Notes from last week’s Medicaid Fair in Columbus, GA

There is a list of providers who will be suspended due to not performing a revalidation on the web portal. To find the list, login to the web port, go to account, messages and click on the link "Suspension of Providers who have not revalidated"

Also if you're interested in any of the power point presentations that were given at the fair, you can click on Provider information, provider notices. You will see the list of numerous presentations listed with the title "Medicaid Fair November 2016". Some of these presentations contain contact information or address that might be of importance, especially during an appeal process.

There will be some changes in HCPCS codes for 2017. More details can be found at cms.gov. ICD10 unspecified codes will not be allowed as much for primary diagnosis.

The name of the Prior Authorization tab on the web portal will be changing at the end of the month to "Medical Review Portal" to make it easier for providers to understand where to file/review appeals.

When I spoke to Amerigroup about issues with authorization denials, they simply kept referring me to their manual on their website. I didn't have much luck there. However, Amerigroup stated that if a provider goes through the CVO process with Medicaid to become a participating provider under a group tax id that is already in network with AG, they are automatically adding the providers to the group as participating once Medicaid notifies them.

The major topic was the introduction of the new CMO company for Georgia. The new company is a non‐profit company called Care Source that will be available for peach care for kids. Care Source has been participating with Medicare and Medicaid programs in other states such as Ohio and Kentucky for more than 20 years. They are now taking applications for network participation for any providers who want to join. In February 2017, open enrollment will begin for all patients who are enrolled in a CMO, and will have the opportunity to change to Care Source, Amerigroup, Peachstate or Wellcare. Members who wish to change will contact Georgia Families ﴾888‐423‐6765 or georgia‐families.com﴿. Members will be given two months to make any changes. I spoke to Care Source about issues that therapists currently have with Amerigroup ﴾requesting hearing screens for speech﴿ and Wellcare ﴾not paying the current rate﴿. They do plan on paying the Medicaid rate, plan on being similar to Amerigroup as far as claims processing, but no hearing screens per a statement from a spokesperson. I've asked other billers in local states that have worked with Care Source what their opinions were working with this company. I heard the following complaints: they have a 1 year deadline for claims whether claim issues are fixed or not, sometimes they delay processing claims, and payments can be delayed. However others said the company was easy to work with and didn't have issues with payments. Most of the billers who didn't have complaints were working in GPs or more common practices. Others who complained more worked in specialties. My opinion is indifferent about Care Source. I believe at least in the beginning the company will be more flexible, but not sure how things will work as time goes on.

There have been a ton of issues with authorizations for both CMO and Medicaid, but as for now, I'm waiting responses from representatives for answers. If anyone has any examples or want to pass information along about auths, please feel free to contact me.

And as usual, feel free to pass this information along. Thanks!