Medicaid/Caresource/AG/BCW reminding you to recredential - I've received a ton of emails about this recently because everyone got contacted lately about it. Here's the deal: When you login to GAMMIS for a particular provider, it warns you 6 months in advance that the credentialing is do, and when it's do. For those providers who just ignore that warning during the pandemic, they're telling those providers that as of 9/15 they're throwing you out if you don't recredential asap. Here is the options on how to check:
Kaiser is calling providers to participate in network - there's been several providers asking me about this. Last time I worked with a clinic that was in network with Kaiser the rates were comparable to Medicaid, but their auth requirements were detailed, took awhile for each one.
Students working in therapy sessions - If you haven't heard, students can assist in sessions as of 4/1/2023. This is taken from the CIS policy manual:
Note: OTA, PTA, SLPA (aides or assistants) etc. are not allowed to provide services under the CIS Program. An exclusion to the above reference – students in an approved academic program and pursuing the requirements of their academic program are allowed to participate in CIS therapy sessions under the guidance of the licensed (supervising) practitioner. The licensed (supervising) practitioner must reference and follow the guidelines of their respective governing therapy practice act / association.
Peachstate is going to start sending ECHO credit card payments instead of checks in September - if you're familiar with other insurances doing this, such as Caresource, they are using the same company ECHO. If you're not familiar, they send a credit card image on your eobs so that you have to get a credit card processing system to get paid (such as square) and pay the fees. I haven't had good experiences with ECHO, hard to get them to set up EFT. I suggest setting up eft with payspan: https://www.payspanhealth.com/nps
Caresource changed their login website - You have to re-register with Caresource to login to their portal. They're requiring a two step verification now.
CMOS and the LOI forms - I sent an email earlier this year about these. I've seen letter of intents from Amerigroup, Kaiser, Humana, UHC, Peachstate, and Caresource so far. Again, it's up to you if you fill these out, but what you're saying by filling it out and signing the form that you support that insurance company to become a CMO (or stay a CMO) provider for Georgia since they're renewing contracts now. IT DOES NOT affect your contract with that insurance company. I've seen the emails they're sending, they're using words every way possible to make you think such. I find it disgusting that they're wording it in such a way and being so pushy about it as well. I have responded to some stating we are not interested in supporting your application for CMO due to horrible rates, authorization issues, lack of communication from reps, whatever you feel the need to complain about.
Eligibility for Medicaid and CMO patients - YOU MUST CHECK ELIGIBILITY ON GAMMIS TO MAKE SURE YOUR PATIENTS ARE ACTIVE. I do this already for providers I bill for, however please make sure you're doing it at least twice a month for your practice. Many members were terminated this month because of the ongoing eligibility redeterminations Medicaid/ Peach Care for Kids is going through right now. If a patent has lost coverage, direct them to register at gateway.ga.gov and see what information the state needs to continue coverage.
Amerigroup updated their provider rep list - finally! See attached... pshp's can be found here: https://www.pshpgeorgia.com/providers/resources/territory-list.html and Caresource can be found here: https://www.caresource.com/ga/providers/contact-us/medicaid/ (click on contracting managers link)
