KHF Question of the Day Results- Admin Fees and Lactation***

• Q1: Does your practice change an annual administrative fee or forms fee?
• Q2: If you charge and administrative fee, is it by child or by family?
• Q3: Do you have a separate lactation provider? If yes, can you share your practice name for questions?

Please click here to view survey results!

When to Expect the New COVID-19 Vaccines

A recent uptick in COVID-19 cases this summer has primarily been related to the XBB variants, which are descended from the original Omicron variant. The new COVID-19 vaccines are targeted to address these new variants and may be available by the end of September from Pfizer, Moderna, and possibly Novavax. However, before that can happen both the FDA and the CDC must sign off on these new vaccines.

For more information on when the new COVID-19 vaccine will be available and who will be eligible click here.

CDC Launches "Bridge to Access Program" for COVID-19 Vaccines

CDC to launch "Bridge Access Program" in Fall 2023 to provide free COVID-19 vaccines to uninsured and underinsured adults. Many of the children served by KHF pediatricians are uninsured or underinsured, as well as their parents. This is important information to share with those parents so that they too can be protected against COVID-19 in the future.

Click here to learn more. 

Webinar Replay Available: TCCN Antibiotic Stewardship Webinar: Why It's Important For Your Practice and Patients***

Thank you for all who joined us last week for part 2 of our virtual series 'Prescribing Guideline.'

This lunchtime series presents the new Georgia Pediatric Antibiotic Stewardship website, gpas-online.org, designed to help you in your busy practices with guidelines and a new antibiogram visualization tool.

If you missed it, click here to watch:

• Webinar #2: Prescribing Guideline
• A copy of the slides may be accessed here

• Webinar #1: How to Access and Use the Website

Save the dates for upcoming webinars!

Webinar #3: November 1: Antibiotic Dosing

Adams Keegan Live Webinar: Summer Topics - Roundtable #3 and Compensation Strategy*** 

Please join us for our last summer roundtable discussion, featuring a comprehensive look at how you think about your organization's overall compensation strategy and market trends. We will also address a variety of your questions regarding updates to the new Form I-9, leaves of absence, pay transparency, etc.

Presenters: Charles Rodriguez (VP of Human Capital Advisory), Amanda McCollum (VP of Human Resources), Natasha Benda (Human Resources Advisor), and Kristin Lockhart (VP of Recruiting)

Date and Time: Thursday, August 31st at 11:00 AM EDT. Click here to register.

Roadmap for Emotional Health Resources

TCCN launched an MOC program for their subspecialty members based on the ABP’s Roadmap project designed to bring additional awareness and training to providers around emotional, behavioral, and mental health.

This training is available to all providers regardless of specialty, and you can watch the 5-minute introductory video here and review more details about the program here including instructions on how to claim MOC credit.

Additional Training Available:

Cincinnati Children’s Grand Rounds: Addressing the Emotional Health of Children and Youth with Chronic Conditions and Their Families

Physicians are eligible to receive ABP MOC Part 2 credit by viewing Grand Rounds and completing a short online post-test.

The Roadmap Project maintains a website (www.roadmapforemotionalhealth.org/patients-and-families) with resources that you may find useful as you manage the behavioral health needs of both well patients and those with chronic conditions, including apps to support mindfulness and emotional health that have been reviewed by Psychologists.

AAP Online Course Opportunity: Managing Acute and Chronic Pain and Substance Use Disorders in Pediatrics

This course will meet the new government-mandated requirement for all DEA-registered practitioners to complete eight hours of training on the treatment and management of patients with opioid or other substance use disorders prior to applying for or renewing their license.

Please click here to learn more.

Recommended CME for Kids Health First Providers

The DEA recently announced that physicians renewing their DEA license from late June onward will need to demonstrate that they have completed 8 hours of training in opioid prescribing and treatment of opioid use disorder. This training is mandated by the MATE Act. 

KHF has identified a free, online, Pediatric-specific course that satisfies the DEA requirement. This course has been vetted by Dr. Lori Desouter, KHF’s Medical Director.

Please click here to learn more and register for the class.

PeachState

Georgia Pathways to Coverage Program

Georgia residents can apply for the program starting on July 1, 2023, with coverage starting the 1st of the month after approval is given.

Included is the introduction flier, FAQ and example ID card.

Virtual Credit Card

Beginning 7/1/2023 providers not enrolled in EFT will receive claim payment through the Virtual Credit Care (VCC). Please click here to read more.

Aetna

Aetna CPT 96160 Error

Aetna implemented a claim processing edit on 4/30/2023 causing CPT 96160 to deny in error.  This edit was removed on 7/7/2023.  

Aetna confirmed a project will be completed to reprocess CPT 96160. All claims within the date span of 4/30/2023-7/7/2023 will be reprocessed. There is no ETA on the project completion at this time, but KHF will continue to track this issue until it is resolved. 

If you have questions, please email us at payorconcerns@khfirst.com.

Anthem

Requests for Additional Information are now digital

Use your Attachments Dashboard to access notifications about documents needed to process your claim. Starting in June (2023) Anthem Blue Cross and Blue Shield began sending notifications to you through your Attachments Dashboard on Availity.com, when medical records, itemized bills, or other documents are required to process Commercial members claims.

Humana

Changes to preauthorization requirements for medical services

Effective July 1,2023, Cigna will update their preauthorization and notification lists for all commercial plans. Preauthorization and Notification Lists for Healthcare Providers - Humana

United Healthcare

Get ready to submit electronically in 2023

Reconsiderations, appeals and claims moving to digital submissions only

Cigna Updates

Digital ID Cards fully by 2024

Cigna Network News : First Quarter 2023 (editiondigital.net)

Modifier 25 Reimbursement Update

Effective 5/22/2023, Cigna will delay the implementation requiring the submission of documentation to support the use of modifier 25 when billed with E&M CPT’s 99212–99215 and a minor procedure. Review the updated Cigna policy here.

Additional Virtual Care Services Now Permanently Reimbursable

Georgia Medicaid

Medicaid Unwinding Toolkit Resources

Beginning April 1, 2023, all Georgia Medicaid and PeachCare for Kids® members will undergo an eligibility review. This process will take approximately 14 months. A member’s date for redetermination may be anytime between April 2023 and March 2024.

For more information, please visit https://staycovered.ga.gov or https://dhs.georgia.gov/medicaid-unwinding. 

Georgia Medicaid Provider Revalidation

Provider revalidation has also been voluntary due to the PHE. However, in 2023 the revalidation will become mandatory.

For providers with multiple service locations, you will be required to Revalidate each additional service location. 

• If you are unsure of your providers revalidation dates, log into www.mmis.gammis.gov
• Select Providers, then Demographic Maintenance, the Revalidation Date is present. 
• Posted on GAMMIS in Provider Notices (9/1/2022) “Presentation-Physician Services-September 2022,” (Slides 25-27) 

DCH to post Member Redetermination Date on GAMMIS

GAMMIS will now be including a member’s date of redetermination within the information posted when checking a member’s eligibility.

As shown in this screenshot, within the section Member ID Information the field titled, “Redetermination Date” is listed under the field titled “Gender” in the second column in the right-hand portion of the screen.

As a reminder, a screen shot noting the child’s eligibility on the date of service will ensure payment of services provided. Additionally, practice staff can also alert families of their child’s redetermination date.

This flyer and coloring sheet from Stay Informed, Stay Covered can help explain this process to families.

Medicaid and Chip Renewal Outreach and Educational Resources

Please visit Medicaid.gov for information on Medicaid and Chip Renewal Outreach and Educational Resources for the unwinding of Medicaid.



Want to learn more about your state’s Medicaid program? Find contact and enrollment information here.

Georgia Department of Community Health Shares Additional Coverage Options for Medicaid/PeachCare for Kids® Members as Redetermination Process Continues

As Georgia processes its first full batch of Medicaid/PeachCare for Kids® eligibility redeterminations in three years, the Georgia Department of Community Health (DCH) is re-sharing options for Medicaid members to maintain, regain, and explore other options for healthcare coverage:

• Members who are no longer eligible for Medicaid or PeachCare for Kids® can see if they are eligible for coverage through the Georgia Pathways to Coverage program, which launched July 1, 2023 by applying at gateway.ga.gov. The new program offers Medicaid coverage to eligible Georgians ages 19-64 who have a household income of up to 100% of the Federal Poverty Level (FPL), and who meet other eligibility requirements. Other coverage options are also available through the federal insurance marketplace.
• Members can submit eligibility paperwork up to 90 days after their termination date. If they are still eligible, their coverage will be retroactively reinstated.
• Members who feel they have been denied due to incorrect information, or for another reason, can appeal a denial up to 30 days after they receive their redetermination decision and elect to retain their coverage during the appeals process.
• Georgia Medicaid and PeachCare for Kids members can update their contact information through one of three ways:

1. Online at Georgia DHS’ benefits website: Gateway.ga.gov
2. In person at their local DFCS office: dfcs.georgia.gov/locations
3. By phone at 1-877-GA-DHS-GO or 711 for the hearing impaired

Click here to download the full press release.

Updated Resources on Screen Time and Social Media for Children

The "AAP's Bold Stance on the Value of Pediatrics" 

From Chip Hart: 2023 Telemedicine Requirement Grid

Developed by Jan Blanchard. Click on the link to download the pdf.

Kids Health First Who to Call List

Kids Health First Intranet Page