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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PPMA STAT Poll Results- Proxy Consent***
PPMA released their weekly poll results regarding proxy consent.
Click here to view the results.
Please note that the information is for sharing purposes only and KHF is not endorsing any suggestions or recommendations.
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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. CMS has developed resources and materials to help people with Medicaid or CHIP take steps to renew their health coverage or find other coverage options.
Want to learn more about your state’s Medicaid program? Find contact and enrollment information here.
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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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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.
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
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Prescribing Guideline-The goal of this guideline is to help clinicians choose the most narrowly focused antibiotics based on the most likely bacterial pathogens and treat for the shortest effective duration
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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Tuesday, July 25, 2023, 11:00 a.m. - 11:30 a.m. ET
PYA Principals Lyle Oelrich and Angie Caldwell will address the No. 1 survey topic in the webinar series: “Compensation for Physicians Working Collaboratively with APPs.”
The webinar will explore the following:
- The four ways APPs practice with physicians
- Potential productivity compensation solutions for physicians who work collaboratively with APPs
- Three key considerations surrounding proposed split/ shared billing regulations on provider compensation plans
Click here to save your spot!
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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.
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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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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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.
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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
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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