Providers - What's New for Providers

What's New for Providers

OHP Injectable Mental Health Medication Notice

All mental health medications regardless of the route of administration are carved out of the managed care benefit for Oregon Health Plan (Medicaid) members and are covered directly by the Division of Medical Assistance Programs (DMAP). This is based on Oregon Administrative Rule 410-141-0070 (1), (8-11).

As of 9/1/10, CareOregon will no longer process medical claims for injectable mental health medications.

This PDF lists the procedure codes that will be excluded from payment by CareOregon.

New Provider Search Function

To make it more user-friendly and helpful for providers and members, CareOregon is redesigning our web site. Our first change is to the Provider Search function.

Beginning June 28, 2010, our new, enhanced search function will enable users to search for primary care providers, specialists, pharmacies, durable medical equipment vendors, etc. for each CareOregon plan (CareOregon Medicaid Plus and Standard, CareOregon Advantage Plus HMO or CareOregon Advantage Star HMO).

Web users can search by city, county, ZIP code or their own address. A special advantage will be the new mapping function, that shows users exactly where a provider is located.

Plus, information is available regarding which languages a provider speaks, what hospital or clinic the provider is associated with, and whether or not the primary care provider is accepting new patients.

If you have any questions about the new search function, please call Customer Service at 503-416-4100 or 1-800-224-4840.

Text4Baby

Text4Baby is a new service that provides text tips to your patient’s cell phone. There is no cost for the text and all messages are based on the patient’s own due date. Text4Baby helps pregnant moms know what to expect throughout the pregnancy and after the birth. To sign up, they can go to www.text4baby.org or just text Baby (for English) or Bebe (for Spanish) to 511411.

National Health Service change leaders share experiences, opportunities with Oregon legislators and health care leaders

In March 2010, Paul Corrigan and Helen Bevan from Britain’s National Health Service met with Oregon clinicians and health care advocates. Britain’s health service was once seen as an example of how not to nationalize health. Through innovation and quality improvement, the NHS is now a global success story.
Oregon nurses, doctors, legislators, and health administrators, insurers and advocates, talked with these NHS representatives about how we can move the focus from providing health care to creating a healthier population.

Learn more, watch the presentations, and download materials from the event

Prioritized List Application Change

To reduce costs, CareOregon will delete our Prioritized List application effective June 1, 2010. DMAP has a Prioritized List application, HSC (Health Services Commission) inquiry, within their Medicaid Management Information System (MMIS). To assist you with this transition, CareOregon prepared a Q&A document, "Frequently asked questions about the MMIS HSC Prioritized List."

If you can access any DMAP MMIS modules (eligibility, for example), open the State Health Care Authority's secure website and log in to open the Prioritized List application.
If you have not registered with DMAP MMIS, open the OHP Provider Web Portal to find information on account administration, eligibility verification, prior authorization, billing, adjustments and training.

Care Support and System Innovation (CSSI) Program

The CSSI Program seeks to support provider organizations that identify and support teams to lead projects and initiatives that improve health care delivery and outcomes. These teams will use the Model for Improvement to create change in their organizations. Each project demonstrates improved design, outcomes reporting, institutional commitment and capability. Read more…

Consultation codes no longer accepted for billing

Effective immediately CareOregon follows CMS guidelines and no longer accepts consultation codes (99241-99245 and 99251-99255) for all lines of business. Providers should code a patient evaluation and management visit with E/M codes that represent where the visit occurs and the complexity of the service performed.

This policy applies to services provided on and after January 1, 2010. CareOregon still covers consultation office visits for our members when medically appropriate. Remember to code the visit correctly with E/M codes.

For more information on our prior authorization guidelines, refer to the “Medical Management Policies and Forms” section on our website, www.careoregon.org/provider/policies.html.

The following URL is an article from CMS about this change: www.cms.hhs.gov/MLNMattersArticles/downloads/MM6740.pdf.

The official instruction, CR6740, issued to Medicare MACs and carriers about this change is at www.cms.hhs.gov/transmittals/downloads/R1875CP.pdf.
Documentation guidelines for Evaluation and Management Services are at www.cms.hhs.gov/MLNEdWebGuide/25_EMDOC.asp.

If you have questions or need help, please call CareOregon Customer Service at 1-503-416-4100 or toll-free at 1-800-735-2900.

Prior Authorizations for Medical services alert!

CareOregon is implementing a new document management system for medical prior authorizations. This system will allow incoming faxes to be immediately seen in a paperless system.

The new system will benefit our providers because all documents will be searchable. The ramp-up period may add processing time to service requests. Our average turnaround is three days. Authorizations that require more information or medical-director review may take longer. We anticipate an increase to seven days during implementation. Please consider this when requesting a service – the longer the lead time you can give us, the better.

Also, if a service is scheduled, please include the date on your request. We anticipate that this impact may last 4 to 6 weeks. Thank you for your patience during implementation.

Hiding Won’t Work… ICD-10 is coming!

CareOregon is actively preparing for the change to ICD-10. We are committed to helping our partners in healthcare prepare, too. Keep an eye out for more information as we get closer to key dates.

CMS has mandated that the 30-year-old ICD-9 diagnostic coding system be replaced by the more flexible ICD-10 CM and PCS system. The advantages of this change include greater clinical detail and updated medical terminology. For example: ICD-9 has a single code for an injury of a lower limb nerve. ICD-10 CM has more that 40 choices depending on criteria such as which nerve, which side and where the patient is in the treatment timeline, from the initial visit through any late effects of the injury.

The deadline for nationwide conversion is October 2013. Part of the preparation for this change includes updating from the HIPAA 4010 transaction record to the 5010 version to accommodate the new seven digit diagnosis and procedure codes. The deadline for full implementation of the 5010 is January 2012.

We are on track to begin external testing of the 5010 by the required January 2011 date.

For more ICD-10 and 5010 information including key dates, please visit http://www.cms.hhs.gov/ICD10/01_Overview.asp#TopOfPage

For questions specific to CareOregon’s preparations, please contact your Network Relations Associate.

The CareSupport Program

The CareSupport Program provides multidisciplinary, person-centered case management services to CareOregon members who: (1) are at risk for or experiencing a functional health decline because of lack of appropriate supports or self management, (2) are using the health care system ineffectively or inappropriately, or (3) are experiencing a significant health-related transition in their life, such as hospital discharge to home with advanced disease. CareSupport staff work to optimize the productive interaction between the patient and provider, working closely with both the patient in becoming informed and activated and the medical team in being prepared and proactive in the medical home.

Please review additional information about the CareSupport Program and how we can work with you to improve the health of your patients.