Well Care of Nebraska Provider Relations Quarterly Update

Well. Care of Nebraska Provider Relations Quarterly Update 2017 1

Agenda § Value Added Benefits 2018 § Behavioral Health updates § Claims § Adding New Providers § PCMH Program § Provider Resources § Contacts 2

Value Added Benefits 2018 3

Behavioral Health Updates § Psychological testing § Initial evaluation and psychological testing can occur on the same day § Prior authorization for psychological and neuropsychological testing is required § Case review is done by a clinical psychologist for evaluation § Outpatient psychotherapy sessions § No preauthorization and no re-authorizations required for individual, family or group psychotherapy sessions DHHS Health Plan Advisory 17 -08 § Peer Support § All peer support professionals will enroll with Nebraska Medicaid as Community Treatment Aides, § Medicaid requirements for peer support professionals include a state and/or national certification in peer support and enrollment under a supervising practitioner, a provider group or a provider organization. DHHS Provider Bulletin 17 -20 4

Claim Denials and Rejections A claim denial is a claim that has been adjudicated and payment or non payment will be explained on the remit

Claim Rejections § A claim rejection will generate a letter to the provider and the claim will not be processed. Provider will need to correct the issue causing the rejection and submit a new claim. EDI-Master@ wellcare. com § EDI Department will be able to view the claim image and help to identify why the claim is being rejected. § NPI not matching § missing information § member information mismatch 6

Known Claims Issues https: //www. wellcare. com/en/Nebraska/Providers/Medicaid/Claims

Adding Providers/Existing Group § Complete a Well. Care roster and submit it to your Provider Relations Representative- CAQH accounts only § Complete credentialing application and provide supporting documents to PR rep § https: //www. wellcare. com/Nebraska

Adding Providers/Existing Group Cont. CAQH Reminders § Providers need to attest to the validity of their information every 4 months § Professional Liability Insurance must not be expiring within the next 30 days § Providers must authorize Well. Care to access their CAQH § Providers must list a minimum of 5 years consecutive work history (an explanation must be provided for any gap greater than 6 months) 9

Well. Care PCMH program § Patient-Centered Medical Home: A way of organizing primary care using teamwork and technology to improve quality and patient experience, and to reduce costs. Practice Organization Quality Measures Health Information Technology Patient Experience Family Medicine Program Services: ü PCMH assessment and ü ü ü recommendations Training and coaching in transformation Quality improvement, Process Improvement Care management assistance Partner in Quality with the National Committee on Quality Assurance to provide assistance with recognition applications Email. NE_PCMH@wellcare. com 10

Patient Centered Medical Home § 3 clinics working toward NCQA recognition for Patient. Centered Medical Home § 1 clinic working toward integrating behavioral health into primary care Margaret Buck, CCE Senior Provider Relations Representative-PCMH Well. Care Health Plans, Inc. Mobile: 402 -547 -0383 | Office: 402 -328 -5439 margaret. buck@wellcare. com

Provider Resources www. Well. Care. com Medicaid Overview & Resources § Provider Handbook § Quick Reference Guide § Provider relations contact list § Authorization look up tool Claims § Institutional/Professional claim/encounter guides § Corrected or voided claim submission guide § CMS 1500 and UB 04 submission sample Forms § Authorization Requests § Pharmacy coverage determination/appeal

Pharmacy Drug Look Up Tool Details: Maximum of 1. 5 tablets per day; Maximum dose of 15 mg per day for age 6 -12; Maximum dose of 30 mg per day for age 13 -18 13

PR Territory List 14

Provider Relations Contact List Michelle Hartman, Behavioral Health Provider Relations Representative Michelle. Hartman@wellcare. com 813 -539 -0103 Amanda Payne, Provider Relations Representative Amanda. Payne@wellcare. com 402 -216 -2315 Kami Hudson, Sr. Provider Relations Representative Kami. Hudson@wellcare. com 308 -227 -8301 Sarah Meyer, Sr. Provider Relations Representative Sarah. Meyer@wellcare. com 402 -384 -3016 Lindsey Gonzales, Provider Relations Representative Lindsey. Gonzales@wellcare. com 402 -590 -0788 Jessica Wykert, Sr. Network Management Representative Jessica. Wykert@wellcare. com 402 -350 -4230 Melissa Humphrey, Manager of Provider Relations Melissa. Humphrey@wellcare. com 402 -384 -3023 15