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July 13 Provider Alert

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.

ODM NPI Educational Document (PDF)

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.

Please Note

  • 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.

  1. Maintain the current course: Continue standard practice to submit PA requests with clinical documentation. This option will prevent retrospective reviews/takebacks later.
  2. Seek administrative authorization: Request administrative authorization with minimal member identifiers. The Plan assigns an authorization number to use with claim submission.
  3. 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.

Remind Your Patients:
Buckeye has Robust Transportation Benefits

As part of our medical benefits, Buckeye offers our member’s outstanding transportation coverage.

Round trip coverage for covered services 30+ miles away.

  • Offers 15 round trips (30 one-way) per member per 12-month period to covered:
    (Note: Women and children have unlimited trips for medical appointments)
    • Dental visits
    • Prenatal care appointments
    • Primary care office visits
    • Childhood immunizations
    • Specialist appointments
    • Urgent care centers
    • WIC appointments
    • Redetermination (face-to-face) visits with caseworkers/CDJFS
  • Pharmacy transportation as a 3rd leg of a trip.
  • Grocery store visits - 5 trips per member per year.

For specific ride details in a member’s area:

  • Visit or call Member Services at 1-866-246-4358.
  • To schedule transportation, members can call directly 48 hours (two business days) in advance.
  • If transportation is needed for an urgent medical appointment, when verified by the doctor, we will arrange for a direct pick-up, without waiting 48 hours.