimentacin saludable, etc.). Repasar cules son sus benecios de salud y laatencin cubierta. Ayudarle a registrarse en nuestros programas de recompensas. Ayudarle a dar los pasos iniciales en el programa deadministracin de la atencin. Referencias: https://www.nami.org/mhstats https://www.nimh.nih.gov/health/statistics/ mental-illness RR2022-IN-MED-M-1035159-SP; Primer uso: 4/21/2022 | Aprobado por OMPP: 4/21/2022 CareSource 2022.Todos los derechos reservados.
Notice Date: April 4, 2022 To: Georgia D-SNP and Marketplace Providers From: CareSource Subject: NEW! Quality Patient Experience Guide SummaryCareSource wants to put our best foot forward when it comes to partnering with our providers. That’s why we created the new Quality Patient Experience Guide . The guide outlines 7 ways we can fulfill our joint commitment to delivering a positive patient experience together : Help patients obtain appointments with ease Offer flexible care options Minimize patient wait times Ensure readiness to deliver needed care Communicate with empathy Empower patients with helpful information Provide courteous and timely follow-up ImpactThe contact information and links to programs and services offer support to you and your CareSource patients.Importanc eThe topics in this guide are those addressed in annual satisfaction surveys such as the Consumer Assessment of Healthcare Providers and Systems (CAHPS ). The information in the Quality PatientExperience Guide is intended to strengthen our partnership and instill quality in every patient interaction. Questions?For additional assistance, please contact Provider Services : Dual Special Needs Plan 1-833-230-2176 Marketplace 1-833-230-2155 GA-Multi-P-1084892New Training Available Provider Satisfaction Survey!View the latest training in the CareSource Provider Education Series to learn more about the provider satisfaction survey and how we use the results to improve performance and relationships with our providers. Visit www.caresource.com > Providers > Education > Training and Events to view this 3-minute video.
EPSDT PROGRAM Early and Periodic Screening, Diagnosis and Treatment (EPSDT) is a federally-mandated program developed for children under the age of 21 who are Medicaid recipients. The state of Indiana calls this program HealthWatch. All HIP members ages 19 and 20 and HHW members under the age of 21 should receive HealthWatch exams at regular intervals. The purpose of these comprehensive preventive visits is to discover and treat health problems early. If a potential health problem is found, further diagnosis and treatment are covered by Medicaid. EPSDT Exam ComponentsThe EPSDT exam is a general health assessment and is com-posed of the following required screening elements:Medical historyComplete unclothed exam (with parent approval)Developmental screening (to assess if a childs physical and mental abilities are age appropriate)Vision screeningDental screeningHearing assessmentImmunization assessment (making sure child received them on time)Lead screening; andOther services or screenings as indicated by the Bright Futures Periodicity Schedule published by the American Academy of PediatricsEPSDT Exam FrequencyThe recommended schedule for EPSDT exams is as follows:Birth3-5 days1 month2 months4 months6 months9 months12 months 15 months8 months24 months30 monthsAfter 30 months, one exam per year until age 21 IN-P-0068a; Date Issued: 11/01/2016 | OMPP Approved: 10/11/2016 | 2021 CareSource. All Rights Reserved.EPSDT CodesThe following billing procedures must be followed for every EPSDT/HealthWatch claim, to permit correct and prompt reimbursement:Providers must use the following ICD-10 diagnosis codes as the primary diagnosis:- Z00.121 Encounter for routine child health examination with abnormal findings or-Z00.129 Encounter for routine child health examination without abnormal findings as the primary diagnosisWhen patient exams are billed in conjunction with the Z00.121 or Z00.129 diagnosis code as the primary diagnosis code, the screen components must have been provided.Physicians are strongly encouraged to include all applicable diagnosis codes (up to four) and procedure codes for each EPSDT/HealthWatch visit.Exams should be coded on claim forms using CPT codes 99381 through 99395, as indicated in the following chart. Correct codes are required for proper documentation of services provided and timely and accurate claims payment. New Patient/Initial Exam Code Description Established Patient/Periodic Examination99381 Infant (age under 1 year) 99391 Infant (age under 1 year)99382 Early childhood (age 1-4 years) 99392 Early childhood (age 1-4 years)99383 Late childhood (age 5-11 years) 99393 Late childhood (age 5-11 years)99384 Adolescent (age 12-17 years) 99394 Adolescent (age 12-17 years)99385 Age 18-20 years 99395 Age 18-20 yearsWhen a member presents to a provider for a sick visit, and his or her records indicate the need for an updated EPSDT visit, physicians can include services for both visits and bill two visit codes for reimbursement of both services on the same day. Providers must maintain a complete problem-focused visit exam for the presenting problem and a complete preventive visit documenting the EPSDT components of the screening exam within the members health records.If a patient is evaluated and treated for a problem during the same visit as an EPSDT annual exam, the problem-oriented exam can be billed separately accompanied by the 25 modifier (separate significantly identifiable E/M service). The problem must require additional moderate level evaluation to qualify as a separate service on the same date. VisitsCPT CodeICD CodingAdditional ReimbursementSick visit plus EPSDT (two visit codes) Preventive visit code and 99203-99215 with modifier 25 Z00.121 or Z00.129 (or V20.2 for ICD-9 claims) must be used as the primary diagnosis for the appropriate preventive visit and multiple diagnoses for presenting problem. Sick visits depend on complexity and doctor/ patient relationship (new/ established)EPSDT Special ServicesEPSDT provides for medically necessary diagnosis and treatment to members under the age of 21 as the result of an EPSDT health assessment or other encounters with a licensed or certified health car e professional, even if the Indiana Medicaid program does not otherwise cover the service. Services not otherwise covered by the Indiana Medicaid Program fall under EPSDT Special Services coverage.EPSDT diagnosis and treatment services not covered by the Indiana Medicaid program are subject to prior authorization from CareSource based on medical necessity guidelines set forth in the Indiana Medicaid program guidelines.
Notice Date: April 1, 2022 To: Ohio Medicaid Providers From: CareSource Subject: Benefits of School-Based Health Centers for Ohio Students Summary School-based health centers (SBHCs) have been improving the health and education outcomes of children and adolescents for 30 years in Ohio. Ohio currently has 85 SBHC programs in both rural and urban regions of the state and is continuously growing in number and expanding health care services to students. SBHC models include traditional school health clinics and at least a dozen mobile health unit programs across the state. Impact The Ohio Department of Education and the Ohio Department of Health are committed to making all Ohio children healthy and improve educational outcom es for all students. Health plays a major role in the ability of students to learn and be successful in school and later in life. SBHCs improve access to health care by removing barriers to health care services in low-income communities by providing health care services where students spend the majority of ti me school . SBHCs improve students overall health, improve attendance rates, decrease graduation dropout rates, and enable students to have increased academic success and help close the academic achievement gap for Ohio students. SBHCs play a major role in students access to health care and address social determinants of health providing increased health equity in low-income school districts. Importance The SBHC model is a partnership between a school district and a health provider including Federally Qualified Health Centers ( FQHCs), hospitals and local health departments that contract to provide health care services to the districts students, staff and families in some cases. SBHCs offer the following health care services: primary, preventive and acute care visits, health, and Social Determinants of Health (SDOH) screenings, behavioral health including therapy and psychiatric visits, comprehensive dental care and eye exams including providing prescription eyeglasses to students. The pandemic provided an expansion of provider services including telehealth services for both medical and behavioral health visits to students and their families in some cases . CareSource has a School-Based Health Administrator available to providers to answer questions, provide information and to be the liaison between providers and SBHCs that serve Ohios children. State and National School-Based Health Alliance organizations: The Ohio School Based Health Alliance is a statewide professional organization that provides advocacy and quarterly meetings to support high quality and sustainable school-based health models of care in school settings. Link to site: https://www.osbha.com The School-Based Health Alliance (SBHA) founded in 1995 is a national nonprofit organization that provides support and resources to more than 2,500 SBHC programs across the country. Link to site: https://www.sbh4all.org For questions, please contact Kim Radominksi at Kimberly.Radominski@CareSource.com . OH-MED-P- 1227389
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