May 2024
Provider Services 1-833-644-6001 

Change Healthcare Access Issue

AmeriHealth Caritas Ohio has not established a timeline for reconnecting to Change Healthcare Electronic Data Interchange (EDI) transaction systems. We are working diligently to assess when to restore the connection for EDI transactions. Our decision-making process will include receiving third-party assurance regarding the security of Change Healthcare systems, as well as internal security validation.
 
We are aware that some providers are experiencing difficulty with reconciliation of accounts due to some detailed payment recovery information missing from the provider remittance advice. Due to the Change Healthcare security incident, remittance advices generated after February 21, do not include certain claim recovery information that was previously provided. We are collaborating with Change Healthcare on a solution for this issue. We are confident as Change Healthcare continues to restore services; this information will soon become available.
 
As a reminder, providers can view and download an electronic remittance PDF via the NaviNet provider portal. Providers can also access the ERA/835 file through ECHO Health’s provider payment portal at: www.providerpayments.com/Login.aspx. If you are not currently registered with ECHO for access to the portal, you will have to create a new account. 
 
Questions: Please note, in the interim, our Provider Services Department will not be able to assist with processing of your payments or access to remittance advice any sooner. If you have other questions, you may contact Provider Services at 1-833-644-6001
 
We appreciate your partnership and patience as we work to re-establish services and will continue to share additional information as it becomes available. 

  Ohio Department of Medicaid updates

State fiscal year-end claims submission and provider payments
What providers need to know about Medicaid claims as the State of Ohio finalizes payments for State Fiscal Year (SFY) 2023 ending June 30:

  • Claims submitted after noon on Friday, June 23, will be held for processing until the Ohio Administrative Knowledge System (OAKS), the state's accounting system, is up and running for SFY 2024 (beginning July 1).
  • Ohio Department of Medicaid anticipates issuing final provider payments for SFY 2023 on Wednesday, June 28, however, fiscal year-end processing may cause a delay in payment until OAKS is up and running for SFY 2024.
  • Ohio Department of Medicaid (ODM) anticipates issuing the first payment of SFY 2024 to providers on July 7.
  • Please note, as a result of fiscal year-end processing and the July 4th holiday, OAKS processing may experience a brief delay and payment may not be made until the week of July 10.

Ohio Medicaid Next Generation OMES new features implementation 

ODM continues to implement new initiatives and improvements to achieve the program’s mission to focus on the individual and improve the provider experience. As an extension of this effort, they will implement new features in Ohio Medicaid Enterprise System (OMES) modules. Providers will see and utilize these new features in the Provider Network Management (PNM) module beginning on June 30. Click here to read ODM's announcement and learn more about the benefits providers and other PNM users will experience as a result of this implementation and find training and resources,

 

Reimbursement Information

In 2023 ODM collected responses from all the MCEs regarding the claims and prior authorization denials processes. To streamline this for providers, ODM created two grids, one for claims denials and one for PA denials. The intent of both grids is for providers to have tools that explain the MCE claims and PA denials processes within one location. Both grids are located here: Reimbursement Information.

 
Medicaid Agreement Revalidations
IMPORTANT UPDATE: Terminations resumed effective January 23, for failure to complete Medicaid Agreement Revalidations in the Provider Network Management module.
 
If you receive a revalidation notice, it is imperative that you take immediate action to complete and submit your revalidation application to renew your Ohio Medicaid Provider Agreement. On January 23, Ohio Department of Medicaid started terminating providers who fail to complete their revalidation prior to their specified deadline. To complete revalidation, please visit PNM & Centralized Credentialing.
 

The importance of the SL modifier in childhood vaccines (corrected article)

Vaccines for Children (VFC) Program

Effective April 30, the Vaccines for Children program will no longer require the use of the SL modifier to indicate when a provider is participating in the program for claims for reimbursement. 

 

Please see the updated billing guidelines below:

AmeriHealth Caritas Ohio PCPs are required to enroll with the Ohio Department of Health (ODH) Immunization Program to receive vaccines for members under age 19 years through the Vaccines for Children (VFC) Program. Vaccinations covered by the VFC program will not be reimbursed by AmeriHealth Caritas Ohio; however, the Plan reimburses providers for appropriate vaccine administration to members aged 18 years and younger. Providers are expected to plan for a sufficient supply of vaccines and are required to report the use of VFC vaccines immunizations by:

  • Toxoid/Immunization CPT codes must be submitted with a charge amount greater than zero.
  • Providers will receive reimbursement for the administration of the vaccine only.
    Updated rates
    The new rates are available on ODM's website.
     
    Update your Specialties page in the Provider Network Management module 
    ODM has seen an increase of provider specialty discrepancies, especially among the Physician/Osteopath Individual provider type. Because of this, providers are strongly encouraged to review the provider specialty page in the PNM module for accuracy.

    What action do providers need to take?
    Review the PNM Specialties page during your revalidation/reenrollment process to make any updates or adjustments to the active practicing specialties. Please note, the “200 Physician/Osteopath Individual” specialty type is no longer a valid specialty and requires an update to add the correct specialty in PNM. See the Specialty Quick Reference Guide for instructions.
     
    Updated HEDIS Guidelines for the Care Gap Closure program
    Click here to view the HEDIS 2023 Documentation and Coding Guidelines for care delivered in 2024.
     
    Ohio Department of Medicaid fraud warning
    Criminals are targeting Medicaid recipients for sensitive, personal, and financial information. If your patient gets a call, text, or email about Medicaid benefits asking for a Social Security number, payment, bank, debit, or credit card information, advise your patient to not respond. They’re not from the State of Ohio or any agency. Instead, it should be reported to the Ohio Attorney General at 1-800-282-0515 or click here to complete the online form.
     
    Incomplete PNM affiliation steps may impact provider billing
    Through a series of PNM queries, ODM has identified several affiliation issues that impact billing organizations claims. It is imperative that providers fully execute all steps when affiliating a rendering provider to their group/organization/hospital to avoid claims payment issues. An Affiliations Quick Reference Guide has been created, showing step-by-step instructions and information related to entering an affiliation as a new individual practitioner; confirming, adding, and removing an individual practitioner’s affiliation as a group or organization. 
     
    New administrator change form
    ODM developed a new form, ODM10304, that must accompany requests to change PNM Administrators from one billing organization provider to another. As a security measure, you must submit a formal request to transfer Administrator ownership of a Medicaid ID within the PNM module. More details are available on ODM's website.  
     
    Claim submission and adjudication FAQ 
    ODM updated the Claims and Prior Authorization Submission Frequently Asked Questions (FAQ) to make it easier for you to find the information you need. It covers fee-for-service, managed care, and OhioRISE billing procedures, adjudication processes, and other answers to common provider questions. You can review the FAQ on the submitting claims and prior authorizations page on the Next Generation website.
     

    EPSDT- HEALTHCHEK annual education as required by ODM

    The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit provides comprehensive and preventative healthcare services for children under age 21 who are enrolled in Medicaid. EPSDT is key to ensuring that children and adolescents receive appropriate preventative, dental, mental health, developmental, AND specialty services.

    Screenings Must Include:

    • Comprehensive Health and Developmental History
    • Comprehensive Unclothed Physical Exam
    • Laboratory Tests – Including Lead Toxicity Screening as guided by the child’s age
    • Appropriate and needed immunizations
    • Health Education – Anticipatory Guidance including Child Development, Healthy Lifestyles, and Accident and Disease Prevention
    • Vision Services – at minimum, diagnosis and treatment for defects in vision, including eyeglasses
    • Dental Services – at minimum, relief of pain and infections, restoration of teeth, and maintenance of dental health
    • Hearing Services – at minimum, diagnosis and treatment for defects in hearing, including hearing aids
    • Nutrition assessment and education
    • Other Necessary Health Care Services – diagnostic and treatment services must be provided when a screening examination indicates the need for further evaluation

    Important Links and Information

    Email links

     Resources and reminders

    Need help?

    Reminder to providers regarding overpayments

    AmeriHealth's Claims Cost Containment Unit is responsible for the manual review of overpaid claims submitted by the Program Integrity department for potential recovery. Claims submitted to the Claims Cost Containment Unit for review are outside of the Subrogation and Check Reconciliation areas. Some examples of identified waste include:

    • Incorrect billing from providers causing overpayment
    • Overpayment due to incorrect set-up or update of contract/fee schedules in the system
    • Overpayments due to claims paid based upon conflicting authorizations or duplicate payments
    • Overpayments resulting from incorrect revenue/ procedure codes, retro TPL/Eligibility

    The Claims Cost Containment Unit is also responsible for the manual review of provider-initiated overpayments. Providers who self-identify claim overpayments may submit their inquiries for review to:

    AmeriHealth Caritas Ohio

    Attn: Claims Cost Containment

    PO Box 7320

    London, KY 40742

     

    Further information can be found on pages 115 through 117 of the AmeriHealth Caritas Ohio Provider Manual.

     

    Reminder to providers regarding urine drug screening
    Drug screen testing detects the presence of drugs or drug classes in a patient’s system during an encounter. The results are reported as positive or negative for the presence of a drug or drugs but do not indicate specific levels. The tests provide information about recent drug use but do not distinguish between occasional users and those who are dependent on or otherwise impaired by drug use. 


    Drug screen testing includes: 

    • Presumptive drug class screening used to identify possible use or non-use of a drug or drug class. It is done on a random basis or for cause, the latter of which should be documented in the medical record. In substance use disorder treatment settings, presumptive testing should be a routine part of initial and ongoing patient assessment. 
    • Definitive drug class screening comprised of qualitative (drug is present or absent), semi-quantitative, or quantitative (measured) tests to identify possible use or non-use of a specific drug; typically, therapeutic drug assay procedures are quantitative tests. Definitive testing may be used to detect specific substances not identified by presumptive methods and to refine the accuracy of the test results when the results are needed to inform clinical decisions. 
    Drug testing should supplement information obtained by history and physical examination and should never be the sole basis for making a diagnosis of a substance use disorder (American Society of Addiction Medicine, 2019). Drug testing should be performed for individuals who would be helped most by such screens. Routine drug screening in the absence of clear clinical suspicion for illicit use should be avoided. Choice of test matrix, selection, and frequency should fit the needs of the tested population, with more intense and less predictable testing reserved for persons at highest risk of drug use (American Society of Addiction Medicine 2019, Manchikanti, 2012). 
     

    AmeriHealth follows OAC rules associated with presumptive and definitive drug screens.

    • For presumptive screens, thirty dates of service per benefit year; and
    • For definitive tests, twelve dates of service per benefit year.

    PNM portal

    Until it is fully active, please continue to send roster updates to both PNM and the MCO’s. Behavioral Health providers ARE able to only update through the PNM portal without submitting rosters to the MCO’s.

     
    Prior authorizations
    Submit authorizations electronically through NaviNet
    AmeriHealth Caritas Ohio offers our providers access to our Medical Authorizations portal for electronic authorization inquiries and submission. The portal is accessed through NaviNet and located on the Workflows menu.

    In addition to submitting and inquiring on existing authorizations, you will also be able to:
    • Verify if No Authorization is Required
    • Receive Auto Approvals, in some circumstances
    • Submit Amended Authorization
    • Attach supplemental documentation
    • Sign up for in-app status change notifications directly from the health plan
    • Access a multi-payer Authorization log
    • Submit inpatient concurrent reviews online if you have Health Information Exchange (HIE) capabilities (fax is no longer required)
    • Review inpatient admission notifications and provide supporting clinical documentation
    Prior authorization lookup tool
    To find out if a service needs prior authorization, click here to get started. 
    • Wait for the page to fully load
    • Enter a CPT or HCPCS code in the search box at the bottom of the page
    • Click Submit
    • The tool will tell you if that service needs prior authorization
    Medicaid Annual Eligibility Redetermination Reviews
    Information for providers regarding Annual Eligibility Redetermination Reviews is on our website. This federally required process is in place to ensure those enrolled in Medicaid programs continue to meet established eligibility criteria. AmeriHealth Caritas Ohio will collaborate with Ohio Department of Medicaid and our provider network to minimize the burden on our members and promote continuity of health coverage.
     
    Access and Availability Standards
    As part of ongoing network management, periodic outreach to confirm maintenance of access and availability standards does occur. The specific access time frames are determined by the provider type of the service and is outlined starting on page 33 of the AmeriHealth Caritas Ohio Provider Manual.  
      Claims and billing
    How to investigate a claim
    1. Log into NaviNet.
    2. On the Health Plans menu, under My Plans, click AmeriHealth Caritas Ohio.
    3. Under Workflows for This Plan, click Claim Status Inquiry, and then find your claim.
    4. On the Claim Details screen, above the status bar, click Claim Investigation. The Investigation Claim # pop-up window appears.
    5. Choose an investigation type, and then type your comments for the investigation reviewers. Claim investigations are per claim, not per line item. To reference a specific claim line, provide the line number in the Comments box.
    6. In the remaining boxes, type your contact information for this investigation so that customer service can contact you, if necessary.
    7. Click Submit.
    A confirmation message appears. For example:
    Your Investigation Request for Claim # 118833994 has been submitted to the plan.
    Our goal is to respond to your inquiry within 7 days, however, at times due to volumes of complexity our response may take up to 30 days.

    To check the status of your investigation after you submit it, click Claim Investigation Inquiry under Workflows for This Plan.

    If you submit an investigation without required information, AmeriHealth Caritas Ohio cannot complete it. AmeriHealth Caritas Ohio responds to the investigation and notes the missing information.

     

    Consent forms

    Providers must submit the appropriate required forms (ODM 03197, ODM 03199, HHS-687, and HHS687-1 [SPANISH VERSION]) with the claim’s submission for these services. Appropriate consent forms can be found on AmeriHealth Caritas Ohio's website or on the ODM website at Pregnancy Risk Assessment | Medicaid (ohio.gov). Providers can submit the consent form along with their claim through Change Healthcare:

    • Submit a 275 claim attachment transaction. AmeriHealth Caritas Ohio is accepting ANSI 5010 ASC X12 275 unsolicited attachments via Change Healthcare. Please contact your Practice Management System Vendor or EDI clearinghouse to inform them that you wish to initiate electronic 275 attachment submissions via payer ID 35374.
    There are three ways that 275 attachments can be submitted:
    • Batch - you may either connect to Change Healthcare directly or submit via your EDI clearinghouse.
    • API via JSON - you may submit an attachment for a single claim.
    • Portal - individual providers can register at Change Healthcare to submit attachments.
    The acceptable supported formats are pdf, tif, tiff, jpeg, jpg, png, docx, rtf, xml, doc, and txt. View the Change Healthcare 275 claims attachment transaction video for detailed instructions on this process. In addition, the following 275 claims attachment report codes have been added. When submitting an attachment, use the applicable code in field number 19 of the CMS 1500 or field number 80 of the UB04, as documented in the Claims Filing Instructions (PDF).
     

    Attachment type

    Claim assignment attachment report code

    Itemized bill

    03

    Medical records for HAC review

    M1

    Single case agreement (SCA)/LOA

    04

    Advance beneficiary notice (ABN)

    05

    Consent form

    CK

    Manufacturer suggested retail price/invoice

    06

    Electric breast pump request form

    07

    CME checklist consent forms (child medical eval)

    08

    EOBs — for 275 attachments, should only be used for non-covered or exhausted benefit letter

    EB

    Certification of the Decision to Terminate Pregnancy

    CT

    Ambulance trip notes/run sheet

    AM

     
    No paper claims
    The Next Generation of Ohio Medicaid program's guidelines require all claims to be submitted via the Electronic Data Exchange (EDI). Use AmeriHealth Caritas Ohio’s EDI Payer ID# 35374. You can get started on our website with claims how-tos, quick guides, links and contact info.   
     

    Correcting claims

    Oops! What if I submitted claims with the wrong rate or CPT code? Please refer to our Provider Claims and Billing Manual on how to submit corrected claims on page 52.

     
    Provider Claims and Billing Manual - Box 33, no PO Box allowed
    Field: 33
    Field description: Billing provider Info and phone number
    Required - identifies the provider that is requesting to be paid for the services rendered and should always be completed. Enter the physical location; PO Boxes are not acceptable. 
    • Required fields must be completed on all claim
    • Loop ID: 2010AA
    • Segment: NM103, NM104, NM105, NM107, N301, N401, N402, N403, PER04.
    See page 17 of the Provider Claims and Billing Manual.  
     

    Claims Payment Systemic Error (CPSE) report

    The Claims Payment Systemic Errors (CPSE) report is updated and posted on the ‘Alerts and Newsletter’ page monthly. AmeriHealth Caritas Ohio encourages you to review this log frequently and before contacting our Provider Services team. If you have additional questions, please feel free to reach out to Provider Services at 1-833-644-6001 and, as always, you can reach out to your local account executive.

    When should the provider submit an Appeal vs. Dispute?

    Item and Definitions

    Timeframe

    Contact Information

    Appeal

    Filed by the member or provider on behalf of the member (with a waiver), related to a denied Service/IP service (Prior Auth denials, Limit to service/Auth) when there is no claim on file.

    60 days from the date of denial letter sent by UM.

    Medical appeals may be submitted via:

     

    Mail: AmeriHealth Caritas Ohio

    Attn: Member Appeals Coordinator 

    PO Box 7346

    London, KY 40742

     

    Phone: AmeriHealth Caritas Ohio Member Services

    1- 833-764-7700

    (TTY: 1-833-889-6446)

     

    Secure contact formhttps://apps.amerihealthcaritasoh.com/securecontact/index.aspx

    Inquiry

    Provider asking for more information on a claim and how it was processed.

    None

    If determined the claim can be adjusted, then the inquiry is a dispute and should follow that timeframe.

    NaviNet portal (www.navinet.net)

    Dispute (or Provider Claim Appeal)

    Provider disagreeing with the way a claim was processed, paid, or denied.

    ODM outlines the following categories of items that are considered a dispute:

    • Claim Status
    • Eligibility
    • Other insurance
    • Improper claim submission 
    • Overpaid/underpaid
    • Provider not eligible to provide service
    • Payment amount clarification
    • Provider not credentialed
    • Duplicate claim
    • Timely filing 
    • Documentation issues 
    • Recoupments
    • Prior Authorization
    • Medical Necessity 
    • Level of Care (LOC)
    • Non-covered services
    • Provider affiliation 
    • Payment not received 
    • Patient Liability
    • Sterilization/Hysterectomy consent form 
    • Past Dispute Timeframe 

      12 months from the DOS or 60 days from the EOB date.

      Disputes may be submitted via:

      Phone: 1-833-644-6001 (Select the prompts for the correct department and then select the prompt for claim issues).


      NaviNet Portal: https://navinet.secure.force.com/ with the claims adjustment inquiry function. 


      Mail: The request must include a copy of the dispute resolution letter.

      AmeriHealth Caritas Ohio

      Attn: Provider Claim Inquiry Team

      PO Box 7126

      London, KY 40742 


      Fax: 1- 833-216-2272 

       

       

       

      Access the Provider Dispute Submission Form (PDF)

      Billing for Hospital Readmission

      For prompt and accurate payment processing, please consult ODM's Hospital Guidance on Hospital Readmissions found on page 31 of the Hospital Billing Guidelines.

       

      Please note, that ODM instructs the following concerning readmissions to a hospital:
      • If a recipient is an inpatient in a hospital, is discharged, then subsequently re-admitted to the same hospital within a day, the hospital must collapse the two inpatient stays into one admit through discharge claim. The hospital must report one non-covered day at the header and use Revenue Code 180 to report a non-covered day at the detail.
      • For example, if the recipient is hospitalized 1/1 and is discharged to a NF on 1/5, then re-admitted to the hospital on 1/6, the hospital must report one non-covered day for the first date of discharge (1/5) at the header, and one non-covered day at the detail level, RCC 180.
      Depending on which claim (hospital or NF) is paid first, the second claim will deny as a duplicate due to a systems configuration limitation that will not process two claims with overlapping dates of service (i.e., the day the patient is readmitted to the NF for 8 hours or more). As a workaround, if your claim is denied as a duplicate, please resubmit your claim via the 6653 process for manual review.

      Diabetes Self-Management Education Enhanced Reimbursement Rates 

      AmeriHealth Caritas Ohio and the Ohio Managed Care Organizations (MCOs) are working collaboratively to make diabetes management easier for providers and their patients. Diabetes education and support for the use of continuous glucose monitors (CGMs) have proven to be effective in diabetes care management.
      To facilitate increased utilization of these enhanced tools, AmeriHealth Caritas Ohio and the other MCOs will pay an enhanced rate to providers rendering Diabetes Self-Management Education (DSME) and billing the appropriate codes: G0108 and G0109. In addition, PA is not required for members who receive a covered CGM device through durable medical equipment (DME) providers or through their pharmacy. Providers must use HCPCS codes A4239 and E2103 for CGMs provided through DME.

                   

      Services rendered in 2023 should be submitted without delay to prevent denials.

      For additional information regarding these updates, including who to contact at each MCO for questions, see the quick reference guide on our provider website.

      Pain Self-Management Education (PSME) is in full swing!  

      PSME is a four-session educational program for adults living with chronic non-cancer pain. PSME teaches pain self-management, healthy lifestyle, mindfulness, and healthy coping skills, with the goal of empowering people to live full and productive lives with pain.

       

      This program is offered in collaboration with Meridian HealthCare at no cost to adults 18+ living with chronic pain and insured by ANY Ohio Medicaid plan.

       

      To refer to this program, please direct patients to contact Meridian HealthCare directly at 1-330-797-0070 or email chronicpain@meridianhealthcare.net. Additional program information and referral flyers can be obtained by contacting Jhilleary@AmeriHealthCaritasOH.com.

      PCPs can help combat infant mortality

      You have just confirmed a positive pregnancy on your patient. You have made a referral and facilitated her first OB appointment which is several weeks out. Now what? Submit a Report of Pregnancy (ROP). This is a reimbursable service that notifies the Managed Care Plans of the pregnancy. This will help ensure Medicaid eligibility without loss of coverage. Once AmeriHealth Caritas Ohio receives the ROP we will outreach the member. This can provide a great source of comfort and connection while the member awaits the first OB appointment. 

       

      We can help with the following:

      • Arrange transportation to appointments as needed
      • Connection to our Bright Start Program, AmeriHealth’s program designed specifically for the pregnant person
      • Have access to the Bright Start Team.  A team of Care Managers and Care Guides with specific training in working with pregnant people
      • Assist with WIC connection
      • Assess for food and housing instabilities and provide resources and support
      • Provide education on the importance of dental health in pregnancy and connection with a dental provider if needed
      • Assess for behavioral health concerns and provide linkage to a care provider as needed and desired
      • Assess for future needs such as crib, car-seat, and breast pump
      • Linkage to a specialized texting program where mom- to -be receives informative text education regarding pregnancy each week
      • Review the Prenatal Visit Care Card Incentive of $15 for completed prenatal visits (up to 7 visits)

        We are seeking providers to serve in advisory roles 

        AmeriHealth Caritas Ohio (ACOH) is seeking providers to serve in advisory roles to shape the Next Generation of managed care in Ohio. Partnering physicians will provide oversight and advise on policies and programs to help patients achieve better health outcomes and reduce the administrative burden for healthcare practitioners. Compensation provided for each meeting participation. Interested in advising? Please contact Bill Walters at wwalters@AmeriHealthCaritasOH.com.

         

        Quality Assessment and Performance Improvement Committee (QAPIC)

        • Purpose: Oversight of ACOH efforts to measure, manage and improve quality of care and services delivered to members/patients.
        • Meetings: Monthly, every 3rd Friday, 7-9 a.m. (subject to change based on provider preference). Meetings are virtual except for one in-person meeting annually.
        • Materials: Delivered electronically one week prior to meeting.
        • Role of external physician: participate in the Quality Improvement (QI) program through planning, design, and implementation/review of the QI program, committee/subcommittees, policy decisions, performance, etc.
        • Ideal candidates: Practitioners with an interest in helping to improve the lives of Medicaid members. Specialty/background in primary care (FM or IM), maternal and infant health (OB/GYN), or behavioral health (MD, DO, PhD).
        • Financial Compensation: $250 per meeting occurrence.

          Provider Advisory Council

          • Purpose: Input into design and improvement efforts for plan programming impacting members and providers. The council will also advise ACOH on clinical improvement efforts, determine options to reduce administrative burden, identify systematic challenges and barriers, problem-solve, share information, and collectively find ways to improve and strengthen the healthcare service delivery system.
          • Meetings: Meetings will occur four times per year, generally in the last week of each quarter. 
          • Materials: Delivered electronically before each meeting with pre-read material usually no longer than five pages.
          • Role of external physician: Provide input and feedback into design of programs and performance improvement efforts.
          • Ideal candidates: Specialty/background in primary care, medical/surgical specialty, or behavioral health provider (MD, DO, PhD) with interest in learning how managed care plans develop clinical quality improvement, reduction in provider administrative burden, healthy disparity reduction efforts.
          • Financial Compensation: $250 per meeting occurrence.

            Appointment availability

            As we all know, the health and well-being of our Medicaid population is our focus and main reason for being. Having access to quality care is so important to our members, your patients. In order to ensure that this is a top priority, please review with your team the importance of availability of primary and urgent care appointments. Federal guidelines require that providers support the following:

             

            Primary care appointments
            This is care provided to prevent illness or injury; examples include but are not limited to routine physical examinations, immunizations, mammograms, and pap smears. These are to be made available within six weeks or less.  


            Urgent care appointments (includes medical, behavioral health, and dental services)
            This is care provided for a non-emergent illness or injury with acute symptoms that require immediate care; examples include but are not limited to sprains, flu symptoms, minor cuts and wounds, sudden onset of stomach pain, and severe, non-resolving headache. Acute illness or substance dependence that impacts the ability to function but does not present imminent danger. These appointments are to be made available 24 hours, 7 days/week within 48 hours of request.

             

            Non-urgent sick primary care appointments

            This care is provided for a non-urgent illness or injury with current symptoms. These appointments are to be made available within three calendar days.

            Mobile Wellness, meeting communities right where they are
            Our Mobile Wellness and Opportunity Center can come to your community! Depending on availability and established criteria, you can work with AmeriHealth Caritas Ohio to
            conduct classes, wellness events, or health education within and around the bus.

            The mobile unit is equipped with kiosks where attendees can access computers and a private location where providers can perform health screenings and engage personally with members.

            Working with AmeriHealth Caritas Ohio, you can increase accessibility to services that address the social determinants of life and improve conditions for members of the community. We are pleased to offer this convenience at no cost to you and your community.
             
            For more information or to reserve time with the Mobile Wellness and Opportunity Center, click to complete the request form or email us at Comms@AmeriHealthCaritasOH.com. We welcome the chance to work with you to help people get care, stay well, and build healthy communities.

            NIA is becoming Evolent

            Evolent (formerly National Imaging Associates, Inc.) has consolidated its various companies (Evolent Care Partner; NIA Magellan; Vital Decisions; Evolent Health Services, IPG; and New Century Health) under a single brand: Evolent. This branding change will have negligible impact on providers, but you will start to see logo switch outs from NIA to Evolent on materials. Providers should continue to use RadMD.com to obtain prior authorizations. Phone numbers to reach Evolent will also remain the same as they were for NIA. For future updates, please see RadMD.com.

              Training

            CEU opportunity from AmeriHealth Caritas Ohio!

            On May 21, Dr. Michael Vilensky, PhD from The Ohio State University's Department of Psychiatry & Behavioral Health will present a virtual workshop: Introduction to Motivational Interviewing for Substance Use Disorders. This presentation will introduce key principles of Motivational Interviewing (MI). Learners will have an opportunity to practice important skills associated with MI and will be pointed toward resources to help develop their MI practice.

             

            This workshop has been pre-approved for 1.5 CEUs for Ohio Counselors, Social Workers, and Marriage and Family Therapists. Click here for more details and to register.

            Provider orientation
            We encourage our new providers to attend one of our live orientation sessions. These offer us the opportunity to welcome you, introduce ourselves, and share our unique member benefits, value-based care program, claims and billing information and our provider portal, NaviNet. Join your personal account executives online or contact your local Account Executive to schedule an individual orientation. Click here to see the entire calendar and register. 
             
            Don't forget to complete the attestation once you attend a session. The Ohio Department of Medicaid requires us to maintain a registry for the New Provider Orientation attendance.
            Cultural Competency Training
            AmeriHealth Caritas Ohio is committed to promoting education on and awareness of culturally and linguistically appropriate services (CLAS) and to combatting the effects of low health literacy on the health status of our members. There are several training opportunities on our website

            2024 Comprehensive Primary Care (CPC) Webinar Series with ODM

            ODM will virtually share program updates, resources, best practices, and more. They are scheduled on:

            • Thursday, September 19
            • Thursday, November 14
            Click here to register

            Ask a Sandata trainer

            Do you have questions about Electronic Visit Verifications (EVV)? You can schedule a private Zoom session with a Sandata trainer to discuss your EVV questions. The sessions cover: improving claims matching, solving reoccurring exceptions, and getting started with EVV.

             

            Did you know?

            Mental Health Awareness Month in May has been observed since 1949. 

            We ALL have a role to play in addressing and impacting the mental health needs of our members and communities.

             

            Fast facts

            • 1 in 5 U.S. adults experience mental illness each year
            • 1 in 20 U.S. adults experience serious mental illness each year
            • 1 in 6 U.S. youth aged 6-17 experience a mental health disorder each year
            • 50% of all lifetime mental illness begins by age 14, and 75% by age 24
            • Suicide is the 2nd leading cause of death among people aged 10-14

            Many patients you see within a given day could be amid a mental health crisis. You are key to screening for this and providing resources and intervention at this crucial time. 

             

            Additionally, if you recognize a member with a special, chronic, or complex health condition who may need the support of one of our programs, you can  Let Us Know by:

            If you or someone you know is experiencing a mental health or addiction crisis, call, text, or chat 988 in order to reach a trained specialist who can offer help and support. Your call is confidential and free 24/7.
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