Provider News 
January 2019 - In this issue:
 portal
Provider Portal 

AllWays Health Partners' Provider Portal is your primary resource for managing your AllWays Health Partners patients. Through the Provider Portal, you will have 24/7 instant access to:
  • Confirming receipt and status of a claim
  • Verifying member eligibility
  • Your Explanation of Payments
  • Submitting and reviewing authorization requests
  • A roster view of credentialed providers
  • And much more 
Access the Provider Portal today at allwaysprovider.org

AllWays Health Partners Website
In addition to the Provider Portal, you can find important resources on our new public website. Here you will find important information and resources such as forms, medical policies, our Provider Directory and authorization guidelines.  Check our website today at allwayshealthpartners.org

Questions? 
For help through the registration process or for additional Provider Portal support, email us at prweb@allwayshealth.org.

     QRG
Quick Reference Guides

We've created some quick reference guides to support you with our transition to AllWays Health Partners. Available resources include an FAQ, sample images of our new member ID card and information about our Partners HealthCare Plans. Please share these resources with your staff. 

      Claims
Claims Information

We're now AllWays Health Partners, but our claims process hasn't changed. For the fastest processing and to get paid sooner, claims should be electronically submitted.

Payer ID: 04293

HMO Paper Claims Address: P.O. Box 853908, Richardson, TX 75085-3908

PPO Paper Claims Address: P.O. Box 852099, Richardson, TX 75085-2099

     medicare
Reminder: Notification to Medicare of Insurance Changes

As a reminder, when a Medicare primary patient notifies you of a change to their secondary coverage, please remember it is the responsibility of the provider to send the new insurance information to Medicare. By sending this information to Medicare timely, this will ensure that claims are appropriately processed, avoid any delays to payment and ensure that the patient isn't caught in the middle when Medicare sends the secondary claim to the incorrect health plan.. 

codes     
New January 2019 Codes 

The following CPT codes are not covered as experimental and investigational:
Code
Description
33274
Transcatheter insertion or replacement of permanent leadless pacemaker, right ventricular, including imaging
33275
Transcatheter removal of permanent leadless pacemaker, right ventricular
33289
Transcatheter implantation of wireless pulmonary artery pressure sensor for long-term hemodynamic monitoring, including deployment and calibration of the sensor, right heart catheterization, selective pulmonary catheterization, radiological supervision and interpretation, and pulmonary artery angiography, when performed
53854
Transurethral destruction of prostate tissue; by radiofrequency generated water vapor thermotherapy
76391
Magnetic resonance (e.g., vibration) elastography
76981
Ultrasound, elastography; parenchyma (e.g., organ)
76982
Ultrasound, elastography; first target lesion
76983
Ultrasound, elastography; each additional target lesion (List separately in addition to code for primary procedure)
93264
Remote monitoring of a wireless pulmonary artery pressure sensor for up to 30 days, including at least weekly downloads of pulmonary artery pressure recordings, interpretation(s), trend analysis, and report(s) by a physician or other qualified health care
0509T
Electroretinography (ERG) with interpretation and report, pattern (PERG)
0510T
Removal of sinus tarsi implant
0511T
Removal and reinsertion of sinus tarsi implant
0512T
Extracorporeal shock wave for integumentary wound healing, high energy, including topical application and dressing care; initial wound
0513T
Extracorporeal shock wave for integumentary wound healing, high energy, including topical application and dressing care; each additional wound (List separately in addition to code for primary procedure)
0514T
Intraoperative visual axis identification using patient fixation (List separately in addition to code for primary procedure)
0515T
Insertion of wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming, and imaging supervision and interpretation, when performed; complete system (includes electrode and generator [transmitter and battery])
0516T
Insertion of wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming, and imaging supervision and interpretation, when performed; electrode only
0517T
Insertion of wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming, and imaging supervision and interpretation, when performed; pulse generator component(s) (battery and/or transmitter) only
0518T
Removal of only pulse generator component(s) (battery and/or transmitter) of wireless cardiac stimulator for left ventricular pacing
0519T
Removal and replacement of wireless cardiac stimulator for left ventricular pacing; pulse generator component(s) (battery and/or transmitter)
0520T
Removal and replacement of wireless cardiac stimulator for left ventricular pacing; pulse generator component(s) (battery and/or transmitter), including placement of a new electrode
0521T
Interrogation device evaluation (in person) with analysis, review, and report, includes connection, recording, and disconnection per patient encounter, wireless cardiac stimulator for left ventricular pacing
0522T
Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, including review and report, wireless cardiac stimulator for left ventricular pacing
0523T
Intraprocedural coronary fractional flow reserve (FFR) with 3D functional mapping of color-coded FFR values for the coronary tree, derived from coronary angiogram data, for real-time review and interpretation of possible atherosclerotic stenosis(es) intervention (List separately in addition to code for primary procedure)
0524T
Endovenous catheter directed chemical ablation with balloon isolation of incompetent extremity vein, open or percutaneous, including all vascular access, catheter manipulation, diagnostic imaging, imaging guidance and monitoring
0525T
Insertion or replacement of intracardiac ischemia monitoring system, including testing of the lead and monitor, initial system programming, and imaging supervision and interpretation; complete system (electrode and implantable monitor)
0526T
Insertion or replacement of intracardiac ischemia monitoring system, including testing of the lead and monitor, initial system programming, and imaging supervision and interpretation; electrode only
0527T
Insertion or replacement of intracardiac ischemia monitoring system, including testing of the lead and monitor, initial system programming, and imaging supervision and interpretation; implantable monitor only
0528T
Programming device evaluation (in person) of intracardiac ischemia monitoring system with iterative adjustment of programmed values, with analysis, review, and report
0529T
Interrogation device evaluation (in person) of intracardiac ischemia monitoring system with analysis, review, and report
0530T
Removal of intracardiac ischemia monitoring system, including all imaging supervision and interpretation; complete system (electrode and implantable monitor)
0531T
Removal of intracardiac ischemia monitoring system, including all imaging supervision and interpretation; electrode only
0532T
Removal of intracardiac ischemia monitoring system, including all imaging supervision and interpretation; implantable monitor only
0533T
Continuous recording of movement disorder symptoms, including bradykinesia, dyskinesia, and tremor for 6 days up to 10 days; includes set-up, patient training, configuration of monitor, data upload, analysis and initial report configuration, download review, interpretation and report
0534T
Continuous recording of movement disorder symptoms, including bradykinesia, dyskinesia, and tremor for 6 days up to 10 days; set-up, patient training, configuration of monitor
0535T
Continuous recording of movement disorder symptoms, including bradykinesia, dyskinesia, and tremor for 6 days up to 10 days; data upload, analysis and initial report configuration
0536T
Continuous recording of movement disorder symptoms, including bradykinesia, dyskinesia, and tremor for 6 days up to 10 days; download review, interpretation and report
0541T
Myocardial imaging by magnetocardiography (MCG) for detection of cardiac ischemia, by signal acquisition using minimum 36 channel grid, generation of magnetic-field time-series images, quantitative analysis of magnetic dipoles, machine learning-derived clinical scoring, and automated report generation, single study;
0542T
Myocardial imaging by magnetocardiography (MCG) for detection of cardiac ischemia, by signal acquisition using minimum 36 channel grid, generation of magnetic-field time-series images, quantitative analysis of magnetic dipoles, machine learning-derived clinical scoring, and automated report generation, single study; interpretation and report

The following CPT codes are covered when prior authorized:
Code
Description
20932
Allograft, includes templating, cutting, placement, and internal fixation, when performed; osteoarticular, including articular surface and contiguous bone (List separately in addition to code for primary procedure)
20933
Allograft, includes templating, cutting, placement, and internal fixation, when performed; hemicortical intercalary, partial (i.e., hemicylindrical) (List separately in addition to code for primary procedure)
20934
Allograft, includes templating, cutting, placement, and internal fixation, when performed; intercalary, complete (i.e., cylindrical) (List separately in addition to code for primary procedure)
33285
Insertion, subcutaneous cardiac rhythm monitor, including programming
76978
Ultrasound, targeted dynamic microbubble sonographic contrast characterization (non-cardiac); initial lesion
76979
Ultrasound, targeted dynamic microbubble sonographic contrast characterization (non-cardiac); each additional lesion with separate injection (List separately in addition to code for primary procedure)
77046
Magnetic resonance imaging, breast, without contrast material; unilateral
77047
Magnetic resonance imaging, breast, without contrast material; bilateral
77048
Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (CAD real-time lesion detection, characterization, and pharmacokinetic analysis), when performed; unilateral
77049
Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (CAD real-time lesion detection, characterization, and pharmacokinetic analysis), when performed; bilateral
81163
BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (e.g., hereditary breast and ovarian cancer) gene analysis; full sequence analysis
81164
BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (e.g., hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (i.e., detection of large gene rearrangements)
81165
BRCA1 (BRCA1, DNA repair associated) (e.g., hereditary breast and ovarian cancer) gene analysis; full sequence analysis
81166
BRCA1 (BRCA1, DNA repair associated) (e.g., hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (i.e., detection of large gene rearrangements)
81167
BRCA2 (BRCA2, DNA repair associated) (e.g., hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (i.e., detection of large gene rearrangements)
81173
 
AR (androgen receptor) (e.g., spinal and bulbar muscular atrophy, Kennedy disease, X chromosome inactivation) gene analysis; full gene sequence
81174
AR (androgen receptor) (e.g., spinal and bulbar muscular atrophy, Kennedy disease, X chromosome inactivation) gene analysis; known familial variant
81185
CACNA1A (calcium voltage-gated channel subunit alpha1 A) (e.g., spinocerebellar ataxia) gene analysis; full gene sequence
81186
CACNA1A (calcium voltage-gated channel subunit alpha1 A) (e.g., spinocerebellar ataxia) gene analysis; known familial variant
81189
CSTB (cystatin B) (e.g., Unverricht-Lundborg disease) gene analysis; full gene sequence
81190
CSTB (cystatin B) (e.g., Unverricht-Lundborg disease) gene analysis; known familial variant(s)
81286
FXN (frataxin) (e.g., Friedreich ataxia) gene analysis; full gene sequence
81289
FXN (frataxin) (e.g., Friedreich ataxia) gene analysis; full gene sequence
81306
NUDT15 (nudix hydrolase 15) (e.g., drug metabolism) gene analysis, common variant(s) (e.g., *2, *3, *4, *5, *6)
81336
SMN1 (survival of motor neuron 1, telomeric) (e.g., spinal muscular atrophy) gene analysis; full gene sequence
81337
SMN1 (survival of motor neuron 1, telomeric) (e.g., spinal muscular atrophy) gene analysis; known familial sequence variant(s)
81443
Genetic testing for severe inherited conditions (e.g., cystic fibrosis, Ashkenazi Jewish-associated disorders [e.g., Bloom syndrome, Canavan disease, Fanconi anemia type C, mucolipidosis type VI, Gaucher disease, Tay-Sachs disease], beta hemoglobinopathies, phenylketonuria, galactosemia), genomic sequence analysis panel, must include sequencing of at least 15 genes (e.g., ACADM, ARSA, ASPA, ATP7B, BCKDHA, BCKDHB, BLM, CFTR, DHCR7, FANCC, G6PC, GAA, GALT, GBA, GBE1, HBB, HEXA, IKBKAP, MCOLN1, PAH)
81518
Oncology (breast), mRNA, gene expression profiling by real-time RT-PCR of 11 genes (7 content and 4 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithms reported as percentage risk for metastatic recurrence and likelihood of benefit from extended endocrine therapy
81596
Infectious disease, chronic hepatitis C virus (HCV) infection, six biochemical assays (ALT, A2-macroglobulin, apolipoprotein A-1, total bilirubin, GGT, and haptoglobin) utilizing serum, prognostic algorithm reported as scores for fibrosis and necroinflammatory activity in liver
0537T
Chimeric antigen receptor T-cell (CAR-T) therapy; harvesting of blood-derived T lymphocytes for development of genetically modified autologous CAR-T cells, per day
0538T
Chimeric antigen receptor T-cell (CAR-T) therapy; preparation of blood-derived T lymphocytes for transportation (e.g., cryopreservation, storage)
0539T
Chimeric antigen receptor T-cell (CAR-T) therapy; receipt and preparation of CAR-T cells for administration
0540T
Chimeric antigen receptor T-cell (CAR-T) therapy; CAR-T cell administration, autologous

The following CPT codes are covered but not reimbursed (resubmit w/ HCPCS):
Code
Description
97153
Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with one patient, each 15 minutes
97154
Group adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with two or more patients, each 15 minutes
97155
Adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, which may include simultaneous direction of technician, face-to-face with one patient, each 15 minutes
97156
Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (with or without the patient present), face-to-face with guardian(s)/caregiver(s), each 15 minutes
97157
Multiple-family group adaptive behavior treatment guidance, administered by physician or other qualified health care professional (without the patient present), face-to-face with multiple sets of guardians/caregivers, each 15 minutes
97158
Group adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, face-to-face with multiple patients, each 15 minutes

The following CPT codes redirect to Optum for consideration under the BH benefit:
Code
Description
96130
Psychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s), or caregiver(s), when performed; first hour
96131
Psychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s), or caregiver(s), when performed; each additional hour (List separately in addition to code for primary procedure)

     report
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.

mpr     
Medical Policy

The following medical policy updates are effective January 1, 2019: 
  • Bariatric Surgery - Annual review without substantial changes in medically necessary indicators. References updated.
  • Breast Surgeries - Annual review without substantial changes in medically necessary indicators. 
  • Phototherapy and Photochemotherapy for Dermatologic Conditions - Annual review. Under UVB Excimer Laser Therapy section, changed trial from 3 months to 2 months. References updated.
  • Reconstructive and Cosmetic Procedures - Annual review. Added CPT codes. References updated.
  • UVB Home Phototherapy Units for Skin Disease - Annual review without substantial changes in medically necessary indicators. 
Click Here to view all medical policies.

contact      
Contact Information 

We are here to help! Contact us today: 

Provider Service: 855-444-4647 or providerservice@allwayshealth.org

Provider Portal Support: prweb@allwayshealth.org

Provider Enrollment & Credentialing: pec@allwayshealth.org