Practicematters Arizona | Spring 2020
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Arizona | Spring 2020
practicematters
For the latest on COVID-19, visit the Centers for Disease
Control at CDC.gov.
For UnitedHealthcare benefits information and resources
related to COVID-19, visit UHCprovider.com/covid19.
Arizona Health Care Cost Containment System (AHCCCS)
frequently asked questions about COVID-19 guidance and
requirements are at ahcccs.gov/covid19. We encourage
you to view the latest COVID-19 information from the
Arizona Department of Health Services website.
For More Information
Call our Provider Services Center at 800-445-1638
Visit UHCprovider.com
Important information for health care professionals and facilities
Policy, drug and Protocol changes contained herein are effective and enforceable as of the dates
indicated, pending notice from UnitedHealthcare to the contrary. Changes to these effective dates
or updates to our business practices and policies as a result of COVID-19 will prevail and be posted
on our care provider website as quickly as possible. As with any public health issue, we are working
with and following guidance and protocols issued by federal, state, and local health authorities.
We understand that it’s a confusing time. Right now, you need all the resources and information you can get.
We’re working to keep you updated so you can focus on keeping Arizona residents healthy and safe.
First and Foremost, Thank You.
As the people on the front lines of COVID-19, we appreciate your efforts to fight this virus. To all health care
professionals who are caring for sick patients and working around the clock to help find solutions — thank you
for all you’re doing.
Find the Up-To-Date Information You Need
We’ll be regularly updating the National UHCprovider.com page with our actions on updating state-specific
guidance at your state-specific UHCprovider.com page. We also suggest that you check your state’s
COVID-19 site for the latest news and regulations.
On our sites, you’ll find information:
To Help Manage Your Business As You Work With Patients
• Acceleration of Claim Payments • Expanded Telehealth Access and Reimbursement
• Extension of Timely Filing Limits • Telehealth Coding Guide
• CARES Act Information • Member Cost-Share Waivers
• Provisional Credentialing • Assistance with Patient Discharge Planning
• Requirements to Practice in a New Location • Easier Access to DME and Supplies
• Changes to Prior Authorization Requirements • Suspension of HouseCalls and Optum at Home
• Updates on Delayed Programs and Policies
2
2 Practice Matters: AZ
TX – Spring 2020
- Summer 2013 Provider Services
Customer Service Center: 800-445-1638
888-362-3368
Important information for health care professionals and facilities
In This Issue...
• New Educational Resources for the 2020
UnitedHealthcare Dual Complete® Plan
• UnitedHealthcare Dual Complete Benefit:
Transportation Assistance – Helping Members
in Arizona Get to Their Appointments
• Encouraging Good Oral Health for the Pediatric Patient
• Updated Ordering, Referring and Supervising
Provider Billing Requirements
• Retro Authorization for Therapy
p.1
• Social Determinants Billing Guidelines
• The Division of Developmental Disabilities
Plan of Care Signature Notice
• Evidence-Based Peer and Family Support
• Peer- and Family-Run Organizations
Practice Matters: AZ – Spring 2020 Provider Services Center: 800-445-1638
Important information for health care professionals and facilities
UnitedHealthcare Dual Complete
Transportation Benefit: Helping
Members in Arizona Get
to Their Appointments
The UnitedHealthcare Dual Complete® plan transportation
benefit can help your patients get to their health care
appointments. For the 2020 plan year, Arizona members
are eligible for 24 one-way rides per year. Members can
request rides to approved locations and back home again.
Transportation coverage may include rides
not covered by Original Medicare to:
New Educational Resources
• Dental appointments
for the 2020 UnitedHealthcare
• Vision appointments
Dual Complete® Plan
• Podiatry appointments
New resources for the 2020 UnitedHealthcare Dual
• Hearing appointments
Complete plan are now available on the Arizona UHC
On Air channel. These courses include valuable program It’s Easy to Set Up a Ride
information and meaningful updates for your office staff.
Courses are pre-recorded and available online 24 hours Non-emergency transportation services are provided by
a day, seven days a week. our service partner, MTBA. Rides should be scheduled
three business days in advance of the desired pick-
2020 courses include: up time. Urgent transportations requests are available
24 hours a day, seven days a week. Members or care
• Dual Special Needs Plans: An Introduction
providers can call:
• Dual Special Needs Members: Who Are They?
MTBA
• The UnitedHealthcare Dual Complete Plan in Arizona
888-700-6822
Simply sign in to Link with your Optum ID and 6 a.m. – 7 p.m. local time, Monday – Friday
begin watching.
Visit UHCprovider.com/AZDSNP >
Visit UHCprovider.com/AZDSNP to learn
2020 Plan > 2020 UnitedHealthcare Dual
more about the Dual Special Needs plans
Complete® Plan Benefit Flyer to see a full list
offered in your area.
of benefits in your area.
4
4 Practice Matters: AZ
TX – Spring 2020
- Summer 2013 Provider Services
Customer Service Center: 800-445-1638
888-362-3368Important information for health care professionals and facilities
Encouraging Good Oral Health • After the screening, physicians should discuss
the importance of visiting their dental home with
for the Pediatric Patient the parent or guardian – for both at-risk and
healthy children. A dental home can offer early and
Did you know that bacteria, such as Streptococcus
periodic intervention, as well as risk assessment,
mutans, causes tooth decay and is transmissible from
anticipatory guidance and regular supervision. All
parents or caregivers to children through the exchange of
UnitedHealthcare Community Plan EPSDT members
saliva? As a result, it is important to educate and caution
are assigned a dental home. Members can call
parents not to share cups, plates, spoons or straws with
Member Services if they don’t know their dental home
their child and avoid kissing them on the mouth.
information.
For those children at a moderate-high risk of tooth decay, • Applying a fluoride varnish is another helpful
also known as caries, multifaceted preventive approaches approach. An effective weapon in preventing
include: early screening of young children, dietary decay, fluoride can be used as a non-surgical
evaluations, access to care and embracing a wide team approach to treating disease by remineralizing the
of health care professionals to collaborate and respond to enamel. Applying varnish is both quick and easy.
the diverse needs of local populations. It can be painted on in a couple of minutes and
it maybe reimbursable under Arizona Medicaid.
The American Academy of Pediatric Dentistry (AAPD)
UnitedHealthcare Community Plan has additional
recommends that a child visit the dentist by age 1 or
resources for PCPs interested in adding fluoride
within six months after the first tooth erupts. However,
varnish to their practice.
because most children visit their pediatrician or family
physician for well-child visits before that first dental • Finally, physicians and their staff can help educate
visit, physicians can be an important influence in setting their patients and patient caregivers on the
children on the path to good oral health. importance of good dental health in early childhood.
For additional information, please contact your
While the child’s dentist is responsible for performing a Provider Advocate or the Clinical Practice Consultant
comprehensive oral examination, primary care providers assigned to your practice.
(PCPs) can help assess a child’s dental health and
recommend appropriate follow-up. A screening can
identify children at risk and can be performed in about a Ordering, Referring and
minute using only a light and tongue blade. . Supervising Care Provider Billing
Some things to look for: Requirements for CMS-1500
• What is the general condition of the teeth? Are there and 837P Electronic Claims
white or brown spots? Decayed or broken teeth?
Teeth that appear deformed or out of position? In accordance with Chapter 5 and Chapter 10 of
the Arizona Health Care Cost Containment System
• What do the gums look like? Are they pink? Red
(AHCCCS) Fee-for-Service Provider Manual, as well
and puffy? Is there noticeable plaque or other debris
as the federal 21st Century Cures Act, an ordering,
present? How is the child’s hygiene in general?
referring or supervising care provider must be included on
• Are there other lesions or ulcerations present? CMS-1500 and 837P claims.
(continued on next page)
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5 Practice Matters: AZ
TX – Spring 2020
- Summer 2013 Provider Services
Customer Service Center: 800-445-1638
888-362-3368Important information for health care professionals and facilities
(continued from previous page)
Requirements for CMS-1500 Claims An ordering provider may be any of the following:**
When submitting CMS-1500 claims, please be sure to • Certified nurse midwife
include the following information: • DO
• Box 17: Qualifier and referring provider name • Dentist
(Last Name, First Name, Middle Initial)
• MD
o If applicable, enter one of these qualifiers:
• Optometrist
– DN: Referring Provider
• Physician assistant
– DK: Ordering Provider*
• Psychologist
– DQ: Supervising Provider
• Registered nurse practitioner
• Box 17a: AHCCCS provider ID number for providers
without a National Provider Identifier (NPI) number **Note: AHCCCS provider type RP is not a valid
provider type for purposes of using as a referring or
• Box 17b: NPI number
ordering provider NPI. According to AHCCCS, the RP
Example provider types are only valid for Fee-for-Service claim
submissions that are sent directly to AHCCCS. They are
not valid for claims processed by AHCCCS Managed
Care Organizations (MCOs), including UnitedHealthcare
*An ordering provider should be included on CMS-1500 Community Plan.
claims billed with the following services:
Requirements for 837P Electronic Claims
• 97001-97546 (excluding 97151-97158)
For 837P electronic claim requirements for ordering,
• Drugs (J-codes) referring or supervising care providers, please see the
• Durable medical equipment (DME) current version of the 1500 - 837P Map from the National
• Enteral and parenteral therapy Uniform Claim Committee.
• Laboratory Please note: If multiple providers are involved in one
• Medical and surgical supplies claim submission, enter one provider using the following
priority order:
• Podiatrist services
1. Referring Provider
• Orthotics
2. Ordering Provider
• Prosthetics
3. Supervising Provider
• Radiology
• Respiratory DME Unless the services are listed above and require an
ordering provider, then the priority order would be:
• Temporary K and Q codes
1. Ordering Provider
• Vision (V-codes)
2. Referring Provider
3. Supervising Provider
(continued on next page)
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6 Practice Matters: AZ
TX – Spring 2020
- Summer 2013 Provider Services
Customer Service Center: 800-445-1638
888-362-3368Important information for health care professionals and facilities
(continued from previous page)
Federally Qualified Health Centers (FQHCs), Rural Social Determinants of
Health Clinics (RHCs) or Multi-Specialty Interdisciplinary
Clinics (MSICs) that are currently required to submit Health Billing Guidelines
provider information in Box 19 are also required to submit
The Arizona Healthcare Cost Containment System
referring, ordering and supervising information in Box 17.
(AHCCCS) has specific guidelines for listing social
For more information, visit our FQHC and RHC Claim
determinants of health codes on claims. According to
Submission Guidelines.
Chapter 4 of the AHCCCS Fee-for-Service Provider
Billing Manual, social determinant ICD-10 diagnosis
We’re Here to Help
code(s) in code range Z55-Z65 must not be listed as
If you have questions, please call Provider the primary ICD-10 diagnosis code(s) on claims.
Services at 800-445-1638. Thank you. These codes may only be used as secondary or tertiary
diagnosis codes.
Retro Authorization for What This Means for You
Therapy Services Starting Feb. 1, 2020, we will deny claims submitted to
us with ICD-10 diagnosis codes Z55-Z65 listed as the
UnitedHealthcare Community Plan would like to inform
primary diagnosis code(s). If this happens, you’ll be
our therapy provider network that we will not be allowing
required to submit a corrected claim.
retro authorizations for physical, occupational or speech
therapies. Authorization requests can only be submitted
Billing Resource
for current or future dates of service.
For more information about coding and reporting
Prior Authorization Resources guidelines, please see the following resources:
• Prior Authorization and Notification Lists • AHCCCS Social_Determinants_of_Health_ICD-
10_Code_List
• UHCprovider.com/paan (Prior Authorization and
Notification tool) • Centers for Medicare and Medicaid Services (CMS)
ICD-10-CM Guidelines, pages 17-18: ICD-10-CDM_
We’re Here to Help Official_Guidelines_for_Coding_and_Reporting
If you have questions, please call Provider
Please note: Coding and reporting guidelines may
Services at 800-445-1638 for AHCCCS
be updated at any time. Please review the coding
Complete Care (ACC) and Developmental
resources regularly to help ensure you’re following the
Disabilities (DD) or 800-293-3740 for Arizona
most current guidelines.
Long-Term Care System (ALTCS). Thank you.
We’re Here to Help
If you have questions, please call Provider
Services at 800-445-1638 for AHCCCS
Complete Care (ACC) and Developmental
Disabilities (DD) or 800-293-3740 for Arizona
Long-Term Care System (ALTCS). Thank you.
7
7 Practice Matters: AZ
TX – Spring 2020
- Summer 2013 Provider Services
Customer Service Center: 800-445-1638
888-362-3368Important information for health care professionals and facilities
The Division of Developmental Over the last 20 years, the practice of peer support in
behavioral health has virtually exploded around the globe
Disabilities Plan of Care with an increase in recovering persons being hired to
Signature Notice provide peer support. Estimates place the number of
peer support staff currently to be over ten thousand in
The Division of Developmental Disabilities (DDD) held the United States alone).1 Peer support was declared an
a meeting to discuss the improvement and efficiency evidence-based practice by CMS in 2007. Individuals who
of the delivery of services in addition to enhancing the receive peer support have reported overall increases in
integration of care. One of the developments of the their quality of life.2
meeting and subsequent field analyst is the requirement
of a certified plan of care (POC) for ongoing therapy RI International (formerly Recovery Innovations of
services, as well as the requirement of a prescription/ Arizona) employs hundreds of peer specialists to offer
referral to initiate a therapy evaluation. peer advocacy services to individuals in the hospital.
Their focus on recovery planning and recovery-oriented
• The member or their responsible party is responsible
discharge plans has produced significant improvements,
for obtaining the discipline-specific prescription or
including:3
referral for a therapist to complete an evaluation.
• 36% reduction in the use of seclusion
• The evaluating therapist will develop the POC and
submit to the referring physician for certification (i.e., • 48% reduction in the use of restraints
dated signature and NPI number). The certified POC • 56% reduction in hospital readmission rates
will then need to be returned to the therapist as
it will serve as the prescription/referral for ongoing You can find more information on peer- and
therapy services. family-run agencies at azahcccs.gov/AHCCCS/
• A recertification of the POC will also require a dated HealthcareAdvocacy/OIFA.html.
signature as well as the NPI number.
1
Davidson, L. et al, 2012
As a valued provider, we appreciate the efforts in 2
SAMHSA, 2016
providing the medical prescription and the certification 3
(RI International, 2016)
of the subsequent POC. You will find UnitedHealthcare
Community Plan’s guidelines regarding the POC in our
Coverage Determination Guidelines available online. Peer- and Family-Run
Organizations
Evidence-Based Peer What Is a Family-Run Organization?
and Family Support Family-run organizations employ parents who have
When an individual experiencing mental health real-life experience in the behavioral, medical and/or
challenges receives “peer or family support” during their DCS systems. They specialize in providing family support
mental health need, we see a 56% reduction in hospital services and can provide one-on-one support to you.
readmission rates. In a 2013 study, 28.7% of respondents
were not employed or had transitional/sheltered
employment before Case for Peer Support (CPS) training.
As a result of their work as CPSs, 60% of respondents
transitioned off or reduced public assistance, which
reduced their use of mental health care services.
(continued on next page)
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8 Practice Matters: AZ
TX – Spring 2020
- Summer 2013 Provider Services
Customer Service Center: 800-445-1638
888-362-3368Important information for health care professionals and facilities
(continued from previous page)
Family Support Services Can Help You: Reach Family Services/Alcanza Servicios de
Familila
• Connect with other family members with shared
experiences (Phoenix)
reachfs.org
• Navigate the child-serving systems
602-512-9000
• Locate services/resources that are the “right fit” for
the needs of the child and family What Is a Peer-Run Organization?
• Learn to be an advocate Peer-run organizations are service provider owned,
• Gain new skills to care for your child operated and administrated by persons who have
experience with mental health and/or substance
• Identify formal and informal support systems use disorders. These organizations are based in the
• Develop a service plan community and provide support services.
• Manage hospital-discharge planning AHCCCS members have the right to request services
• Feel supported during child and family team and/or participate in programs provided at a peer-run
meetings (CFT), Foster Care Review Boards (FCRB) organization.
and court hearings
Peer-Run Organization Offer:
• Keep things consistent in your child’s care when case
• One-on-one peer support
managers or therapists change
• Daily support groups
• Understand decision letters and how to submit
appeals • Social outings
• Help you deal with agencies that are not supportive of • Meals
the needs of your child • Employment programs
• Find classes, trainings, support groups and more • Learning opportunities
• Health and exercise programs
Caring Connections for Special Needs
• Creative arts
(Benson, Sierra Vista, Payson, Douglas,
Safford and Tucson) • Resources
ccsneeds.com • Advocacy
520-686-9436
• Volunteer opportunities
Family Involvement Center (FIC) • Youth and young-adult programs
(Phoenix, Prescott, Flagstaff and Tucson) • Meeting new people
familyinvolvementcenter.org
• Personal development
602-288-0155
• Empowerment
Mentally Ill Kids in Distress (MIKID)
• Extended hours and/or weekends
(Phoenix, Tucson, Yuma, Casa Grande,
Kingman, Nogales)
mikid.org
602-253-1240
(continued on next page)
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9 Practice Matters: AZ
TX – Spring 2020
- Summer 2013 Provider Services
Customer Service Center: 800-445-1638
888-362-3368Important information for health care professionals and facilities
(continued from previous page)
How to Access Services from a Peer-Run Hope Lives/Vive La Esperanza
Organization Phoenix, Flagstaff
1. Contact a peer-run organization in your area to learn vivehopelives.org
what services they offer. 855-747-6522
2. Request the service be added to your service plan Wellness Connections
at the peer-run organization of your choice. Once
Sierra Vista, Douglas, Safford, Nogales
the service has been requested, services should be
wellness-connections.org
initiated within 45 days.
520-452-0080
3. Here is a list of peer-run organizations:
Coyote TaskForce – Our Place Clubhouse/Café
Recovery Empowerment Network 54 and Truck 54
Phoenix Tucson
renaz.org ourplaceclubhouse.org
602-248-0368 520-884-5553
Helping Ourselves Pursue Enrichment Transitional Living Center Recovery (TLCR)
(HOPE), Inc.
Yuma, Casa Grande
Tucson, Yuma tlcrecoveryaz.com
hopetucson.org 928-261-8668
520-770-1197
Northern Arizona Consumers Advancing
Recovery
by Empowerment (NAZCARE)
Prescott, Benson, Globe, Show Low, Bullhead City,
Kingman, Eagar, Parker, Yuma, Casa Grande,
Apache Junction, Cottonwood
nazcare.org
928-442-9205
Center for Health Empowerment Education
Employment Recovery Services (CHEEERS)
Phoenix
cheeers.org
602-246-7607
Stand Together and Recover (STAR) Centers
Avondale, Phoenix, Mesa
thestarcenters.org
602-231-0071
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10 Practice Matters: AZ
TX – Spring 2020
- Summer 2013 Provider Services
Customer Service Center: 800-445-1638
888-362-3368Arizona
practicematters
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