Note: New Content Noted with Asterisks*** and Highlighted
Dear KHF Providers and Practice Administrators,
We have several updates to share regarding payor updates, programs and upcoming events. There is a lot of information, and we want to make sure we are keeping our membership informed. We recommend reading through this communication in its entirety and please reach out to us with any questions you may have!
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APB MOC Part 4 Program Opportunity- Depression Screening
Kids Health First is excited to announce that we will be offering a free American Board of Pediatrics Maintenance of Certification (MOC) Part 4 Program for our providers! Kids Health First is an ABP Portfolio site and has designed a MOC program that will help the providers and patients in our metro Atlanta area.
Please note that while we do not anticipate any problems, we do not yet have approval from the Board of Pediatrics. We have submitted the MOC application for Part 4 credit and we are awaiting approval. The program will begin in late July and will extend through the end of the year. If you need your points in 2023 and have completed the program, they will be rewarded before the end of the year. Please see the attached flyer
In a partnership with TCCN, The Kids Health First Quality Utilization Management Committee is looking to define the scope of the behavioral health crisis in our network and to be part of the data driven solution. As a TCCN minimum requirement, you are already screening for depression at adolescent visits. The MOC program will focus on the results of the screen and assess if follow up is received in an appropriate time frame. We all understand that resources for behavioral and mental health are not adequate. It is our goal to determine the rate of positive screens and with your help, demonstrate the need for more services.
This is a fantastic opportunity to receive MOC Part 4 points, that can be carried over to next year, as well as an opportunity to impact change. Please see the attached flyer and send an email to MOC@khfirst.com to register.
The registration deadline is July 19th.
We strongly encourage all providers in your practice to participate since the MOC will require coding updates to your EMR.
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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:
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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:
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Online at Georgia DHS’ benefits website: Gateway.ga.gov
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In person at their local DFCS office: dfcs.georgia.gov/locations
- By phone at 1-877-GA-DHS-GO or 711 for the hearing impaired
Click here to download the full press release.
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Georgia Pathways to Coverage™ Launches, Establishing a New Category of Medicaid Assistance***
The Georgia Department of Community Health (DCH) announced today the launch of Georgia Pathways to Coverage™, an innovative program that establishes a new category of Medicaid assistance for Georgians who otherwise would not be eligible for traditional Medicaid.
As one of Governor Kemp’s key priorities, this program seeks to increase access to affordable healthcare coverage, lower the uninsured rate across Georgia, support participating members on their journeys to financial independence, and promote members’ transitions from Medicaid into private coverage.
Pathways offers Medicaid coverage to eligible Georgians who are U.S. citizens or legally residing non-citizens, are ages 19-64 who have a household income of up to 100 percent of the Federal Poverty Level (FPL), are not otherwise eligible for traditional Medicaid, are not incarcerated, and can document that they meet the qualifying activities threshold. Qualifying activities include full-time or part-time employment, on-the-job training, job readiness assistance programs, community service, vocational educational training, enrollment in the Vocational Rehabilitation program of the Georgia Vocational Rehabilitation Agency (GVRA), and higher education. Qualifying activity requirements only apply to Pathways members, and not those enrolled under traditional Georgia Medicaid. Furthermore, there are currently no member copays or premiums associated with Pathways.
Click here to download the full press release.
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Alert to KHF Practices on Redetermination of Medicaid Eligibility
As the COVID-19 Public Health Emergency ended, states could begin terminating coverage for ineligible Medicaid recipients, who were temporarily covered during the PHE. According to CMS, while some states have begun the redetermination process, most will not begin terminating coverage until June or July.
In a survey conducted by the Kaiser Family Foundation completed in late May, results indicated that 65% of Medicaid recipients are not aware that states could begin terminating coverage. For more information, click here.
To ensure our patients are aware of the possible termination and redetermination process, please share the following information with them.
If your child is on Medicaid or Peach Care for Kids, please review the following information carefully.
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Continuous enrollment in temporary Medicaid was tied to the end of the public health emergency but will end on March 31, 2023. Recent legislation has allowed states to begin un-enrolling patients as early as April 1, 2023.
- Most states will take approximately one year to complete this process of disenrolling individuals. This is referred to as Medicaid Unwinding or Medicaid Redetermination.
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The state of Georgia will begin the Medicaid Redetermination process on April 1, 2023. This includes all children currently on Medicaid and Peach Care for Kids.
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It is extremely important for you to make sure your information is up to date with the Georgia Department of Human Services (DHS) . If you have not created an account in Gateway, please visit https://www.gateway.ga.gov/access/ and create your account.
- Be sure to update all information including the following: (Available in English and Spanish)
- Name
- Phone number
- Job or income
- Number of people in the household
- DHS encourages you to select “email” notifications which is the easiest way for them to reach you.
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DHS has also created a website that will post currents news and information about Medicaid. Go to https://staycovered.ga.gov/ to stay informed.
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Call 877-423-4746 for more information on Medicaid. Please pay attention to any communications you may receive from the Department of Human Services and CMS.
Resources:
https://staycovered.ga.gov/ (In English and Spanish)
http://www.gateway.ga.gov/
Also attached is a communication with wording that you can use to send an update to your patients to alert them of the changes. Click for the Word version and the PDF version.
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TCCN Sponsors the Children’s Annual Professional Staff Meeting***
The Children’s Care Network is sponsoring the 2023 Children’s Annual Professional Staff Meeting on Wednesday, August 23 at 6:00 pm at the Children’s Support Center.
This meeting replaces the TCCN Fall Clinical Quality Forum, so your attendance at the event will count towards your 2023 meeting attendance requirement.
We have coordinated to make tables available for subspecialty physicians to connect with pediatricians and other physician attendees.
This networking opportunity has been requested by many of you and we strongly encourage pediatricians in particular to attend!
Please note that this meeting will not be recorded. Come and enjoy free food, beer and wine!
If you have not sent your RSVP and are planning to attend, please respond to the calendar invite that you should have received from Physician Communications or complete this online registration.
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TCCN Antibiotic Stewardship Webinar: Why It's Important For Your Practice and Patients
Join us on August 16 at 12:30 pm as we continue our 3-part virtual series 'Antibiotic Stewardship: Why it's Important for Your Practice and Patients'.
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.
Webinar #2: August 16, 12:30-1:30
Please be sure to register in advance to receive the meeting link. Same-day registrations may experience issues with logging on.
If you missed it, click here to watch
Webinar #1: How to Access and Use the Website
Save the dates for upcoming webinars:
Webinar #3: November 1: Antibiotic Dosing
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TCCN Seizure Action Plan Video and Resources
TCCN member group, Children’s Neurology, has been awarded a 1998 Society grant for a quality improvement project aimed to reduce emergency department visits and hospitalizations for patients with breakthrough seizures. Read more here.
TCCN has developed the following video in support of this grant. The video provides an overview of the self-management education and resources provided to patients and families as well as coordination of care documents for providers and how to locate them in accessCHOA. Teaching sheets utilized by the neurology team are also included.
Click Here to View the Seizure Action Plan Video
Resources:
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Children's Pediatrics Zero Suicide Webinar Series
The Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD), Office of Behavioral Health Prevention and Federal Grants is pleased to announce the Pediatric Zero Suicide Webinar Series, which will target Georgia's pediatric primary care providers and their staff. This webinar series will offer training sessions that will help to uncover and care for the mental health needs of youth as well as support parents and guardians.
For more information and to register please click here.
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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.
Pain in pediatric patients is common, under-recognized, and undertreated. Unrelieved acute, chronic, and needle pain in childhood directly results in poorer clinical outcomes, including increased morbidity, degree of anxiety, needle-phobia, health care avoidance, and chronic pain, which may contribute to substance use disorders.
Please click here to learn more.
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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. Physicians who have previously completed similar training to meet Georgia’s licensing requirements can count those courses, but they typically were not enough to fulfill the 8-hour requirement.
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.
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Amerigroup Notification Error Update
On May 23, 2023, Children’s was notified that Amerigroup members received notices advising them Scottish Rite Hospital is out-of-network as of May 15, 2023. Amerigroup is the Medicaid CMO that covers all kids in foster care in Georgia as well as many other children across the state.
Amerigroup confirmed that the member notifications were sent in error due to a system issue that has impacted many providers. There should not be any network disruption for Amerigroup policy holders.
Contact managedcare@choa.org if you or your patients experience any authorization issues related to the inaccurate notification.
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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.
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Humana
Introducing an online community resource directory
https://humana.findhelp.com/
Addressing health-related social needs can be important to your patient’s health. That’s why Humana Community Navigator, powered by findhelp, offers an online directory of community resources with more than 500,000 social service programs across the United States.
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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.
Additional Resources
AAP unwinding two pager_3.15.23.pdf
Practice_Template_Letter_Unwinding_Medicaid.docx (live.com)
Practice Template Letter Unwinding Medicaid Spanish Copy.docx (live.com)
Microsoft Word - AAP_Georgia.docx
Lactation Consultants – Revised Policy effective 3/15/2023
Medicaid Member Redetermination
DCH has not contacted members in 2 years and will begin member redetermination outreach on February 1, 2023. They must initiate contact with all Medicaid members within 12 months and complete the redetermination within 14 months in accordance with CMS guidelines. Members will be contacted during their renewal month. For example, if a member had a historical renewal in April, they will not be contacted until April. If the member utilizes SNAP/TANF, DCH will align with those programs to only contact the member one time.
How can the provider community help?
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Please review https://staycovered.ga.gov/ for the latest PHE Unwinding information.
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Proactively encourage and remind Medicaid patients to update their personal information on the Gateway website: https://gateway.ga.gov/access/
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Share video, images, and the PHE toolkit that are found on https://staycovered.ga.gov/ with your patients.
Georgia Medicaid Provider Revalidation
Provider revalidation has also been voluntary due to the PHE. However, in 2023 the revalidation will become mandatory. Gainwell is reaching out to providers to assist with the revalidation process. The Revalidation/Recredential application is one application.
For providers with multiple service locations, you will be required to Revalidate each additional service location.
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Kids Health First Who to Call List
Please contact our team with any needs you may have.
TCCN 2-Week Data Submission Requirement
The TCCN BOD requires all practices to submit claims data to the PHM Tool within 14 calendar days of the most recent encounter date.
Replay: Virtual PA Meeting- Active Shooter Training
KHF Updates: https://vimeo.com/819629693/b7d7ab5e02?share=copy
Active Shooter Discussion with Zachary Williams:
Recording is available for replay on the KHF Intranet site.
- Go to the University tab, then webinars to access the video.
2023 Pediatric Coding Update and Managing the Challenge of Surge
Here is the link to view the recording. Passcode: u*1Xuh11
2023 Pediatric Coding Update and Managing the Challenge of Surge Slide Deck
Nov. 17th Pediatric Coding Seminar Recording and Materials
2023 Pediatric Coding Seminar Recording
Slides: Color and Black & White
Free OSHA Training
Here is the link to the OSHA Webinar held on 9/15/22.
Here is the pdf of the deck.
Here is the end of course test.
If you were unable to attend live and you watch the video above and complete the test and would like your certificate of completion, please email Tandric Bowden at tandric.bowden@tccn-choa.org.
KHF Q&A for Parents
Q&A Resources are posted on the KHF Intranet here.
Topics Include:
- Q & A for parents on the end of the Public Health Emergency and the unwinding of Medicaid.
- Q & A for parents about the COVID-19 Bivalent Vaccine Boosters from Pfizer BioNTech and Moderna for children 5 years of age and older.
- Q & A for parents on what to know about monkeypox from Kids Health First.
- Q & A for parents on Covid-19 Booster Vaccines for 5-11 years old.
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Q & A for parents on recall of Abbott formula and re-opening of plant.
KHF Question of the Day Results
Survey Results: Credit Card Processing Fees
Question: Are you charging a credit card processing fee with each transaction or some sort of other flat fee?
0 of 30 respondents said yes they charge a processing fee.
30 of 30 respondents said they do not charge a processing fee.
Survey Results: Fever in Infants
Question: What is your office policy regarding infants between 4-8 weeks old whose parent calls the office to say they have a fever?
We surveyed! You answered! Previous Surveys are below!
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TCCN Roundup:
The TCCN Roundup is designed to be a twice weekly information hub for all things TCCN.
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Please to check out the latest issue
- Please note that the link above only accounts for some TCCN updates. In order to view the full TCCN Newsletter with your contracted payor updates please check your TCCN inbox!
TCCN Quality Steps Newsletter
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