June 2019

Featured Story: We Are Growing

More and more members and employers are selecting AllWays Health Partners because of our comprehensive coverage, innovation, and world-class provider network.

In this Issue

• RSVP Today For Our June 14 Provider Meeting
• We Are Growing
• Reminder: Your Laboratory Claims Will Reject If the Referring Provider Field is Incomplete
• GIC Plan Year Begins on July 1
• HCAS Provider Directory Newsletter
• Formulary Updates
• Drug Fee Schedules To Be Updated
• Medical Policy
• Code Updates
• Contact Information

RSVP Today For Our June 14 Provider Meeting

AllWays Health Partners Provider Relations is hosting our next meeting on Friday, June 14th at our headquarters in Assembly Row, Somerville.

Join us to hear the latest news and updates.

Lunch will be served.

• Topics will include:
  • Product updates and information
  • Authorization updates/reminders
  • Important websites and resources
• Date: Friday, June 14, 2019
• Time: Doors open at 11:30 AM, Presentation 12:00-1:00 PM
  Location: Partners HealthCare campus
  • 399 Revolution Drive
    Assembly Room B
    Somerville, MA 02145
• Parking: Visitor parking is available in the on-site parking garage. Parking is FREE without
  validation for the first 3 hours.
• RSVP: Click Here

We are Growing

AllWays Health Partners is one of the fastest growing health plans in the region. More and more members and employers are selecting AllWays Health Partners because of our comprehensive coverage, innovation, and world-class provider network.

We are excited to share that the Town of Hopkinton has selected AllWays Health Partners to provide health coverage to their employees and covered dependents beginning on July 1, 2019.

Additionally, here's a look at some of the new employer groups that recently switched to AllWays Health Partners in just the past few months:

• Paul W. Marks Co., Inc.
• VERC Enterprises, Inc.
• MaryLou's Coffee
• Norel Services Co., Inc.
• Kelly's Roast Beef, Inc
• Midtown Home Health Services, Inc
• Barrett Restaurant Group
• Lawton Welding Co., Inc.
• Cooperative Production, Inc.
• Orthopedics New England
• St. Sebastian's School
• Behavioral Connections, Inc.
• OCEANAIR, Inc.
• Sizer School
• A-Affordable Insurance Agency

Reminders:

As member eligibility can change through the year, here a few tips to share with your staff:

1. Prior to the service, use the Provider Portal verify active eligibility for your patient
2. Check member benefits and cost share information
3. If required, obtain the necessary referrals and prior authorizations

AllWays Health Partners' Provider Portal gives you 24/7 access to important information and transactions.

For additional support, contact Provider Service at 855-444-4647. We are available Monday through Friday, 8:00 AM to 6:00 PM.

Reminder: Your Laboratory Claims Will Reject If The Referring Provider Field is Incomplete

Federal regulations require that the referring provider be included on all laboratory service claim submissions. Please refer to the HIPAA X12 standards for additional information on
this requirement.

For facility and professional laboratory claims submitted on or after June 1, 2019 that do not include the referring provider, the claim will reject as noted below. To ensure your lab claims are processed appropriately, please identify the referring provider on all laboratory claims.

Claims submitted without a referring provider will reject with the following message:

STC*A7:21:DN

A7 Acknowledgement/Rejected for Invalid Information - The claim/encounter has invalid information as specified in the

Status details and has been rejected.

21 Missing or invalid information.

DN Referring Provider

Please share this information with the appropriate billing staff within your organization.

GIC Plan Year Begins on July 1

As a reminder, the upcoming GIC plan year will begin on July 1, 2019. As required by the GIC, all specialty care will be tiered. Tier designations will be based on the provider group level: Tier 1 (Lower Cost) or Tier 2 (Higher Cost). You can look up provider tier designations on our online provider directory.

For all services, please remember to always verify the latest member eligibility, cost share and benefit information.

For the latest information our pharmacy programs, visit our online formulary today.

HCAS Provider Directory Newsletter

HealthCare Administrative Solutions, Inc. (HCAS) member plans have partnered with CAQH to improve the accuracy of provider directories, as well as the timeliness and efficiency of making demographic updates.

This will result in a better experience for members, who rely on directories to select and contact clinicians, and providers, who will be able to update directory information in a streamlined way.

Check out the HCAS Provider Directory Newsletter for the latest updates.

Formulary Updates

AllWays Health Partners regularly reviews and updates our formulary. Check out the latest updates effective August 1, 2019.

For the latest information on our pharmacy programs, visit our online formulary today!

Drug Fee Schedules to be Updated!

AllWays Health Partners reviews its drug fee schedules quarterly to ensure that they are current, comprehensive and consistent with industry standards, to the extent supported by its systems. In most cases, changes involve adding fees for new or existing codes to supplement the fees already on the fee schedule.

The next update will occur on July 1, 2019. 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.

Medical Policy

The following medical policy updates are effective June 1, 2019:

Acupuncture - Annual update.

Definition of Skilled Care - Annual update

The following medical policy updates are effective July 1, 2019

• Gender Affirming Procedures - Annual review.
  • Changed title of policy from Gender Reassignment Treatment to Gender Affirming Procedures.
  • Revised overview section to include hormone therapy and My Care Family language.
  • Under Gender Affirming Surgery section, removed requirement that the diagnosis of gender dysphoria be done by a behavioral health provider.
  • Under Gender Affirming Surgery section, removed requirement that the member complete 12-month, real life experience trial.
  • Changed subheading name from Genital Surgery to Vaginoplasty, Metoidioplasty, Phalloplasty.
  • Under subheading Vaginoplasty, Metoidioplasty, Phalloplasty, added documentation requirement of 12 continuous months living in a gender role congruent with their gender identity.
  • Added Adolescent Members criteria section.
  • Revised criteria under Facial Feminization/Masculinization section.
  • Revised Exclusion section
• Prostheses - Lower Limb - Annual review. Exclusion list added.
• Prostheses - Upper Limb - Annual review. Exclusion list added

Click Here to view all medical policies.

Code Updates

May 2019 Code Updates

The following codes are covered; no prior authorization required:

The following codes/services are not covered as they are considered experimental/investigational:

The following service is not covered:

Vaccine Codes

The following codes are covered; no prior authorization required: