Connection supplemental articles and policies - July 2009
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Connection - July 2009 (pdf, 77 KB)
Supplemental articles
Payment policies
The following policies are new:
The following policies have been reviewed. Changes are indicated on the policies and summarized in the print version of Connection:
Changes to preauthorization process for home health
We’re pleased to let you know about some exciting changes to our preauthorization process for skilled home health care services—that is, visiting nurse services.
Beginning April 28, 2009, FCHP’s contracted vendors will no longer need to request preauthorization for in-home skilled care. Claims meeting the criteria can be submitted in the usual manner.
FCHP will continue to require preauthorization for commercial plan hospice care. In addition, any skilled home health care services provided by an FCHP non-contracted vendor will continue to require preauthorization.
When referring members for skilled home health care, home health care agencies have the responsibility to ensure their services meets the Centers for Medicare & Medicaid Services Home Health Service Conditions. These regulations can be found on the CMS Web site at cms.hhs.gov/manuals/Downloads/bp102c07.pdf.
In addition, effective April 28, 2009, FCHP’s contracted home infusion vendors will no longer need to obtain preauthorization for the following home infusion services:
- In-home nursing care
- Catheter insertion kits and supplies
- Catheter care maintenance supplies
- Total parental nutrition and supplies
- Hydration therapy and supplies
Claims meeting the criteria for these services can be submitted in the usual manner.
No changes
Any home infusion services provided by an FCHP non-contracted vendor will continue to require preauthorization.
There has been no change to the list of medications that require preauthorization from our Pharmacy Services Department. The current preauthorization process continues to apply. The FCHP formulary can be found at fchp.org/Extranet/Providers/OnlineDrugFormulary.htm. Any medication requiring preauthorization will be designated with “PA” in the requirements column.
Enteral therapy formula and supplies will continue to require preauthorization. Vendors need to submit requests by fax to our Utilization Management and Special Services Department at 1-508-368-9700.
MMIS information for MassHealth and Commonwealth Care providers
MassHealth introduced the new MassHealth Medicaid Management Information System (NewMMIS) in May 2009. NewMMIS provides MassHealth with increased flexibility to establish and manage effective benefit-plan structures, implement new payment methodologies and support the timely delivery of services to MassHealth members. Real-time claims processing and online services will reduce administrative burdens on the provider community.
The former Recipient Eligibility Verification System (REVS) has been replaced by the NewMMIS Eligibility Verification System (EVS), now available through the Web-based Provider Online Service Center. To take full advantage of the benefits of the Provider Online Service Center, including the ability to verify member eligibility, MassHealth recommends that providers arrange Internet access for all appropriate staff.
For questions and clarifications on NewMMIS and provider online services, MassHealth and Commonwealth Care providers should go to MassHealth’s NewMMIS Web site at mass.gov/masshealth/newmmis. You also may contact MassHealth Customer Service at providersupport@mahealth.net, call 1-800-841-2900 or fax your inquiry to 1-617-988-8974.
MassHealth training program for fluoride varnish application
As you may be aware, effective October 1, 2008, physicians and other qualified health care professionals may now apply fluoride varnish to eligible FCHP MassHealth members under age 21. This procedure would occur during a pediatric preventive care visit. The goal is to increase access to preventive dental treatment in an effort to prevent early childhood cavities in children who are at moderate to high risk for dental decay.
Eligibility for fluoride varnish application is primarily intended for children up to age three, but is allowed for children up to age 21 who don’t have access to a dentist. Providers seeking to apply fluoride varnish to MassHealth children under the age of 21 are required to complete a MassHealth-approved training program. Providers have the option of completing:
- A MassHealth-approved self-administered Web-based training;
- A MassHealth-approved instructor-led training session; or
- A program sponsored by the Department of Public Health’s Office of Oral Health, targeted to community health centers.Providers must maintain proof of completion of the training (CME credit documentation or certificate) and provide such documentation to MassHealth upon request. To learn more about the approved MassHealth training opportunities, please visit mass.gov/masshealth/fluoridevarnish.