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Arizona | Spring 2020

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.

Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33682 Practice Matters: AZ – Spring 2020 Provider Services Center: 800-445-16382

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 NeedWe’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.

To Help Manage Your Business

• Acceleration of Claim Payments• Extension of Timely Filing Limits• CARES Act Information• Provisional Credentialing• Requirements to Practice in a New Location• Changes to Prior Authorization Requirements• Updates on Delayed Programs and Policies

On our sites, you’ll find information:

As You Work With Patients

• Expanded Telehealth Access and Reimbursement• Telehealth Coding Guide• Member Cost-Share Waivers• Assistance with Patient Discharge Planning• Easier Access to DME and Supplies• Suspension of HouseCalls and Optum at Home

Practice Matters: AZ – Spring 2020 Provider Services Center: 800-445-1638

Important information for health care professionals and facilities

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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

• 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: TX - Summer 2013 Customer Service Center: 888-362-33684 Practice Matters: AZ – Spring 2020 Provider Services Center: 800-445-16384

Important information for health care professionals and facilities

New Educational Resources for the 2020 UnitedHealthcare Dual Complete® Plan New resources for the 2020 UnitedHealthcare Dual Complete plan are now available on the Arizona UHC On Air channel. These courses include valuable program information and meaningful updates for your office staff. Courses are pre-recorded and available online 24 hours a day, seven days a week.

2020 courses include:

• Dual Special Needs Plans: An Introduction

• Dual Special Needs Members: Who Are They?

• The UnitedHealthcare Dual Complete Plan in Arizona

Simply sign in to Link with your Optum ID and begin watching.

Visit UHCprovider.com/AZDSNP to learn more about the Dual Special Needs plans offered in your area.

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: • Dental appointments

• Vision appointments

• Podiatry appointments

• Hearing appointments

It’s Easy to Set Up a RideNon-emergency transportation services are provided by our service partner, MTBA. Rides should be scheduled three business days in advance of the desired pick-up time. Urgent transportations requests are available 24 hours a day, seven days a week. Members or care providers can call:

MTBA

888-700-68226 a.m. – 7 p.m. local time, Monday – Friday

Visit UHCprovider.com/AZDSNP > 2020 Plan > 2020 UnitedHealthcare Dual Complete® Plan Benefit Flyer to see a full list of benefits in your area.

Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33685 Practice Matters: AZ – Spring 2020 Provider Services Center: 800-445-16385

Important information for health care professionals and facilities

Encouraging Good Oral Health for the Pediatric PatientDid you know that bacteria, such as Streptococcus mutans, causes tooth decay and is transmissible from parents or caregivers to children through the exchange of saliva? As a result, it is important to educate and caution parents not to share cups, plates, spoons or straws with their child and avoid kissing them on the mouth.

For those children at a moderate-high risk of tooth decay, also known as caries, multifaceted preventive approaches include: early screening of young children, dietary evaluations, access to care and embracing a wide team of health care professionals to collaborate and respond to the diverse needs of local populations.

The American Academy of Pediatric Dentistry (AAPD) recommends that a child visit the dentist by age 1 or within six months after the first tooth erupts. However, because most children visit their pediatrician or family physician for well-child visits before that first dental visit, physicians can be an important influence in setting children on the path to good oral health.

While the child’s dentist is responsible for performing a comprehensive oral examination, primary care providers (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 minute using only a light and tongue blade. .

Some things to look for:

• What is the general condition of the teeth? Are there white or brown spots? Decayed or broken teeth? Teeth that appear deformed or out of position?

• What do the gums look like? Are they pink? Red and puffy? Is there noticeable plaque or other debris present? How is the child’s hygiene in general?

• Are there other lesions or ulcerations present?

• After the screening, physicians should discuss the importance of visiting their dental home with the parent or guardian – for both at-risk and healthy children. A dental home can offer early and periodic intervention, as well as risk assessment, anticipatory guidance and regular supervision. All UnitedHealthcare Community Plan EPSDT members are assigned a dental home. Members can call Member Services if they don’t know their dental home information.

• Applying a fluoride varnish is another helpful approach. An effective weapon in preventing decay, fluoride can be used as a non-surgical approach to treating disease by remineralizing the enamel. Applying varnish is both quick and easy. It can be painted on in a couple of minutes and it maybe reimbursable under Arizona Medicaid. UnitedHealthcare Community Plan has additional resources for PCPs interested in adding fluoride varnish to their practice.

• Finally, physicians and their staff can help educate their patients and patient caregivers on the importance of good dental health in early childhood. For additional information, please contact your Provider Advocate or the Clinical Practice Consultant assigned to your practice.

Ordering, Referring and Supervising Care Provider Billing Requirements for CMS-1500 and 837P Electronic ClaimsIn accordance with Chapter 5 and Chapter 10 of the Arizona Health Care Cost Containment System (AHCCCS) Fee-for-Service Provider Manual, as well as the federal 21st Century Cures Act, an ordering, referring or supervising care provider must be included on CMS-1500 and 837P claims.

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Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33686 Practice Matters: AZ – Spring 2020 Provider Services Center: 800-445-16386

Important information for health care professionals and facilities

Requirements for CMS-1500 ClaimsWhen submitting CMS-1500 claims, please be sure to include the following information:

• Box 17: Qualifier and referring provider name (Last Name, First Name, Middle Initial)

o If applicable, enter one of these qualifiers:

– DN: Referring Provider

– DK: Ordering Provider*

– DQ: Supervising Provider

• Box 17a: AHCCCS provider ID number for providers without a National Provider Identifier (NPI) number

• Box 17b: NPI number

Example

*An ordering provider should be included on CMS-1500 claims billed with the following services:

• 97001-97546 (excluding 97151-97158)

• Drugs (J-codes)

• Durable medical equipment (DME)

• Enteral and parenteral therapy

• Laboratory

• Medical and surgical supplies

• Podiatrist services

• Orthotics

• Prosthetics

• Radiology

• Respiratory DME

• Temporary K and Q codes

• Vision (V-codes)

An ordering provider may be any of the following:**

• Certified nurse midwife

• DO

• Dentist

• MD

• Optometrist

• Physician assistant

• Psychologist

• Registered nurse practitioner

**Note: AHCCCS provider type RP is not a valid provider type for purposes of using as a referring or ordering provider NPI. According to AHCCCS, the RP 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 Community Plan.

Requirements for 837P Electronic ClaimsFor 837P electronic claim requirements for ordering, referring or supervising care providers, please see the current version of the 1500 - 837P Map from the National Uniform Claim Committee.

Please note: If multiple providers are involved in one claim submission, enter one provider using the following priority order:

1. Referring Provider

2. Ordering Provider

3. Supervising Provider

Unless the services are listed above and require an ordering provider, then the priority order would be:

1. Ordering Provider

2. Referring Provider

3. Supervising Provider

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Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33687 Practice Matters: AZ – Spring 2020 Provider Services Center: 800-445-16387

Important information for health care professionals and facilities

Social Determinants of Health Billing GuidelinesThe Arizona Healthcare Cost Containment System (AHCCCS) has specific guidelines for listing social determinants of health codes on claims. According to Chapter 4 of the AHCCCS Fee-for-Service Provider Billing Manual, social determinant ICD-10 diagnosis code(s) in code range Z55-Z65 must not be listed as the primary ICD-10 diagnosis code(s) on claims. These codes may only be used as secondary or tertiary diagnosis codes.

What This Means for YouStarting Feb. 1, 2020, we will deny claims submitted to us with ICD-10 diagnosis codes Z55-Z65 listed as the primary diagnosis code(s). If this happens, you’ll be required to submit a corrected claim.

Billing Resource For more information about coding and reporting guidelines, please see the following resources:

• AHCCCS Social_Determinants_of_Health_ICD-10_Code_List

• Centers for Medicare and Medicaid Services (CMS) ICD-10-CM Guidelines, pages 17-18: ICD-10-CDM_Official_Guidelines_for_Coding_and_Reporting

Please note: Coding and reporting guidelines may be updated at any time. Please review the coding resources regularly to help ensure you’re following the most current guidelines.

We’re Here to HelpIf 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.

Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs) or Multi-Specialty Interdisciplinary Clinics (MSICs) that are currently required to submit provider information in Box 19 are also required to submit referring, ordering and supervising information in Box 17. For more information, visit our FQHC and RHC Claim Submission Guidelines.

We’re Here to HelpIf you have questions, please call Provider Services at 800-445-1638. Thank you.

Retro Authorization for Therapy ServicesUnitedHealthcare Community Plan would like to inform our therapy provider network that we will not be allowing retro authorizations for physical, occupational or speech therapies. Authorization requests can only be submitted for current or future dates of service.

Prior Authorization Resources• Prior Authorization and Notification Lists

• UHCprovider.com/paan (Prior Authorization and Notification tool)

We’re Here to HelpIf 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.

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Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33688 Practice Matters: AZ – Spring 2020 Provider Services Center: 800-445-16388

Important information for health care professionals and facilities

The Division of Developmental Disabilities Plan of Care Signature NoticeThe Division of Developmental Disabilities (DDD) held a meeting to discuss the improvement and efficiency of the delivery of services in addition to enhancing the integration of care. One of the developments of the meeting and subsequent field analyst is the requirement of a certified plan of care (POC) for ongoing therapy services, as well as the requirement of a prescription/referral to initiate a therapy evaluation.

• The member or their responsible party is responsible for obtaining the discipline-specific prescription or referral for a therapist to complete an evaluation.

• The evaluating therapist will develop the POC and submit to the referring physician for certification (i.e., dated signature and NPI number). The certified POC will then need to be returned to the therapist as it will serve as the prescription/referral for ongoing therapy services.

• A recertification of the POC will also require a dated signature as well as the NPI number.

As a valued provider, we appreciate the efforts in providing the medical prescription and the certification of the subsequent POC. You will find UnitedHealthcare Community Plan’s guidelines regarding the POC in our Coverage Determination Guidelines available online.

Evidence-Based Peer and Family Support When an individual experiencing mental health challenges receives “peer or family support” during their mental health need, we see a 56% reduction in hospital 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.

Over the last 20 years, the practice of peer support in behavioral health has virtually exploded around the globe with an increase in recovering persons being hired to provide peer support. Estimates place the number of peer support staff currently to be over ten thousand in the United States alone).1 Peer support was declared an evidence-based practice by CMS in 2007. Individuals who receive peer support have reported overall increases in their quality of life.2

RI International (formerly Recovery Innovations of Arizona) employs hundreds of peer specialists to offer peer advocacy services to individuals in the hospital. Their focus on recovery planning and recovery-oriented discharge plans has produced significant improvements, including:3

• 36% reduction in the use of seclusion

• 48% reduction in the use of restraints

• 56% reduction in hospital readmission rates

You can find more information on peer- and family-run agencies at azahcccs.gov/AHCCCS/HealthcareAdvocacy/OIFA.html.

1Davidson, L. et al, 20122SAMHSA, 2016 3(RI International, 2016)

Peer- and Family-Run OrganizationsWhat Is a Family-Run Organization? Family-run organizations employ parents who have real-life experience in the behavioral, medical and/or DCS systems. They specialize in providing family support services and can provide one-on-one support to you.

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Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33689 Practice Matters: AZ – Spring 2020 Provider Services Center: 800-445-16389

Important information for health care professionals and facilities

Family Support Services Can Help You: • Connect with other family members with shared

experiences

• Navigate the child-serving systems

• Locate services/resources that are the “right fit” for the needs of the child and family

• Learn to be an advocate

• Gain new skills to care for your child

• Identify formal and informal support systems

• Develop a service plan

• Manage hospital-discharge planning

• Feel supported during child and family team meetings (CFT), Foster Care Review Boards (FCRB) and court hearings

• Keep things consistent in your child’s care when case managers or therapists change

• Understand decision letters and how to submit appeals

• Help you deal with agencies that are not supportive of the needs of your child

• Find classes, trainings, support groups and more

Caring Connections for Special Needs

(Benson, Sierra Vista, Payson, Douglas, Safford and Tucson) ccsneeds.com 520-686-9436

Family Involvement Center (FIC)

(Phoenix, Prescott, Flagstaff and Tucson) familyinvolvementcenter.org 602-288-0155

Mentally Ill Kids in Distress (MIKID)

(Phoenix, Tucson, Yuma, Casa Grande, Kingman, Nogales) mikid.org 602-253-1240

Reach Family Services/Alcanza Servicios de Familila

(Phoenix) reachfs.org602-512-9000

What Is a Peer-Run Organization? Peer-run organizations are service provider owned, operated and administrated by persons who have experience with mental health and/or substance use disorders. These organizations are based in the community and provide support services.

AHCCCS members have the right to request services and/or participate in programs provided at a peer-run organization.

Peer-Run Organization Offer:• One-on-one peer support

• Daily support groups

• Social outings

• Meals

• Employment programs

• Learning opportunities

• Health and exercise programs

• Creative arts

• Resources

• Advocacy

• Volunteer opportunities

• Youth and young-adult programs

• Meeting new people

• Personal development

• Empowerment

• Extended hours and/or weekends

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Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-336810 Practice Matters: AZ – Spring 2020 Provider Services Center: 800-445-163810

Important information for health care professionals and facilities

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How to Access Services from a Peer-Run Organization 1. Contact a peer-run organization in your area to learn

what services they offer.

2. Request the service be added to your service plan at the peer-run organization of your choice. Once the service has been requested, services should be initiated within 45 days.

3. Here is a list of peer-run organizations:

Recovery Empowerment Network

Phoenix renaz.org 602-248-0368

Helping Ourselves Pursue Enrichment (HOPE), Inc.

Tucson, Yuma hopetucson.org 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

Hope Lives/Vive La Esperanza

Phoenix, Flagstaff vivehopelives.org 855-747-6522

Wellness Connections

Sierra Vista, Douglas, Safford, Nogales wellness-connections.org 520-452-0080

Coyote TaskForce – Our Place Clubhouse/Café 54 and Truck 54

Tucson ourplaceclubhouse.org 520-884-5553

Transitional Living Center Recovery (TLCR)

Yuma, Casa Grande tlcrecoveryaz.com928-261-8668

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Practice Matters is a quarterly publication for physicians and other health care professionals and facilities in the UnitedHealthcare network.

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