Together Georgia

Meeting / Together Georgia
Date / July 17, 2014
Bridge Line / GA2 Bridge Line 1 x74420 or 706-868-4420 Tone 02447;
Facilitator / Earlie Rockette
Recorder / Tanya Chambers-Ashford

Invitees

Melvin Lindsey / √ / Kate Cantrell / √ / Urcel Fields / √ / Christy Schuster / √
Danielle Nabinger / √ / Joel Axler / X
Tanya Chambers-Ashford / √ / David Cooke / √ / Michelle Rush / X
Earlie Rockette / √ / David Bolt / √
Aaron Lambert / √ / David Newton / √ / Melinda Smith / √

X = absent √ = present

Follow Up/Action Items from 6/17/14

Description / Discussion / Status
The audit tool – ready for review/discussion? / David is still working on this – he reported that it will be complete within the next 30 days. They are taking into consideration APS and other CMO standards as it is created. We will review it in our next workgroup meeting with Amerigroup in August.
o NCCI edit clarity and webinar – any update? / Aaron is working through these still – he believes he will be finished by the end of Aug/beginning of Sept and at that time will send a provider communication. After this is complete, if a webinar is needed to train on the contents, he will look at doing that as well.
o POS 99 – one provider heard that this was live in the system last week, but we haven’t seen a formal communication about it yet – can providers begin using this as appropriate? / POS 99 is now permitted for Amerigroup and is configured in the system. It is critical that providers must indicate where the service was provided in the content of their note for that service. They also let us know that a high number of POS 99 could trigger an audit.
o CSI – we discussed doing some training/discussion with Amerigroup and providers to ensure common understanding – any update? / We will use the first 30 minutes of next month’s meeting to discuss both CSI and IFI to begin this dialogue. Dr. Axler will be present for this discussion.
Upcoming dates for Trauma Assessment trainings / Earlie reported that they plan to share with providers the preferred tools for trauma assessments in August.

New Agenda Items

Outcome / Status
• POS guidance – requirement to use specific POS code to bill as opposed to billing 053 (Community Mental Health Center) and utilizing the specific U code modifier to distinguish in/out of clinic. This is a follow-up to an email between a provider and DBHDD. / Providers must use the actual place of service code when they bill for services. There was some confusion with some providers using POS 53 (community mental health) for all services rendered. POS must match location where service was provided.
• IFI providers who do not also offer CORE services are unclear about how to bill for their intakes because they can only bill the IFI code (H2021) and this requires prior authorization. How should they do this? / Per David Newton, all credentialed providers with Amerigroup should be able to bill 9 codes. This means that IFI only providers are not limited to billing H2021 only for Amerigroup consumers.
• Service guidelines – there is some confusion among providers around service guidelines – some have gotten the direction to follow APS guidelines. Which service guidelines should providers follow for Amerigroup members and where can these be found? / Amerigroup recommended that providers use the DBHDD manual. The only exception that David Newton could think of at the time of our meeting was the age requirements for CSI. Other than that, he said that the requirements relating to services should follow the DBHDD manual. This led to a discussion about CSI related to consumer age. Amerigroup bases eligibility for CSI as opposed to PSRI on chronological age. CSI (2015) should be used for youth under 18. PSRI (2017) should be used for youth age 18 and older regardless of custody status. Further, PSRI can be billed by child and adolescent providers (you don’t have to be an adult provider to bill this). An authorization is required for PSRI though so it’s critical that a request for auth be submitted ahead of a consumer’s 18th birthday if they will need this service.
• Authorization response lag – some providers have reported lag times of up to 30 days waiting for a response to authorization/reauthorization requests. / David and Earlie reported that there should be a 7-14 day processing period with auth requests currently. They shared that there was an issue when all of the 360 kids needed reauths at the same time, but that now the issue should be resolved. They also commented that they got auth requests from many providers requesting the full array of services for a consumer as opposed to the particular services needed for that consumer. If auth requests take longer than 7-14 days, providers should log into the web portal to track and re-submit.
• Online authorization/reauthorization requests – some providers are using the online system to submit auth/reauth requests, other providers are unaware that this exists. How can we help all providers become aware and get trained on how to do this? We also have a few clarifying questions about the process that we would like to discuss when we meet. / I am sending along some additional information about Amerigroup’s online authorization system – Availity. This is available for all providers to do now. There is a webinar included in what I will send. After entering the basic consumer information online, there is a need to attach pages 2-4 of the OTR form. There is a fillable OTR document on the Amerigroup website that can be used to make this process simpler. Providers will get a tracking number when they submit requests online which makes tracking these much easier.
• Denials related to the glitch in the system that was looking for authorizations effective 6/3 – some providers being told it may be another couple of weeks until this is fixed, any update on this? / This has reportedly been fixed now for all providers. If anyone is still having an issue, please let me know.
• Lag in eligibility for some DJJ youth – experiencing some situations where DJJ-committed youth are stepped down from YDC/RYDC to an RBWO program and there is a delay in their becoming eligible for GA Families 360 – is this something Amerigroup is aware of and working with DJJ on? / Amerigroup and DJJ are aware of this issue. It is complicated but they are working on it.
PRTF application – some providers reporting confusion on what specifically is needed for a PRTF request. We discussed this a bit last month, but wanted to get a bit more detail on specifically what should be included in these requests. / Ran out of time – will be covered next meeting
• Denials and delays in payment – several CORE agencies are reporting a higher number of denials and delays in payments. We will work to gather some specifics for our meeting. / Ran out of time – will be covered next meeting
• Family therapy encounter time – is this going to be changed to 90 minutes (currently at 45 minutes)? / Ran out of time – will be covered next meeting
Related to the above and similar to our discussion last month about CSI, we would like to begin a dialogue about Intensive Family Intervention (IFI) with the goal of reaching a common understanding and ultimately making it an appropriate, effective service for youth. / We will use the first 30 minutes of next meeting to begin our dialogue about both CSI and IFI with Amerigroup.

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