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April 2020

Featured Story: AllWays on Teams virtual visit app is now available 

On March 13, we announced AllWays on Teams, our partnership with Microsoft to offer a free telehealth app for providers. Now we’ve decided to add AllWays on Teams to our digital tools for network providers beyond the COVID-19 health crisis.

In This Issue

 


 

AllWays on Teams virtual visit app is now available 

On March 13, we announced AllWays on Teams, our partnership with Microsoft to offer a free telehealth app for providers. Now we’ve decided to add AllWays on Teams to our digital tools for network providers beyond the COVID-19 health crisis.

Since we launched AllWays on Teams, we've gotten an overwhelmingly positive response from our network. For this reason, we're offering this to participating providers even after the end of the coronavirus pandemic — and at no cost.

Learn more about AllWays on Teams and register to get access today. 

AllWays on Teams FAQ

 


 

COVID-19 updates

FAQ for providers

We developed this COVID-19 FAQ for providers to give you the latest information, updates and resources. This page will be updated as new information becomes available.  

COVID-19 claims status 

If you are checking the provider portal for the status of a claim related to COVID-19, you may see that the claim has denied. That’s because we’re in the process of configuring our systems to reflect the rapid administrative changes we’ve made in response to the COVID-19 health crisis. If your claim was submitted while this configuration work was in progress, it will show as denied. You do not need to take any action. We are proactively reprocessing all claims related to COVID-19 to ensure that providers are being reimbursed accurately.

Financial impact

In the current environment, our cash flow is expected to come under significant pressure and likely to be negatively impacted by the financial distress in the employer and individual markets stemming from the pandemic. As a health plan, we are not eligible for any federal or state relief under the new $100 billion relief package being made available for hospitals and providers. In addition, for more than 60% of our membership, claims are funded as incurred, not in advance. Therefore, we are unable to offer supplemental cash flow to our providers at this time.

Postponed: April 8 Rhode Island provider meeting

Due to the increased travel restrictions that organizations are implementing to prevent the spread of the coronavirus and for the safety of our attendees, we have postponed the AllWays Health Partners' regional provider meeting on April 8. We'll let you know when a new date is confirmed.

Digital resources

To support you and your staff, we are dedicated on making training resources available online. We recently launched a new Provider Education site to promote upcoming webinars and digital tools - all in one place. Check out our page today and don't forget to RSVP for a webinar today.

 


 

Required documentation for non-emergency medically necessary transportation

In order for all non-emergency transportation services to be covered, they must be medically necessary and reasonable. Medical necessity is established when the patient’s condition is such that the use of any other method of transportation is contraindicated.

A completed Physician Certification Statement (PCS) for Non-Emergency Ambulance Services form is required for all forms (ground, sea, air) of non-emergency transportation and provides the information necessary to make the medical necessity determinations for the transportation.

For commercial members whose plan does not require them to have a primary care physician/clinician, an acceptable form of documentation in place of the PCS would be a completed Non-Emergency Medically Necessary Ground Transportation form.

Read the updated Non-emergency medically necessary transportation medical policy for more information.

 


 

Medical policy

The following medical policy updates are effective April 1, 2020:

  • Neuromodulation for Overactive Bladder – Annual review. Under initial Treatment Assessment with PTNS, changed behavioral training requirement time period from 6 months to 3 months. References updated. 
  • Prostatic Urethral Lift – Annual review. References updated.
  • Zolgensma - Off-cycle review. Updated page 1 table to reflect coverage for MassHealth. Added Criteria section to reflect MassHealth coverage.

View all medical policies.

 


 

Code updates

Stay current on the latest code and reimbursement updates.

Check out the latest updates here.

 


 

Prior authorization resources

Don't forget to visit our Prior authorization and referral webpage for important resources. On this webpage, you can access a list of services that require prior authorization, updated prior authorization submission user guides, vendor contact information and more. 

 



Hospital inpatient utilization report

The latest quarterly hospital inpatient utilization report is now available. To review this report, click on the Reports tab in the Provider Portal and select Clinical Reports. If you do not have access to the Provider Portal, you may register online at allwaysprovider.org.




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