CareSource Contract Implementation Updates

CareSource PMPM Payments:

CareSource has confirmed with TCCN that January through March 2023 Per Member Per Month (PMPM) payments were mailed to practices in the first week of May. They also informed us that January and February PMPM payments did not pay the correct amounts. Retro payments for January and February, and current April PMPM payments are expected to be paid in May.

CareSource 2023 VBR Quality Enhancer (QE) Program:

The CareSource Quality Enhancer (QE) program is an annual incentive opportunity that allows contracted CareSource PCPs to maximize financial incentives per patient visit. The QE program is effective 1/1/2023 and requires practices to submit claims with the appropriate CPT code, Trigger code, and Two-digit modifiers. Quality Enhancer payments are made at the claim level when the claim processes resulting in an immediate financial gain for the practice.

 PROGRAM DETAILS:

Please review the attached QE flier that contains program information, including CPT codes and modifiers. The QE Program focuses on six quality measures:

• Child and Adolescent Well-Care Visits
• Social Determinants of Health Screening
• Developmental Screening in the First Three Years of Life
• Screening for Depression
• Influenza Vaccine
• COVID-19 Vaccine

In addition, TCCN has asked CareSource for their policy guidance for the Social Determinants of Health Screening measure. We will provide the information when it is received.

You must bill the qualifying service CPT with the trigger code and the modifier to be reimbursed the Quality Enhancer payment amounts indicated below. 

Please be aware, CareSource completed the configuration of the 2023 QE program on 2/2/2023. They completed a mass claims adjustment on 4/6/2023 for practices that billed the 2023 QE codes. If you have received rejections due to the delayed configuration of the 2023 QE and received front end rejections or denials, please verify the QE codes and modifiers, and resubmit the claim. 

Redetermination Fliers:

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. Notices will be sent to all members. Please encourage members to confirm their contact information is up to date. If the state finds that a member is still eligible for Medicaid, coverage will be renewed. If a member is no longer eligible, they will be connected with alternative healthcare options. For more information, please visit https://dhs.georgia.gov/medicaid-unwinding. Attached is a CareSource redetermination flier for providers.

ECHO EFT Enrollment Process:

To sign up your practice for Electronic Funds Transfers with CareSource, please complete the attached ECHO EFT enrollment forms. Enrollment takes 7-10 business days for processing. If bank verification is needed, enrollment requires a bank letter or voided check and could extend set up time.

Thank you for your continued support!

Your TCCN team