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GPA’s Insurance and Managed Care Committee Met with Wellcare and Peachstate

Wednesday, February 13, 2019   (0 Comments)
Posted by: Hannah Steinberg

GPA’s Insurance and Managed Care Committee Met with Wellcare and Peachstate

 

We wanted to provide a quick update regarding our recent meetings conducted on 2/1 with Wellcare and Peachstate. The principal purpose of our meetings with the CMO's was to discuss issues with the new psychological and neuropsychological testing codes. Our committee brought up the concerns that GPA members have expressed to us directly and on this listserve in two independent meetings conducted this past Friday.

There was one issue common to both CMO's. We brought up the confusion with the wording in the Medicaid policy manual regarding 5 unmanaged units, rather than hours. These are hours that providers should be able to utilize without getting an authorization. Wellcare and Peachstate agreed that since some of these new units are only 30 min increments, the policy should read 5 hours. Peachstate and Wellcare agreed that this was likely a mistake, and they promised to follow up with DCH. GPA is also independently in the process of verifying this policy and will keep everyone updated. For now we suggest that psychologists request authorization for any testing until this is clarified.

Wellcare:

  • Fee Schedule: Wellcare has still not established a fee schedule. They report report that they are working on this issue and anticipate having something finalize shortly. Despite what I would describe is aggressive advocacy on our part, Wellcare would not give us a specific date or any rationale to explain why a fee schedule is not yet established. They did say that they would be looking at the DCH schedule (which is already set) and coming up with their own shortly. We reminded them of the previous Wellcare promise to keep consistent with Medicaid rates.
  • Automated Billing System: Wellcare still does not have their system updated with the new codes, and they offered no work around in terms of receiving payment at this time. They suggested that we continue to request authorizations. When pressed for a projected completion date, we were told 2 weeks to 2 months. We suggest that psychologist continue to submit claims to establish timely filing.
  • Peer to Peer: Wellcare continues to use psychiatrists to conduct their peer-topeer reviews when authorizations are denied. We brought it to their attention that at least some of these psychiatrists are not even aware of the new CPT codes. Wellcare agreed to address this issue by providing their reviewers with more information. We again reiterated that we did not think psychiatrist were appropriate peers to review psychological testing.

Peachstate:

  • Fee Schedule: Peachstate has established a fee schedule. They adopted the fee schedule published by DCH for the new codes, so they will be paying the Medicaid rates.
  • Automated Billing System: Peachstate is working to update their system with the new CPT codes, but this is not yet completed. However, Peachstate is taking the step to manually walk claims through. This means that psychologists should be able to submit and be paid by Peachstate now!

 

Takeaway: Please know that we are doing our best to advocate for GPA Members and the At-Risk children and families we serve. Despite presenting the issue of CPT Code Changes to all of the CMO's in October, they apparently did not receive any official guidance from DCH until Jan 1st. This meant that they could not begin updating their systems until January. Some CMO's (Peachstate, Amerigroup) are really trying to work with us to develop ways to keep claims moving through and keep psychologists getting paid. Unfortunately, others (I won't name names) are not only dragging their feet, but they have not offered any reasonable steps to keep claims moving. Please be assured that our committee and GPA leadership has strongly voiced your frustrations and struggles with the leadership of the these companies. Wellcare agreed to send us an update weekly to keep us apprised of their progress towards 1. setting a fee schedule and 2. processing and paying claims. We will continue to immediately post any updates that we receive to this listserve. We are also in the process of setting up meetings with Amerigroup and Caresource.