AETNA BETTER HEALTH OF WEST VIRGINIA Molina Spring

AETNA BETTER HEALTH® OF WEST VIRGINIA Molina Spring Workshop April 2018

Our Core Values 1

Provider Relations Update • Provider Relations phone line is now staffed by live agents • If all agents are busy, providers can leave a voicemail and calls will be returned within 24 hours • Warm transfer process from Provider Service line 2

Provider Webinars • New Provider Orientation Webinar – the last Thursday of every month at 11: 00 am. • Quarterly Existing Provider Education/Updates Webinars –June 28, September 27, December 27, 2018 at 1: 00 pm. RSVP to your Provider Relations Representative 3

Corrected Claims and Resubmissions Update • Effective February 1, 2018, the time frame Practitioners and Providers have to file corrected claims and resubmissions changed from 90 days from the date of the original remittance advice to 120 days. • Practitioners and providers may resubmit a claim that: – Was originally denied because of missing documentation, incorrect coding, etc. 4

Coming soon…. • • IVR – Internal Voice Recognition - Self Serve Option Expected roll out will be second quarter 2018 You will be able to get member eligibility information Members will be able to request ID cards Members can change their PCPs You can get Prior Authorization header status If the system cannot answer your question, it will go to a representative with a pop-up of the information you provided 5

New Provider Resource for Peer to Peer Requests • Effective September 15, 2017, providers have a new resource for making Peer to Peer Requests for Aetna Better Health of WV. • Please call 1 -866 -389 -1667 to contact our Health Services/Medical Management Department directly with your request. 6

Community Psychiatric Supportive Treatment Policy Update • Effective March 1, 2018, Aetna Better Health of West Virginia will require notification and clinical information after three days (144 units) of treatment. This will enable our medical management team to anticipate the needs of the member and assist in discharge planning and coordination of care. – The first three days (144 units) of Community Psychiatric Supportive Treatment will not require notification or authorization of services – Continued treatment after three days (144 units) will require prior authorization 7

Drug Screening Policy Update • Effective October 1, 2017, for all places of service except inpatient claims for G 0481, G 0482, G 0483, and G 0659 require medical records that explicitly substantiate the medical necessity of testing for more than 7 drug classes. Further, reimbursement for G 0480 requires documentation of a presumptive test within 5 business days of the date of service. 8

Drug Screening Policy Update • Effective May 14, 2018, for all places of service except inpatient G 0480, G 0481, G 0482, G 0483, and G 0659 will require prior authorization. • Presumptive Drug Testing Codes: 80305, 80306, and 80307 • Definitive Drug Testing Codes: G 0480, G 0481, G 0482, G 0483, and G 0659 9

Thank you 10