Provider Alerts

See our latest communication updates on our Coronavirus Page.

For our physician offices providing vaccinations to our Buckeye members.

Ohio Managed Care Plans (MCPs) have extended the $100 provider incentive administration free timeframe until September 15, 2021.

To help reach vaccination goals, beginning July 26, 2021 Ohio MCPs have also increased the member incentive amount for the COVID-19 vaccine. Until September 15, 2021, all Buckeye Medicaid and MyCare members aged 18 and older who receive their first dose (or single dose of Johnson & Johnson) of the COVID-19 vaccine will receive $100 added to their MyHealth Pays card. Please see the COVID-19 Vaccine Member Incentive Voucher on the website to learn more about this benefit for members.

NOTE: The COVID-19 Vaccine Member Incentive Voucher is NOT for promotional use. Please only share the flier with OH Medicaid and MyCare members (18+) after they have received their first dose of the vaccine.

Please refer to the updated program overview below. Thank you for your support of the Ohio Medicaid and MyCare members.

Updated Summary

Beginning June 10, 2021 to September 15, 2021, Buckeye has increased the administration fee for the first dose of the Pfizer-BioNTech and Moderna COVID-19 vaccinations, and the single dose of Johnson & Johnson’s Janssen COVID-19 vaccination to $100. Please find the applicable CPT codes below:

• 0001A: Pfizer-BioNTech
• 0011A: Moderna
• 0031A: Johnson & Johnson’s Janssen

Buckeye will pay the incentive for participating and non-participating providers for services provided between June 10, 2021 through  September 15, 2021. The increase of the administration fee includes all professional claims. Federally qualified health clinics (FQHCs) and rural health clinics (RHCs) are also included in the administration fee increase and will be sent a separate communication regarding the billing process. However, it does not apply to the following providers and/or claims:

• Hospitals
• Emergency Rooms
• Hospital Clinics
• Pharmacies
• ASCs
• Dialysis Centers
• EAPG and DRG claims
• SNF claims
• LTAC claims

Payments will be notated by the following CARC and RARC codes:

• CARC code: 144 – incentive adjustment (e.g. preferred product/service)
• RARC code: MA125 – per legislation governing this program, payment constitutes payment in full

Please note that while it is not required, we encourage you to bill the vaccine and the administration code together for reporting purposes. You will need to bill one vaccine code and one administration code per dose of the vaccine administered. At this time there will be no reimbursement for the vaccine, only the administration fee.

Providers will have until November 30, 2021 to submit claims for administration of the initial vaccination to receive the bonus payment (regardless of FQHC status).

Questions?

For questions, please reach out to Provider Services at 866.296.8731 from 8:00 a.m.-noon and 1 - 5:00 p.m.

Update to: Increase in Administrative Fee for COVID-19 Vaccines

Please note: Buckeye Health Plan is monitoring all guidance related to COVID-19. This communication is an update to the previous version dated June 14, 2021. Buckeye will communicate updates aligned with state guidance as it is released. Please check back regularly for updated information.

Summary

Beginning June 10 to September 15, 2021, Buckeye has increased the administration fee for the first dose of the Pfizer-BioNTech and Moderna COVID-19 vaccinations, and the single dose of Johnson & Johnson’s Janssen COVID-19 vaccination to $100. Please find the applicable CPT codes below:

• 0001A: Pfizer-BioNTech
• 0011A: Moderna
• 0031A: Johnson & Johnson’s Janssen

Buckeye will pay the incentive for participating and non-participating providers for services provided between June 10 through September 15, 2021. The increase of the administration fee includes all professional claims. Federally qualified health clinics (FQHCs) and rural health clinics (RHCs) are also included in the administration fee increase and will be sent a separate communication regarding the billing process. However, it does not apply to the following providers and/or claims:

• Hospitals
• Emergency Rooms
• Hospital Clinics
• Pharmacies
• ASCs
• Dialysis Centers
• EAPG and DRG claims
• SNF claims
• LTAC claims

Payments will be notated by the following CARC and RARC codes:

• CARC code: 144 – incentive adjustment (e.g. preferred product/service)
• RARC code: MA125 – per legislation governing this program, payment constitutes payment in full

Please note that while it is not required, we encourage you to bill the vaccine and the administration code together for reporting purposes. You will need to bill one vaccine code and one administration code per dose of the vaccine administered. At this time there will be no reimbursement for the vaccine, only the administration fee.

Providers will have until November 30, 2021 to submit claims for administration of the initial vaccination to receive the bonus payment (regardless of FQHC status).

Questions?

For questions, please reach out to Provider Services at 866.296.8731 from 8:00 a.m.-noon and 1 - 5:00 p.m.

MCAIDOAHP-VAX-0006a   

Increase in Administrative Fee for COVID-19 Vaccine

Beginning June 10, 2021 to August 15, 2021, Buckeye Health Plan has increased the administration fee for the first dose of the Pfizer-BioNTech and Moderna COVID-19 vaccinations, and the single dose of the Johnson & Johnson’s Janssen COVID-19 vaccination to $100 for our Medicaid members. Please find the applicable CPT codes below:

• 0001A: Pfizer-BioNTech
• 0011A: Moderna
• 0031A: Johnson & Johnson’s Janssen

Buckeye will pay the incentive for participating and non-participating providers for services provided between Thurs. June 10, 2021 through Sun. August 15, 2021. The increase of the administration fee includes all Professional claims. FQHC’s and RHC’s are also included in the administration fee increase and will be sent a separate communication regarding the billing process. However, it does not apply to the following providers and/or claims:

• Hospitals
• Emergency Rooms
• Hospital Clinics
• Pharmacies
• ASC’s
• Dialysis Centers
• EAPG and DRG claims
• SNF claims
• LTAC claims

Payments will be notated by the following CARC code and RARC code:

• CARC code: 144 - Incentive adjustment (e.g. preferred product/service)
• RARC code: MA125 - Per legislation governing this program, payment constitutes payment in full.

Please note that while it is not required, we encourage you to bill the vaccine and the administration code together for reporting purposes. You will need to bill one vaccine code and one administration code per dose of the vaccine administered. At this time there will be no reimbursement for the vaccine, only the administration fee.

Questions?

For questions, please reach out to Provider Services at 866.296.8731 from 8:00 a.m. to noon and 1:00 to 5 p.m.

The Centers for Medicare and Medicaid (CMS) Release Billing Guidelines for COVID-19 Vaccine

Buckeye Health Plan is closely following advancements in the prevention and treatment of COVID-19, including vaccinations. As a healthcare provider, you will play an integral role as COVID-19 vaccines become available. We want to update you on important new information about vaccine coverage. 

Buckeye Provider COVID-19 Page

The Centers for Medicare and Medicaid (CMS) Release an Interim Final Rule Addressing COVID-19 Vaccine Coverage

Ambetter from Buckeye Health Plan is closely following advancements in the prevention and treatment of COVID-19, including vaccinations. As a healthcare provider, you will play an integral role as COVID-19 vaccines become available. We want to update you on important new information about vaccine coverage.

Buckeye Provider COVID-19 Page

The Centers for Medicare and Medicaid (CMS) Release Billing Guidelines for COVID-19 Vaccine

Allwell is closely following advancements in the prevention and treatment of COVID-19, including vaccinations. As a healthcare provider, you will play an integral role as COVID-19 vaccines become available. We want to update you on important new information about vaccine coverage.

Buckeye Provider COVID-19 Page

2019 Suicide Safe Care Report

We hope you were able to participate in the Suicide Prevention Seminars we shared with you in our July 13, 2020, Provider Alert. Now available for your review on our Education Page is the 2019 Suicide Safer Care Report covering the Suicide Safer Care program results.

NIA Magellan Healthcare Requesting Feedback

Magellan Healthcare is interested in getting feedback on your experience working with Magellan Healthcare for the prior authorization of advanced imaging services. They are conducting several provider experience sessions and are asking for your participation.

For Your Information

Retrospective Authorizations - Conditions under which they may be performed:

The Medical Management Department makes retrospective medical necessity review decisions for the following services delivered without prior authorization and/or timely notification to Buckeye in the following circumstances:

• Inpatient admission for obstetrical delivery.
• Inpatient admissions when the member is still hospitalized
• Outpatient services when the patient is still receiving the out-patient services requiring authorization
• Retrospective review will also be performed based on contractual agreements with Buckeye.
• Retrospective review will occur due to extenuating circumstances, with appropriate documentation including:
  • “Unable to know” situations:  member was unconscious at presentation, member did not have Buckeye Health Plan ID card, etc. or
  • “Not enough time” situations:  member requires immediate medical services and prior authorization cannot be completed prior to service delivery.  (urgent and Emergent situations do not require a PA)
  • In cases of Retrospective Eligibility of a member (neither Buckeye nor the Provider knew the member was a BHP member at the time of service), but rather were notified of this by ODM after the date of service. In these cases, whether claims were already submitted and denied, or not yet submitted Provider may submit a retrospective authorization request and it will be reviewed for medical necessity.

Peer to Peer Mailbox for providers to request a Peer to Peer review:  Buckeye_peer_to_peer_notification@CENTENE.COM  (There are underscores between words in email address.) This is another option to request a Peer to Peer conversation in addition to the current phone number (866 246-4356 X 24084).

New Covid-19 ICD-10 Procedure Codes

The Center for Medicare & Medicaid Services (CMS) has new COVID-19 ICD-10 procedure codes that will be effective date on 8/1/2020.  The codes and their description are can be found on the CMS Procedure Code List (PDF).

Buckeye/Everlywell Send HbA1c Test Kits to Members

Buckeye is pleased to partner with Everlywell to reach our members that are currently prescribed atypical antipsychotic medications and ask them to complete an HbA1c home test. We are sending members an at home test kit, instructions for use and how to receive their results. The kit also provides telephonic contact information to assist the member, if needed. Additionally, the member will receive $50 on their MyHealthPays card when completing the test. Results will be sent to the member, their behavioral health physician and the Buckeye care team. Contact our Provider Services at 866-296-8731 if you have any questions.

For your reference: according to paragraph (D) of the Ohio Administrative Code (OAC) rule 5160-1-17, which took effect November 25, 2019, all Medicaid providers are required to have a National Provider Identifier (NPI) number, and report it to the Ohio Department of Medicaid (ODM) upon enrollment. If you currently don’t have an NPI, ODM is offering a helpful educational document to help obtain your NPI, which can be found at the link below.

ODM NPI Educational Document (PDF)

Suicide Prevention Seminars - Free

Buckeye is proud to share an opportunity for Ohio’s clinicians to participate in free virtual suicide prevention training. One of Centene’s strategic partners, Association of Clinicians for Underserved Populations (ACU) is collaborating with the Ohio Association of Community Health Centers (OACHC) to offer two virtual suicide prevention training opportunities – one for PCPs and the other for Health Center leaders. Both trainings are adapted to address the potential impact of COVID19 on suicide rates and the second, on July 30, specifically addresses the higher risks for clinicians themselves as a result of the pandemic.We hope you will take advantage of these training opportunities by registering below and identifying yourself as a Buckeye provider.

• July 23 - Suicide Safer Care Training 1: Suicide Safer Care for Primary Care Providers and their Teams 
• July 30 - Suicide Safer Care Training 3: Considerations for Health Center Leaders.

Please Note

• ACU’s research indicated that although a significant portion of people who attempt/commit suicide saw their PCP in the month prior, many PCPs express a lack of comfort discussing suicide with their patients. In addition, they often lack the information/tools needed for best practice interventions.
• According to the Ohio Department of Health, suicide is the leading cause of death in Ohio for 10-14 y/o and second leading cause for 15-34 y/o.
• Governor Mike DeWine's Recovery Ohio initiative addresses mental illness and other issues that contribute to suicide. This initiative’s early recommendations include "Establish statewide prevention coordination with all state departments and agencies to ensure best practices, consistent messaging, technical assistance, and delivery of prevention services across multiple domains." The Suicide Safer Care trainings serve as a significant response those recommendations.

Reminders

ODM Reinstated Prior Authorization Guidelines

The Ohio Department of Medicaid (ODM) has updated prior authorization (PA) guidelines: Effective July 1, 2020, all medical & behavioral health PA requirements will resume. These updates will be accurately reflected in the Buckeye Health Plan Secure Provider Portal.

Prior Authorization Retrospective Reviews

In our July 1, 2020, communication we notified providers of Buckeye Health Plan’s schedule to perform retrospective reviews of claims submitted without proper PA during the COVID crisis period. See the schedule here.

For your reference, the ODM April 9, 2020, Emergency Provider Agreement outlined three PA options for providers during this crisis period. A brief reminder of the options are below. Please note: Option 1 is the only option that eliminated the need for managed care plan retrospective reviews.

1. Maintain the current course: Continue standard practice to submit PA requests with clinical documentation. This option will prevent retrospective reviews/takebacks later.
2. Seek administrative authorization: Request administrative authorization with minimal member identifiers. The Plan assigns an authorization number to use with claim submission.
3. Bypass prior authorization: Request no PA. Claims will be paid without authorization.

Please review the ODM April 9, 2020, Emergency Provider Agreement (PDF) for more details.

Timely Filing for Behavioral Health Claims

The MCP shall accept claims for behavioral health services described in OAC Chapter 5160-27 for 365 calendar days from the date of service.