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On June 1, 2021, Plan Waivers for Applicable COVID-19 Treatment and Telehealth Services Expire

As we continue to address the COVID-19 pandemic, we want to update you on important changes for our Medicaid and Medicare plans. Last year, we instituted temporary prior authorization waivers for both plans for select services to ensure critical care could be quickly delivered to our members during a time of heightened need. In addition, we instituted temporary member cost share liability on our Medicare plan. On June 1, 2021, these temporary waivers expire. Please see our COVID website page within for full details for each plan.

Behavioral Health Providers

[Applicable to all Medicaid and Medicare Providers]

Thank you for being a valued partner and providing outstanding care to our members, your patients. In our efforts to streamline the prior authorization process and remove some administrative burden, we are implementing the following changes related to behavioral health services:

  • Effective 3/15/20 forward, providers are no longer required to obtain a prior authorization for ACT (H0040) and IHBT (H2015) for the first six months of treatment.
    • After 6 months of treatment/billed services, a prior authorization will be required for both ACT (H0040) and IHBT (H2015) services. All billed services after 6 months without an authorization will deny.

If you have any questions or concerns about the policy changes above, please outreach your local provider relations team member or contact our provider services team at 866-296-8731.


MyCare Home Health RN Assessment Extension

In our ongoing efforts to make working with Buckeye as easy as possible, we are modifying our Home Health RN assessment billing policy.

  • Buckeye’s current policy allows for 1 RN assessment, without authorization, to be billed every 60 days. If there is significant change in condition, we allow an additional authorized RN assessment(s) during that time period.
  • Buckeye’s new policy: allows for 1 RN assessment, without authorization, to be billed every 60 days and we allow an additional RN assessment, without authorization, in the time period of 56 to 60 days.

All other aspects of the Home Health RN assessment billing policy remains the same.

We have updated our claims system configuration to allow for this additional assessment as of April 19, 2021, with an effective date back-dated to January 1, 2019. Buckeye will work with our contracted providers to reprocess claims for one RN assessment falling in the 56-60 day timespan for reimbursement.

Please contact Provider Services with any questions.