Provider News ConnecticutJune 2020 Anthem Connecticut Provider NewsWe want to express our most sincere thanks for your dedication to serving the patients in your care. Please take a moment to watch this brief thank you message from Anthem.
Like many, Anthem is closely monitoring COVID-19 developments and what it means for our customers and our health care provider partners. We are working to help employers who are facing tough decisions on furloughing or reducing hours of their workforce. Anthem is doing this by creating health insurance options that provide continued access to care. We continue to seek ways to support our customers by offering affordable alternate products with more flexibility while ensuring members can continue to see their established physicians.
Beginning June 1, 2020, we are introducing our Anthem Health Access Plans for certain large group employers currently enrolled in our commercial lines of business only.
Anthem Health Access Plans cover the diagnosis and treatment for COVID-19 at 100% in accordance with Anthem guidelines.
These benefit plans cover preventive care, unlimited telemedicine, office visits, prescriptions, and more. In addition, members enrolled in these plans have digital ID cards and access to Sydney Health and Sydney Care (Anthem’s mobile app that runs on intelligence – as part of our digital strategy).
These plans include some coverage exclusions or limitations. For information about eligibility, available benefits, and a list of exclusions, please visit Availity – our Web-based provider tool at www.availity.com.
We are committed to working with our provider partners to help our members focus on their health and well-being. The new Health Access plans give your patients the needed coverage to manage their everyday health needs.
NOTE: As with all eligibility and benefits inquiries on Availity, providers must have the member ID number (including the three-character prefix) and one or more search options of date of birth, first name and last name.
We are now using the Notification Center on the Availity Portal home page to communicate vital, time sensitive information to you. A Take Action call out and a red flag in front of the message will make it easy to see that there is something new requiring your attention.
The Notification Center is currently being used to notify you if there are payment integrity requests for medical records or recommended training in the Custom Learning Center. Select the 'Take Action' icon to instantly access the custom learning recommended course.
For membership where the disputes tool is available, Availity will also post a message in the notification center when a dispute request you have submitted is finalized. Selecting the 'Take Action' icon will allow easy access to your appeals worklist for details.
View the Notification Center updates regularly so you are always aware of any outstanding action items and can respond timely.
The American Medical Association has an alphabetical listing of clinical conditions with which measures and CPT Category II codes are associated. The use of CPT Category II Codes and ICD-10-CM codes can reduce the number of medical records that we request during the HEDIS® medical record review season (January – May each year), thus reducing the administrative burden on physician offices.
The PDF attachment to this article contains some commonly used codes for your convenience. This information applies to both Commercial and Federal Employee Program® (FEP®) members.
We are committed to collaborating with providers and offering flexible options to meet the needs of both the retrospective program and the prospective program. The retrospective program focuses on medical chart collection. The prospective program focuses on member health assessments for patients with undocumented hierarchical condition categories (HCC’s) in order to help close patients’ gaps in care.
Retrospective chart requests
We appreciate that care providers across the country on the front line are committed to providing care during these challenging times, and as such, that care results in a visit where we may need the medical chart. Medical chart collection must be done to obtain undocumented HCC’s on your patients in order to be compliant with the provisions of the Affordable Care Act (ACA) that require our company to collect and report diagnosis code data for ACA membership. This process will begin in June. We have electronic options available to help make these chart requests the most efficient for your office:
- EMR interoperability
- Allscripts (opt in -- signature required)
- NextGen
- Athenahealth
- MEDENT
- Remote/Direct Anthem access
- Vendor virtual or onsite visit (if the offices are opened back up from COVID-19 closures)
- Secure FTP
The goal of these electronic options is to both improve the medical record data extraction and the experience for Anthem’s contracted providers. If you are interested in this type of set up or any other remote access options, please contact our Commercial Risk Adjustment Network Education Representative, Alicia Estrada, at Alicia.Estrada@anthem.com.
Prospective patient outreach (Incentive opportunity for properly completed health assessments: physicians are eligible to receive $100 for electronic submissions or $50 for paper in addition to the office visit reimbursement.)
We encourage members to form a relationship with their primary care physician to complete a clinical assessment to ensure you have a clearer picture of your patients’ health. Telehealth visits are an acceptable format for seeing your patients and assessing if they have risk adjustable conditions. Previous Anthem news updates have given telehealth reimbursement guidance to follow when submitting the claim.
As a reminder, we included information about the incentives for prospective program participation in the May 2020 issue of Provider News. We would be happy to meet and review incentive opportunities along with other flexible options for program participation and chart collection. Please contact Alicia Estrada at the email address above to set up a meeting.
Thank you for your continued efforts with the CRA Program.
We are excited to announce improvements to the process for submitting behavioral health authorization requests. We have enhanced the Interactive Care Reviewer (ICR) tool on the Availity Portal to provide the opportunity for quicker resolutions.
The ICR tool on the Availity Portal will now utilize sophisticated clinical analytics in order to provide an immediate decision on an authorization for higher levels of care such as inpatient, intensive outpatient (IOP) and partial hospitalization (PHP). Here are a few of the many reasons behavioral health providers will benefit from using ICR with the newly enhanced functionality:
- Reduction of administrative burden
- Quicker access to care for certain services deemed eligible for our immediate decisions
- Increased member focus
- Prioritizes more complex cases
- Reduced possibility of errors such as illegible faxes
- Maximize the amount time spent with members
Follow these instructions to access ICR through the Availity Portal (www.Availity.com). First, ask your Availity administrator to grant you the appropriate role assignment.
- Do you create and submit prior authorization requests?
- Required role assignment: Authorization and Referral Request
- Do you check the status of the case or results of the authorization request?
- Required role assignment: Authorization and Referral Inquiry
Once you have the authorization role assignment, log onto Availity with your unique user ID and password follow these steps.
- Select ‘Patient Registration’ from Availity’s home page
- Select ‘Authorizations & Referrals’
- Select ‘Authorizations’ (for requests) | Select ‘Auth/Referral Inquiry’ (for inquiries)
Training
Follow these instructions to access ICR on demand training through the Availity Custom Learning Center:
- From Availity’s home page, select: Payer Spaces | Anthem tile | Applications | Custom Learning Center tile.
- From the Courses screen use the filter catalog, and select ‘Interactive Care Reviewer – Online Authorizations’ from the menu and click ‘Apply’
You will find two pages of online courses consisting of on demand videos and reference documents illustrating navigation and features of ICR. Enroll for the course(s) you want to take immediately or save for later.
As a provider, we understand you are committed to providing the best care for our members, including follow up appointments with members after a behavioral health (BH) inpatient stay. Since regular monitoring, follow up appointments and making necessary treatment recommendations or changes are all part of excellent care, we would like to provide an overview of the related HEDIS measure.
The Follow-Up after Hospitalization for Mental Illness (FUH) HEDIS measure evaluates members (6 years and older) who were hospitalized for treatment of selected mental illness diagnoses and who had a follow-up visit with a mental health practitioner.
Two areas of importance for this HEDIS measure are:
- The percentage of behavioral health inpatient discharges for which the member received follow-up within 7 days after discharge.
- The percentage of behavioral health inpatient discharges for which the member received follow-up within 30 days after discharge.
On a regular basis, we continue to monitor if these two consecutive follow-up appointments are being recommended and scheduled during the inpatient stay as part of discharge planning by the eligible behavioral health facilities (such as psychiatric hospitals, freestanding mental health facilities and acute care hospitals with psychiatric units), as well as practicing behavioral health providers.
Please consider the following for improving member outcomes for this measure:
- Earliest follow up with a BH provider can help with continuing treatment after leaving the hospital.
- With greater emphasis on care coordination, primary care providers can help facilitate the BH follow up appointments.
- Weekend member discharges have shown to have very inconsistent follow up after discharge. Start discharge planning as soon as possible while members are inpatient so those who are discharged on weekends have scheduled follow up appointments.
- In addition, other social determinants of health pertinent to the member such as housing, food, living in a rural area, transportation, job schedule, family and social support, child care, etc., can impact follow-up opportunities. Please address these needs and issues; refer to resources that can help support the member.
- Social workers at the facilities can contact Anthem member services to learn if additional sources of assistance are available through Anthem such as case management and other referrals.
- Telehealth services have been identified as part of follow up for this HEDIS measure available in certain parts of the country. Telehealth follow up may not be the best choice for everyone; however, not having a BH follow up for several weeks can be detrimental to the member can be a reason for relapse.
A new professional reimbursement policy for nurse practitioner and physician assistant services will be implemented beginning with dates of service on or after September 1, 2020. The new policy will allow reimbursement for services provided by nurse practitioner (NP) and physician assistant (PA) providers. Unless provider, state, federal, or CMS contracts and/or requirements indicate otherwise, reimbursement will be based upon all of the following:
- service is considered a physician’s service
- service is within the NP or PA provider’s scope of practice
- payment reduction will be consistent with CMS reimbursement
Services furnished by the NP or PA should be submitted with their own NPI.
For more information on the Nurse Practitioner and Physician Assistant Services Professional policy, visit the Reimbursement Policies page at anthem.com.
Effective October 1, 2020, Anthem will transition the clinical criteria for medical necessity review of certain rehabilitative services to AIM Rehabilitative Service Clinical Appropriateness Guidelines as part of the AIM Rehabilitation Program. Reviewed services will include certain physical therapy, occupational therapy and speech therapy services.
As part of this transition of clinical criteria, the following procedures will be subject to prior authorization as part of the AIM Rehabilitation program:
CPT code
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Description
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90912
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Biofeedback training for bowel or bladder control, initial 15 minutes
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90913
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Biofeedback training for bowel or bladder control, additional 15 minutes
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96001
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Three-dimensional, video-taped, computer-based gait analysis during walking
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0552T
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Low-level laser therapy, dynamic photonic and dynamic thermokinetic energies, provided by a physician or other qualified health care professional
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S8940
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Therapeutic horseback riding, per session
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S8948
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Treatment with low level laser (phototherapy) each 15 minutes
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S9090
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Vertebral axial decompression (lumbar traction), per session
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20560
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Needle insertion(s) without injection(s), 1 or 2 muscle(s)
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20561
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Needle insertion(s) without injection(s), 3 or more muscle(s)
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90901
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Biofeedback training by any modality (when done for medically necessary indications)
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97129
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One-on-one therapeutic interventions focused on thought processing and strategies to manage activities
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97130
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each additional 15 minutes (list separately in addition to code for primary procedure)
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92630
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Hearing training and therapy for hearing loss prior to learning to speak
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92633
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Hearing training and therapy for hearing loss after speech
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The following procedure will be removed from the program:
S9117
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back school, per visit
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As a reminder, ordering and servicing providers may submit prior authorization requests to AIM in one of several ways:
- Access AIM’s ProviderPortalSM directly at providerportal.com. Online access is available 24/7 to process orders in real-time, and is the fastest and most convenient way to request authorization.
- Access AIM via the Availity Web Portal at availity.com
- Call the AIM Contact Center toll-free number: 866-714-1107, Monday – Friday, 8:00 a.m. – 5:00 p.m.
For questions related to guidelines, please contact AIM via email at aim.guidelines@aimspecialtyhealth.com. Additionally, you may access and download a copy of the current and upcoming guidelines here.
Please be aware that the Level of Care Medical Necessity Review of Upper and Lower Endoscopy procedures that was previously announced in the March 2020 edition of Provider News is delayed until further notice. A new program launch date will be communicated prior to implementation of the review.
We invite you to take advantage of an informational webinar that will introduce you to the Level of Care Review of Upper and Lower Endoscopy procedures and the capabilities of the AIM ProviderPortalSM. Visit the AIM Surgical Procedures microsite to register for an upcoming training session.
The following Clinical Criteria documents were endorsed at the March 26, 2020 Clinical Criteria meeting. To access the clinical criteria information please click here.
Revised clinical criteria effective April 1, 2020
(The following criteria were updated with new procedure and/or diagnosis codes.)
- ING-CC-0153 Adakveo (crizanlizumab)
- ING-CC-0154 Givlaari (givosiran)
Revised clinical criteria effective April 27, 2020
(The following criteria were reviewed and may have word changes or clarifications, but had no significant changes to the policy position or criteria.)
- ING-CC-0037 Kanuma (sebelipase alfa)
- ING-CC-0070 Jetrea (ocriplasmin)
- ING-CC-0087 Gamifant
Revised clinical criteria effective April 27, 2020
(The following criteria were revised to expand medical necessity indications or criteria.)
- ING-CC-0119 Yervoy (ipilimumab)
- ING-CC-0125 Opdivo (nivolumab)
New clinical criteria effective September 1, 2020
(The criteria below is new and may result in services previously covered now being considered either not medically necessary and/or investigational.)
- ING-CC-0161 Sarclisa (isatuximab-irfc)
Revised clinical criteria effective September 1, 2020
(The following criteria listed below might result in services that were previously covered now being considered either not medically necessary and/or investigational.)
- ING-CC-0002 Colony Stimulating Factor Agents
- ING-CC-0058 Octreotide Agents
Effective for dates of service on and after September 1, 2020, the following specialty pharmacy codes from current or new clinical criteria documents will be included in our pre-service review process.
Please note, inclusion of NDC code on your claim will help expedite claim processing of drugs billed with a not otherwise classified (NOC) code. To access the clinical criteria document information please click here.
Prior authorization of non-oncology specialty pharmacy drugs will be managed by Anthem’s medical specialty drug review team. Review of specialty pharmacy drugs for oncology indications will be managed by AIM Specialty Health® (AIM), a separate company, and are in italics.
Clinical Criteria
|
HCPCS Code
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Drug
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ING-CC-0161
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C9399
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Sarclisa
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ING-CC-0161
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J3490
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Sarclisa
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ING-CC-0161
|
J3590
|
Sarclisa
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ING-CC-0161
|
J9999
|
Sarclisa
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*ING-CC-0058
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J2354
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Bynfezia
|
* Non-oncology use is managed by Anthem’s medical specialty drug review team; oncology use is managed by AIM.
Step therapy updates
Effective for dates of service on and after September 1, 2020, the following specialty pharmacy codes from current or new clinical criteria documents will be included in our existing specialty pharmacy medical step therapy review process.
To access the step therapy drug list, please click here.
Prior authorization clinical review of non-oncology specialty pharmacy drugs will be managed by Anthem’s medical specialty drug review team.
Clinical Criteria
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Status
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Drug(s)
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HCPCS Code
|
ING-CC-0003
|
Non-preferred
|
Panzyga
|
J1599
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ING-CC-0003
|
Non-preferred
|
Xembify
|
J3490
|
For more information on copayment/coinsurance requirements and their applicable drug classes, drug lists and changes, prior authorization criteria, procedures for generic substitution, therapeutic interchange, step therapy or other management methods subject to prescribing decisions and other requirements, restrictions or limitations that apply to certain drugs, visit https://www11.anthem.com/pharmacyinformation/.
- To locate the commercial drug list, select ‘Click here to access your drug list’.
- To locate the Marketplace Select Formulary and pharmacy information, scroll down to ‘Select Drug Lists’, then select the applicable state’s drug list link.
The commercial and marketplace drug lists are reviewed and updates are posted to the website quarterly (the first of the month for January, April, July and October).
Federal Employee Program (FEP) pharmacy updates and other pharmacy related information may be accessed at www.fepblue.org > Pharmacy Benefits. This drug list is also reviewed and updated regularly as needed.
As we announced in May in an email to Connecticut providers, the State of Connecticut employer group is implementing several changes to their health plan coverage through Anthem in 2020. As a reminder, Anthem will be the sole medical carrier for the State of Connecticut Employer Group and the Connecticut Partnership Plan effective October 1, 2020. Effective July 1, 2020, we will begin administering medical benefits for new Connecticut Partnership Plan members (groups).
Our new Connecticut Partnership Plan members will be enrolled in the State BlueCare POS plan utilizing the State BlueCare tiered provider network. You may begin seeing identification cards with alpha prefix SHP on July 1 with the State of CT Partnership Plan group name as shown in the example below.
Please refer to the May communication to read more about the changes for the State of Connecticut Employer Group and the Connecticut Partnership Plan.
If you have any questions, please call the Provider Call Center.
Billing for patient treatment can be complex, particularly when determining whether modifiers are required for proper payment. Anthem reimbursement policies and correct coding guidelines explain the appropriate use of coding modifiers. We would like to highlight the appropriate use of some commonly used modifiers.
Things to remember
- Review the CPT® Surgical Package Definition found in the current year’s CPT Professional Edition. Use modifiers such as 25 and 59 only when the services are not included in the surgical package.
- Review the current CPT Professional Edition Appendix A — Modifiers for the appropriate use of modifiers 25, 57 and 59.
- When an evaluation and management (E&M) code is reported on the same date of service as a procedure, the use of the modifier 25 should be limited to situations where the E&M service is “above and beyond” or “separate and significant” from any procedures performed the same day.
- When appropriate, assign anatomical modifiers (Level II HCPCS modifiers) to identify different areas of the body that were treated. Proper application of the anatomical modifiers helps ensure the highest level of specificity on the claim and show that different anatomic sites received treatment.
- Use modifier 59 to indicate that a procedure or service was distinct or independent of other non-E&M services performed on the same date of service. The modifier 59 represents services not normally performed together, but which may be reported together under the circumstances.
If you feel that you have received a denial after appropriately applying a modifier under correct coding guidelines, please follow the normal claims dispute process and include medical records that support the use of the modifier(s) when submitting claims for consideration.
Anthem will publish additional articles on correct coding in provider communications.
Risk adjustment is the process by which the Centers for Medicare & Medicaid Services (CMS) reimburses Medicare Advantage plans, based on the health status of their members. Risk adjustment was implemented to pay Medicare Advantage plans more accurately for the predicted health cost expenditures of members by adjusting payments based on demographics (age and gender) as well as health status.
In 2020, Anthem will work with Optum, who is working with Ciox Health, to request medical records with dates of service for the target year 2019 through present day.
Jaime Marcotte, Medicare Retrospective Risk Program Lead, is managing this project. If you have any questions regarding this program, please contact Jaime at jaime.marcotte@anthem.com or 843-666-1970.
Additional information, including an FAQ, will be available on the provider website at Important Medicare Advantage Updates.
The Medicare Risk Adjustment Regulatory Compliance team at Anthem offers two provider training programs regarding Medicare risk adjustment and documentation guidelines. Information for each training is outlined below.
Medicare Risk Adjustment and Documentation Guidance (General)
When: Offered the first Wednesday of each month from 1:00 p.m. to 2:00 p.m.
Learning objective: This onboarding training will provide an overview of Medicare Risk Adjustment, including the Risk Adjustment Factor and the Hierarchical Condition Category (HCC) Model, with guidance on medical record documentation and coding.
Credits: This live activity, Medicare Risk Adjustment and Documentation Guidance, from January 8, 2020, to December 2, 2020, has been reviewed and is acceptable for up to one prescribed credit(s) by the American Academy of Family Physicians. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
For those interested in joining us to learn how providers play a critical role in facilitating the risk adjustment process, register for one of the monthly training sessions.
*Note: Dates may be modified due to holiday scheduling.
Medicare Risk Adjustment, Documentation and Coding Guidance (Condition specific)
Series: Offered on the third Wednesday of every other month at 12:00 p.m. to 1:00 p.m.
Learning objective: This is a collaborative learning event with Enhanced Personal Health Care (EPHC) to provide in-depth disease information pertaining to specific conditions, including an overview of their corresponding hierarchical condition categories (HCC), with guidance on documentation and coding.
Credits: This live series activity, Medicare Risk Adjustment Documentation and Coding Guidance, from January 15, 2020, to November 18, 2020, has been reviewed and is acceptable for credit by the American Academy of Family Physicians. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
For those interested in joining us for this six-part training series, please see the list of topics and scheduled training dates below:
- Red Flag HCCs, part one: Training will cover HCCs most commonly reported in error as identified by CMS (chronic kidney disease stage 5, ischemic or unspecified stroke, cerebral hemorrhage, aspiration and specified bacterial pneumonias, unstable angina and other acute ischemic heart disease, end-stage liver disease) {Recording will play upon registration.}
- Red Flag HCCs, part two: Training will cover HCCs most commonly reported in error as identified by CMS (atherosclerosis of the extremities with ulceration or gangrene, myasthenia gravis/myoneural disorders and Guillain-Barre syndrome, drug/alcohol psychosis, lung and other severe cancers, diabetes with ophthalmologic or unspecified manifestation) {Recording will play upon registration.}
- Neoplasms (recording link will be available later 2020.)
- Acute, Chronic and Status Conditions (July 15, 2020)
- Diabetes Mellitus and Other Metabolic Disorders (September 16, 2020)
- TBD - This Medicare Risk Adjustment webinar will cover the critical topics and updates that surface during the year (November 18, 2020)
Diabetes is a complex chronic illness requiring ongoing patient monitoring. The National Committee for Quality Assurance (NCQA) includes diabetes in its HEDIS® measures on which providers are rating annually.
Since diabetes HbA1c testing is a key measure to assess for future medical conditions related to complications of undiagnosed diabetes, NCQA requires that health plans review claims for diabetes in patient health records. The findings contribute to health plan Star Ratings for commercial and Medicare plans and the Quality Rating System measurement for marketplace plans. A systematic sample of patient records is pulled annually as part of the HEDIS medical record review to assess for documentation.
Which HEDIS measures are diabetes measures?
The diabetes measures focus on members 18 to 75 years of age with diabetes (type 1 and type 2) who had each of the following assessments:
- Hemoglobin A1c (HbA1c) testing
- HbA1c poor control (> 9%)
- HbA1c control (< 8%)
- Dilated retinal exam
- Medical attention for nephropathy
The American College of Physicians’ guidelines for people with type 2 diabetes recommend the desired A1c blood sugar control levels remain between 7% to 8%.1
In order to meet the HEDIS measure HbA1c control < 8, providers must document the date the test was performed and the corresponding result. For this reason, report one of the four Category II codes and use the date of service as the date of the test, not the date of the reporting of the Category II code.
To report most recent hemoglobin A1c level
|
Use
|
HbA1c level less than 7.0%
|
3044F
|
HbA1c level equal to or greater than 7.0% and less than 8.0%
|
3051F
|
HbA1c level equal to or greater than 8.0% and less than or equal to 9.0%
|
3052F
|
HbA1c level greater than 9.0%
|
3046F
|
HbA1c level ≤9.0%
|
3044F, 3051F, 3052F2
|
Continued management and diverse pathways to care are essential in controlling blood glucose and reducing the risk of complications. While it is extremely beneficial for the patient to have continuous management, it also benefits our providers. As HEDIS rates increase, there is potential for the provider to earn maximum or additional revenue through Pay for Quality, Value-Based Services and other pay-for-performance models.3
Racial and ethnic disparities with diabetes
It is also important for providers to be aware of critical diabetes disparities that exist for diverse populations.
Compared to non-Hispanic whites:4
- African Americans, Hispanics, and American Indian/Alaska Natives have higher mortality rates from diabetes.
- African Americans and Hispanics have higher rates of complications from uncontrolled diabetes, including lower limb amputation and end-stage renal disease.
- More than half of Asian Americans and nearly half of Hispanic Americans with diabetes are undiagnosed.5
- Asian Americans are at risk for type 2 diabetes at a lower body mass index (BMI); therefore, diabetes screening at a BMI of 23 is recommended.6
Sources include:
- Diabetes prevalence:
- 2015 State Diagnosed Diabetes Prevalence, https://www.cdc.gov/diabetes/data.
- 2012 State Undiagnosed Diabetes Prevalence, Dall et al., “The Economic Burden of Elevated Blood Glucose Levels in 2012”, Diabetes Care, December 2014, vol. 37.
- Diabetes incidence:
- Cost:
- American Diabetes Association, “Economic Costs of Diabetes in the U.S. in 2017”, Diabetes Care, May 2018.
- Research expenditures:
Effective for dates of service on and after August 16, 2020, the following updates will apply to the AIM Specialty Health® (AIM) Sleep Disorder Management Clinical Appropriateness Guideline.
Sleep Disorder Management Clinical Appropriateness Guideline updates:
- Bi-Level Positive Airway Pressure (BPAP) Devices:
- Change in BPAP FiO2 from 45 to 52 mmHg based on strong evidence and alignment with Medicare requirements for use of BPAP
- Multiple Sleep Latency Testing and/or Maintenance of Wakefulness Testing:
- Style change for clarity
- Code changes: none
As a reminder, ordering and servicing providers may submit prior authorization (PA) requests to AIM by:
- Accessing AIM’s ProviderPortalSM directly at com. Online access is available 24/7 to process orders in real time, and is the fastest and most convenient way to request PA.
- Accessing AIM via the Availity Portal.
- Calling the AIM Contact Center at 800-714-0040 from 7:00 a.m. to 7:00 p.m.
What if I need assistance?
If you have questions related to guidelines, email AIM at aim.guidelines@aimspecialtyhealth.com. Additionally, you may access and download a copy of the current and upcoming guidelines here.
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