When we receive urgent or critical information that can't wait for our newsletter delivery, we send you a Provider Alert.
New Items on Our Provider Education Page
2019 Suicide Safe Care Report
We hope you were able to participate in the Suicide Prevention Seminars we shared with you in our July 13, 2020, Provider Alert. Now available for your review on our Education Page is the 2019 Suicide Safer Care Report covering the Suicide Safer Care program results.
NIA Magellan Healthcare Requesting Feedback
Magellan Healthcare is interested in getting feedback on your experience working with Magellan Healthcare for the prior authorization of advanced imaging services. They are conducting several provider experience sessions and are asking for your participation.
For Your Information
Retrospective Authorizations - Conditions under which they may be performed:
The Medical Management Department makes retrospective medical necessity review decisions for the following services delivered without prior authorization and/or timely notification to Buckeye in the following circumstances:
- Inpatient admission for obstetrical delivery.
- Inpatient admissions when the member is still hospitalized
- Outpatient services when the patient is still receiving the out-patient services requiring authorization
- Retrospective review will also be performed based on contractual agreements with Buckeye.
- Retrospective review will occur due to extenuating circumstances, with appropriate documentation including:
- “Unable to know” situations: member was unconscious at presentation, member did not have Buckeye Health Plan ID card, etc. or
- “Not enough time” situations: member requires immediate medical services and prior authorization cannot be completed prior to service delivery. (urgent and Emergent situations do not require a PA)
- In cases of Retrospective Eligibility of a member (neither Buckeye nor the Provider knew the member was a BHP member at the time of service), but rather were notified of this by ODM after the date of service. In these cases, whether claims were already submitted and denied, or not yet submitted Provider may submit a retrospective authorization request and it will be reviewed for medical necessity.
Peer to Peer Mailbox for providers to request a Peer to Peer review: Buckeye_peer_to_peer_notification@CENTENE.COM (There are underscores between words in email address.) This is another option to request a Peer to Peer conversation in addition to the current phone number (866 246-4356 X 24084).
New Covid-19 ICD-10 Procedure Codes
The Center for Medicare & Medicaid Services (CMS) has new COVID-19 ICD-10 procedure codes that will be effective date on 8/1/2020. The codes and their description are can be found on the CMS Procedure Code List (PDF).
Buckeye/Everlywell Send HbA1c Test Kits to Members
Buckeye is pleased to partner with Everlywell to reach our members that are currently prescribed atypical antipsychotic medications and ask them to complete an HbA1c home test. We are sending members an at home test kit, instructions for use and how to receive their results. The kit also provides telephonic contact information to assist the member, if needed. Additionally, the member will receive $50 on their MyHealthPays card when completing the test. Results will be sent to the member, their behavioral health physician and the Buckeye care team. Contact our Provider Services at 866-296-8731 if you have any questions.
Enrolling Your NPI in ODM
For your reference: according to paragraph (D) of the Ohio Administrative Code (OAC) rule 5160-1-17, which took effect November 25, 2019, all Medicaid providers are required to have a National Provider Identifier (NPI) number, and report it to the Ohio Department of Medicaid (ODM) upon enrollment. If you currently don’t have an NPI, ODM is offering a helpful educational document to help obtain your NPI, which can be found at the link below.
Suicide Prevention Seminars - Free
Buckeye is proud to share an opportunity for Ohio’s clinicians to participate in free virtual suicide prevention training. One of Centene’s strategic partners, Association of Clinicians for Underserved Populations (ACU) is collaborating with the Ohio Association of Community Health Centers (OACHC) to offer two virtual suicide prevention training opportunities – one for PCPs and the other for Health Center leaders. Both trainings are adapted to address the potential impact of COVID19 on suicide rates and the second, on July 30, specifically addresses the higher risks for clinicians themselves as a result of the pandemic.We hope you will take advantage of these training opportunities by registering below and identifying yourself as a Buckeye provider.
- July 23 - Suicide Safer Care Training 1: Suicide Safer Care for Primary Care Providers and their Teams
- July 30 - Suicide Safer Care Training 3: Considerations for Health Center Leaders.
- ACU’s research indicated that although a significant portion of people who attempt/commit suicide saw their PCP in the month prior, many PCPs express a lack of comfort discussing suicide with their patients. In addition, they often lack the information/tools needed for best practice interventions.
- According to the Ohio Department of Health, suicide is the leading cause of death in Ohio for 10-14 y/o and second leading cause for 15-34 y/o.
- Governor Mike DeWine's Recovery Ohio initiative addresses mental illness and other issues that contribute to suicide. This initiative’s early recommendations include "Establish statewide prevention coordination with all state departments and agencies to ensure best practices, consistent messaging, technical assistance, and delivery of prevention services across multiple domains." The Suicide Safer Care trainings serve as a significant response those recommendations.
ODM Reinstated Prior Authorization Guidelines
The Ohio Department of Medicaid (ODM) has updated prior authorization (PA) guidelines: Effective July 1, 2020, all medical & behavioral health PA requirements will resume. These updates will be accurately reflected in the Buckeye Health Plan Secure Provider Portal.
Prior Authorization Retrospective Reviews
In our July 1, 2020, communication we notified providers of Buckeye Health Plan’s schedule to perform retrospective reviews of claims submitted without proper PA during the COVID crisis period. See the schedule here.
For your reference, the ODM April 9, 2020, Emergency Provider Agreement outlined three PA options for providers during this crisis period. A brief reminder of the options are below. Please note: Option 1 is the only option that eliminated the need for managed care plan retrospective reviews.
- Maintain the current course: Continue standard practice to submit PA requests with clinical documentation. This option will prevent retrospective reviews/takebacks later.
- Seek administrative authorization: Request administrative authorization with minimal member identifiers. The Plan assigns an authorization number to use with claim submission.
- Bypass prior authorization: Request no PA. Claims will be paid without authorization.
Please review the ODM April 9, 2020, Emergency Provider Agreement (PDF) for more details.
Timely Filing for Behavioral Health Claims
The MCP shall accept claims for behavioral health services described in OAC Chapter 5160-27 for 365 calendar days from the date of service.