Effective January 1, 2016, the Department of Community Health will implement a change to its existing physician office visits policy in order to allow Medicaid eligible members to have access to preventive health services. Members 21 years of age and older will now be able to access one preventive health visit each calendar year (CY) and 10 office visits (evaluation and management codes 99201 to 99215) each CY. The Department encourages primary care practitioners (PCPs) of the following types to perform the preventive health visits: physicians (internists, family physicians, or OB/GYN specialists), certified nurse practitioners, or physician assistants. FQHCs and RHCs may bill for these provider types performing preventive health visits within the FQHC or RHC. Additional office visits (above the 10 visits) will still be available based upon documentation and supporting medical necessity that must be sent to Alliant/Georgia Medical Care Foundation (GMCF) for review. This policy change supports the Department’s goal to improve the health outcomes of our enrolled Medicaid members by allowing them to establish a medical home and receive preventive health services. The establishment of a medical home will also support the Department’s efforts to reduce hospital re-admissions.

Providers may bill ONE (1) preventive health visit (993XX) for a member annually (between January and December of the CY). Providers must use one of the following ICD-10 diagnosis codes when billing the preventive health visit code: Z00.00 or Z00.01 (Encounter for adult examination). Each member is allowed 10 office visits (992XX) per CY without prior authorization. The following preventive visit codes are billable for this policy change:

99385 or 99395 (Adults 21 through 39 years of age). This code is currently open for members under the age of 21 years in the Health Check program (COS 600),

99386 or 99396 (Adults 40 through 64 years of age), and

99387 or 99397 (Adults 65 years and older).

The Georgia Medicaid Management Information System (GAMMIS) will be configured to align with these changes. We anticipate the configurations will be complete by the second quarter of CY 2016. Providers may begin billing for the preventive health visits in January 2016. Reimbursement will not be available until GAMMIS is configured according to the new policy. Please keep your claims timely for the future mass adjustment.

If you have any questions regarding this policy change, please contact HPE’s Customer Call Center at 1-800-766-4456.

Effective January 7, Georgia’s Department of Community Health’s (DCH) Centralized Credentialing Verification Organization (CVO) will be responsible for credentialing and recredentialing Fee-for-Service Medicaid/PeachCare for Kids® providers that are not affiliated with a Care Management Organization (CMO). This change will result in a uniform credentialing process for both Fee-for-Service and CMO providers (providers associated with Amerigroup, Peach State, or WellCare).

The CVO’s one-source application process will:

• Save time;
• Increase efficiency; and
• Create one uniform credentialing and recredentialing process for both Fee-for-Service and CMO providers.

The CVO will perform primary source verification and query databases such as the American Medical Association’s National Practitioner Database for information on the provider, check required medical malpractice insurance, confirm Drug Enforcement Agency (DEA) numbers, etc. Once the provider’s application is approved for credentialing or recredentialing, this information will be forwarded to the CMOs who may begin contract discussions with interested providers.

Fee-for-Service Only providers will continue to utilize the existing web portal to submit all required credentialing documentation. The CVO will contact providers to inform them of when to begin the credentialing process.

If you have additional questions, contact your local HP Provider Relations representative at 1-800-766-4456 or go to www.mmis.georgia.gov to review the Frequency Asked Questions (FAQ).

Questions regarding the CMO contracting process should be directed to the specific CMO listed below:

September 9, 2015

ATLANTA (September 9, 2015) – Clyde L Reese III, Esq., Commissioner of the Georgia Department of Community Health (DCH), various healthcare associations and Georgia Medicaid’s care management organizations are urging Georgia’s healthcare industry to make final preparations for the October 1, 2015 go-live of ICD-10.

“The Georgia Academy of Family Physicians, Georgia Association of American Pediatrics, Georgia Hospital Association, Georgia OBGYN Society, HomeTown Health, Medical Association of Georgia, Amerigroup Community Care, PeachState Health Plan and WellCare have been instrumental in raising awareness of the federal mandate and assisting stakeholders and providers in preparing for the (ICD-10) transition,” said Clyde L. Reese III, DCH Commissioner. “With less than 30 days to golive, it is of vital importance that providers are prepared to fully transition to ICD-10 in order to receive payment.”

The federally mandated transition from ICD-9 to ICD-10 pertains to all HIPAA-covered entities including providers, payers, vendors and their business associates. Claims submitted for services rendered on or after the compliance date that do not contain the ICD-10 coding will be pended, denied or rejected. Payments to providers cannot be made without the proper ICD-10 coding.

Vendors should monitor ICD-10 implementation and assist in troubleshooting and promptly resolving post-implementation issues following the transition. Providers should review processes to confirm effectiveness and sustainability regarding clinical documentation changes, coding practices and processes, revenue cycle processes and changes, and any other organizational changes made during the transition.

DCH has been conducting preparedness training for over a year. Stakeholders can access DCH’s ICD-10 materials and repository of recorded webinars by visiting dch.georgia.gov/icd-10. Stakeholders are also encouraged to view materials on the Center for Medicare and Medicaid Services (CMS) website (www.CMS.gov) and other online resources, such as www.aapc.com or www.ahima.com.

About ICD-10
ICD-10 is a diagnostic coding system implemented by the World Health Organization (WHO) in 1993 to replace ICD-9. The system was developed by WHO in the 1970s and is now used in almost every country in the world. In the United States, ICD-10 usually refers to the U.S. clinical modification of ICD-10: ICD-10-CM. The new ICD-10 code set is scheduled to replace ICD-9, our current U.S. diagnostic code set on October 1, 2015. Another designation, ICD-10-PCS, which stands for procedural coding system, will also be adopted in the U.S. on October 1, 2015. ICD-10- PCS will replace Volume 3 of ICD-9-CM as the inpatient procedural coding system.

About the Georgia Department of Community Health
Through effective planning, purchasing and oversight, the Georgia Department of Community Health (DCH) provides access to affordable, quality health care to millions of Georgians, including some of the state’s uninsured and most vulnerable populations.

DCH is responsible for Medicaid and PeachCare for Kids^®, the State Health Benefit Plan, Healthcare Facility Regulation and Health Information Technology in Georgia.

Clyde L. Reese III, Esq., serves as Commissioner for the Georgia Department of Community Health.

To learn more about DCH and its dedication to A Healthy Georgia, visit www.dch.georgia.gov.

To help dispel some of the myths surrounding ICD-10, the Centers for Medicare & Medicaid Services (CMS) recently talked with providers to identify common misperceptions about the transition to ICD-10. These five facts address some of the common questions and concerns CMS has heard about ICD-10:

1. The ICD-10 transition date is October 1, 2015.
   The government, payers, and large providers alike have made a substantial investment in ICD-10. This cost will rise if the transition is delayed, and further ICD-10 delays will lead to an unnecessary rise in health care costs. Get ready now for ICD-10.
2. You don’t have to use 68,000 codes.
   Your practice does not use all 13,000 diagnosis codes available in ICD-9. Nor will it be required to use the 68,000 codes that ICD-10 offers. As you do now, your practice will use a very small subset of the codes.
3. You will use a similar process to look up ICD-10 codes that you use with ICD-9.
   Increasing the number of diagnosis codes does not necessarily make ICD-10 harder to use. As with ICD-9, an alphabetic index and electronic tools are available to help you with code selection.
4. Outpatient and office procedure codes aren’t changing.
   The transition to ICD-10 for diagnosis coding and inpatient procedure coding does not affect the use of CPT for outpatient and office coding. Your practice will continue to use CPT.
5. All Medicare fee-for-service providers have the opportunity to conduct testing with CMS before the ICD-10 transition.
   Your practice or clearinghouse can conduct acknowledgement testing at any time with your Medicare Administrative Contractor (MAC). Testing will ensure you can submit claims with ICD-10 codes. During a special “acknowledgement testing” week to be held in June 2015, you will have access to real-time help desk support. Contact your MAC for details about testing plans and opportunities.

Keep Up to Date on ICD-10
Visit the CMS ICD-10 website for the latest news and resources to help you prepare.