June 2020

Featured Story: COVID-19 updates 

Don't forget to check out our COVID-19 FAQs for the latest news and updates for providers. 

In This Issue

 


 

COVID-19 updates

Remember to check our COVID-19 FAQs for providers

Our COVID-19 FAQs for providers give you the latest information, updates and resources. We are constantly updating these FAQs as more information becomes available from the Federal and State governments. Please check back periodically to get the most recent news.

Read the COVID-19 FAQ for Commercial providers

Read the COVID-19 FAQ for My Care Family providers

Optum COVID-19 toolkit

Optum, our behavioral health partner, developed a toolkit to highlight the latest COVID-19 behavioral health updates and policies. Remember to check back for the most up-to-date resources to support you and your patients.

Visit the behavioral health COVID-19 toolkit.

Access free virtual care app through AllWays on Teams

As a reminder, we've partnered with Microsoft to offer our network providers with free access to a virtual care app through AllWays on Teams. AllWays on Teams will be available to our providers through the COVID-19 pandemic and beyond - at no cost.

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

AllWays on Teams FAQ

 


 

Reminder: NovoLogix online authorization submission now available

As a reminder, network providers can now submit online medical specialty drug prior authorizations through the NovoLogix online prior authorization tool. Online submission is fastest way to request and receive a decision on your prior authorization. Requests that meet criteria may be approved in seconds.

Access the NovoLogix online authorization tool via the Provider Portal

All registered AllWays Health Partners provider portal users will have direct access to the NovoLogix online prior authorization tool. No additional registration will be required.

If you are not currently registered for AllWays Health Partners' provider portal, sign-up today at allwaysprovider.org. Visit our provider portal resource page for more information about the registration process or email prweb@allwayshealth.org.  

 


 

Formulary updates

AllWays Health Partners regularly reviews and updates our formulary to ensure alignment with the industry. Check out the latest updates effective August 2020. 

For the latest information on our pharmacy programs, visit our online formulary today.

 


 

Coverage for emergency department distributed Naloxone kits

To support the fight against opioid addiction, AllWays Health Partners now covers Naloxone kits for My Care Family members when seen in the emergency department (ED) for an overdose. Members will have improved access to potentially lifesaving medication by obtaining a Naloxone kit at ED instead of picking it up at a pharmacy.

For more information and billing guidance, read the MassHealth bulletin on ED distributed nasal Naloxone packages.


 

Medical policy

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

  • Acute Inpatient – Annual review. Revisions made to table on page 1.
  • Experimental and Investigational – Annual review. 
  • Phototherapeutic Keratectomy - New medical policy. Guidelines AllWays Health Partners utilizes to determine medical necessity for phototherapeutic keratectomy for conditions:
    • Corneal scars and opacities 
    • Superficial corneal dystrophy
    • Irregular corneal surfaces
    • Epithelial basement membrane dystrophy
    • Recurrent corneal erosion when standard therapeutic regimens measures (e.g. lubricants, hypertonic saline, patching, bandage contact lenses, gentle debridement of severely aberrant epithelium) have failed to halt the erosions

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

  • Durable Medical Equipment - Annual review. Under General coverage criteria, changed item #3; language on appropriate for use in a home setting. Under Exclusions; revised #6 to reflect language on home setting. Under Exclusions; added the Ottobock C-Brace.
  • Gender Affirming Procedures - Annual review. Revised policy statement on Vaginoplasty, Metoidioplasty, Phalloplasty stating documentation is required that the member has lived as their reassigned gender full-time for 12 months or more. Clarified policy statement under Hair Removal by Electrolysis or Laser to replace treating provider with licensed provider. Updated code list to include 21196. References updated.
  • Preimplantation Genetic Testing - Annual update. Under Coverage Guidelines, added clarification statement regarding authorization requirements. Updated references.
  • Home Health Care - Annual update. Under Commercial and Connector/Qualified Health Plans on page 1, edited for clarity the prior authorization requirements.
  • Chiropractic Services - Annual review without substantial changes in medically necessary indicators. Minor formatting to table on page 1.
  • Acupuncture - Annual review without substantial changes in medically necessary indicators, including minor formatting changes, clarified Exclusions heading, references updated.
  • Definition of Skilled Care - Annual review without substantial changes.
  • Extended Care Facility - Annual review without substantial changes.

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

  • Out of network provider - Changes made to coverage guidelines. Distance and Travel Guidelines section changed. References updated.

View all medical policies.

 


 

Code updates

Stay current on the latest code and reimbursement updates.

Check out the latest updates here.

 


 

Provider payment guidelines

The following provider payment guideline has been updated: 

  • Serious Reportable Events - Updated Policy Definitions Section: Added Serious Adverse Drug Event (SADE) definition. Added a section regarding Provider Reporting Requirements outlining regulatory timeframes and mechanisms to be used by providers (fax, claims) to report these events. Updated Serious Reportable Events (SREs) and Provider Preventable Conditions (PPCs) Crosswalk. Updated Policy References Section to include SRE/PPC State and Federal regulations for New Hampshire, Rhode Island and Maine.

View all provider payment guidelines

 


 

Annual updates to physician and outpatient reimbursement

AllWays Health Partners reviews its physician and outpatient fee schedules quarterly, to ensure that they are current, comprehensive and consistent with industry standards, to the extent supported by its systems. In most cases, changes involve adding fees for new or existing codes to supplement the fees already on the fee schedule

Consistent with prior years, AllWays Health Partners will update its Commercial/PPO physician, ambulance, drug, DME, laboratory, radiology and outpatient hospital fee schedules to incorporate new codes, effective January 1, 2020.  Rate updates to existing CPT and HCPCS codes will occur on July 1, 2020.

With a few exceptions, AllWays Health Partners will continue to base fees on the Centers for Medicare & Medicaid Services (CMS) and MassHealth fee schedules, adjusted to achieve the contracted level of reimbursement.

Commercial/PPO Physician Fee Schedules

  • AllWays Health Partners will continue to base physician reimbursement on CMS RVU’s and conversion factors.
  • AllWays Health Partners will continue to base drug, vaccine and toxoid reimbursement on CMS Part B levels, as indicated on the CMS Part B drug quarterly notices. If no CMS pricing is available, drug pricing will be set in relation to average wholesale price (AWP). Reimbursement for vaccines and toxoids will continue to be updated on a quarterly basis.

Commercial/PPO Outpatient Fee Schedules

  • Consistent with prior years, reimbursement will be based on a combination of ancillary and surgical fee schedules.
  • AllWays Health Partners will continue to base drug, vaccine and toxoid reimbursement on CMS Part B levels, as indicated on the CMS Part B drug quarterly notices. If no CMS pricing is available, drug pricing will be set in relation to average wholesale price (AWP). Reimbursement for vaccines and toxoids will continue to be updated on a quarterly basis.

My Care Family Fee Schedules

  • AllWays Health Partners will continue to base physician reimbursement on MassHealth published rates, where a published rate exists. 
  • Consistent with prior years, AllWays Health Partners will updated its My Care Family physician, ambulance, drug, DME, laboratory, radiology and outpatient hospital fee schedules to incorporate new codes, effective January 1, 2020.  Rate updates to existing CPT and HCPCS codes will occur within 30 days of receipt of notification of rate change from MassHealth.

If you have questions about the fee schedule changes, please contact your AllWays Health Partners Provider Network Account Executive.