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Provider Notices

provider notice

Provider Notices are sent when we have specific notices from ODM, CMS or Buckeye operations/policies that you need to know, but can’t wait for the newsletter.

Thank you for your partnership with Buckeye Health Plan. In addition to other Buckeye member vaccination initiatives, we are also working with our parent company, Centene, to navigate the COVID-19 pandemic to ensure our members have the support they need in their efforts to get vaccinated. We have recently undertaken an initiative in support of the national goal to vaccinate 70% of eligible Americans by July 4th, and we hope to enlist your support in this work

We are contacting our members across all lines of business for whom we did not have evidence of a COVID-19 vaccine.  We asked them to indicate their vaccination status over the phone. We have posted a preliminary roster of your unvaccinated members to our secure provider portal.  We will post an updated file when our member outreach is complete

As we work together to keep our members healthy, we are counting on you to help your Buckeye patients get vaccinated, address any concerns they may have about the vaccine, and offer guidance on the best way to find an appropriate vaccine site in your community.  The rosters posted in our secure portal include each unvaccinated member’s name and phone number for easy outreach, and we are asking you to contact them and encourage them to get vaccinated.

To navigate to the roster of unvaccinated members, log into the secure portal at Buckeye Provider Home Page.  Once in the portal, go to the “Welcome” center on the right-hand side of the screen and click on the “Reports” tab.  From there you will be able to find and download date-stamped member roster files.

If you have any questions about this program you may reach Provider Services at 866.296.8731.

May 13, 2021

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.
 

New Somatus Care Management Program for Patients with CKD/ESRD

[Applicable to Allwell Advantage HMO Providers]

Effective June 1, 2021, Buckeye will partner with Somatus Inc., to establish a care management program for members with end-stage renal disease and chronic kidney disease. Some of your patients may qualify for this program.

Patient benefits include:

  • Care management of kidney disease and comorbidities
  • Instruction to better understand the condition, treatment options and diet
  • Help to transition from hospital to home
  • Guidance in transplant options

Social workers can help with transportation, food or other issues that limit the member’s compliance with treatment. 

We will be in touch with you about your eligible patients. If you have questions before we contact you, please call Somatus at (855) 851-8354, Monday-Friday from 9 a.m. to 5 p.m. Eastern Time.

Prenatal Risk Assessment Form (PRAF) Overview/Checklist

A complete PRAF helps Moms receive the best support for a healthy pregnancy

As you know, it’s important to ensure pregnant moms maintain Medicaid eligibility throughout pregnancy and during the immediate post-partum period. Buckeye is dedicated to helping our providers with the tools they need to make their job easier. Download our new PRAF Overview/Checklist.
 

Prior Authorization Changes – Preferred Biosimilar Changes Effective 11-21-2020

On November 21, 2020, the following changes will take effect.

Epoetin alfa-epbx, Retacrit, Q5105 and Q5106 will be the preferred erythropoiesis-stimulating agent (ESA) for new and continuation therapy. 

This change effects the following site of care settings: provider-administered, outpatient hospital or ambulatory care center. Please see the announcement for full details