Provider Monthly: Interqual updates, editing system upgrade, and recognizing national recovery month in September 2021
Meet Barry Shelton: peer recovery coach at AllWays Health Partners
Did you know that AllWays Health Partners was one of the first health plans in the country to have peer recovery coaches on staff? Seeing as September is National Recovery Month, we want to take this timely opportunity to share some of the life-changing work of our Peer Recovery Coaches and the impact that has on members' access to the different pathways of recovery.
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In this issue:
- On-demand webcast by Optum
- AllWays Health Partners’ Drug fee schedules to be updated
- Claims editing system upgrade
- InterQual 2021 Updates
- Cardiac Imaging- change in PA status
- COVID-19 specimen collection
- Urgent authorization requests
- Revised medical policies
- Code updates
- Formulary updates
On-demand webcast by Optum
Sign up now for Behavioral Health Identification, Treatment and Referral in Primary Care - A 3-Part On-demand Learning Series from Optum (earn up to 3 credits)
AllWays Health Partners’ Drug fee schedules to be updated
The next update will occur on October 1, 2021. Changes may involve both new and existing CPT and HCPCS codes, and will include the planned quarterly update to physician administered drugs, immune globulin, vaccine and toxoid fees.
Claims editing system upgrade
We upgraded our claims editing system to better reflect the industry standards within the New England market. Effective August 16 we moved to ClaimsXten. This will improve claim accuracy and reduce appeals. For more information, visit their website.
InterQual 2021 updates
Cardiac Imaging- change in PA status
Effective immediately (9/1/2021), prior authorization is not required for the following CPT codes related to Cardiac Imaging:
Covid-19 specimen collection
Beginning September 16, 2021, Covid-19 specimen collection will be no longer be separately reimbursable for the MassHealth LOB. Specimen collection is included in the reimbursement of the Covid-19 lab test or Evaluation and Management Service. For more info, visit mass.gov
Urgent authorization requests
Reminder for providers: If you have an urgent authorization request you should page the on call nurse reviewer at 1-855-444-4647 after submitting the authorization and corresponding clinical information, otherwise there could be a delay in these urgent requests.
Medical Policy Updates -September 1, 2021 Effective Date
5 medical policies were reviewed and passed by the AllWays Health Partners Medical Policy Committee. These policies are now posted to allwayshealthpartners.org
The table below is a summary of the policies and the changes:
For more information or to download our medical policies, go to allwayshealthpartners.org/providers/medical-policies and select the policy under the medical policy listings.
CPT Code Updates
Drug Code Updates