Provider News & Updates – June 2021

Stay Informed of Updates & Changes

Are you using the provider portal, Provider Connect? Utilizing Provider Connect to access benefits, eligibility, authorizations and claims data saves you time and reduces the need for you to call Customer Service. It offers real-time information you need to focus on patient care and is accessible 24/7, giving you flexibility and convenience that works with your schedule. It is important to note that contracted providers are required to submit prior authorizations through Provider Connect, so registration is a necessity for your office workflow.

Provider Connect is accessed through Oregon’s OneHealthPort, which is also the gateway for many other payer portals. When you are registered with OneHealthPort you get access to all portals with just one login. If you have not registered for a Provider Connect account, please visit OneHealthPort and follow the steps to register your practice. If you are already registered and need user training, please contact Provider Relations at shpprovider@samhealth.org or call 541-768-5207 or 888-435-2396, 8 a.m. to 6 p.m., Monday through Friday.

Ordering and Referring Providers Can Avoid Claim Denials

Samaritan Health Plans (SHP) and InterCommunity Health Network Coordinated Care Organization (IHN-CCO) follows state and federal guidelines requiring the listing of referring and ordering providers on all DME, lab and imaging professional claims. Beginning May 31, 2021, claims submitted for imaging, lab or DME services will be denied if they do not accurately report the name and NPI number of the ordering and referring provider.

Also beginning May 31, 2021, referring providers for IHN-CCO must have an active Oregon Medicaid provider ID number as required by the Oregon Health Authority.

In-network Referrals Lower Cost Shares

Contracted providers are responsible for referring members to in-network providers (if available). In-network referrals enables lower cost shares to our members and ensures rendered services are performed by fully credentialed and licensed providers. In-network referrals are a contractual obligation to ensure the highest quality outcomes and lower financial risks to both members and our provider network.

When services are needed that are not available within our network, a contracted provider may request a referral for the member to utilize out-of-network services. The request must indicate the reason for the out-of-network referral, such as no available contracted providers for the services in question or wait times to see a contracted provider exceeds the medical necessity of the service. The contracted provider referring an IHN-CCO or Samaritan Advantage Health Plans member for out-of-network services is also required to obtain all necessary prior authorizations as mandated by the plan.

For providers making referrals for Samaritan Health Plans (SHP) members, providers are responsible for only referring for services covered by CMS or Samaritan Health Plans. Referrals made for IHN-CCO members, must be made to a Medicaid participating provider. To find an in-network provider, please visit the Refer for Care webpage to access provider directories for our plans. If you need assistance finding an in-network provider, please contact SHP Customer Service at 541-768-5207 or 888-435-2396, Monday through Friday, 8 a.m. to 8 p.m.

Clinical Practice Guidelines Approved for Hypertension

Samaritan Health Plans develops and adopts evidence-based Clinical Practice Guidelines (CPGs). The CPGs are meant to assist providers in making decisions about appropriate health care for specific clinical circumstances. They are also intended to improve the quality and consistency of care provided to members. Each SHP CPG is endorsed by a physician champion and approved by our Quality Management Council (QMC).

The QMC recently approved a CPG for hypertension. To review the hypertension CPG, as well as the other CPGs, please visit the Clinical Guidelines webpage. There you’ll find existing medical, behavioral health and dental health guidelines.

Review Upcoming Educational Opportunities

Are you looking for educational opportunities? The Oregon Quality and Health Outcomes Committee has shared several webinars and courses with topics ranging from adolescent immunizations to tobacco cessation. Some courses even offer no-cost CME credit. Browse through the listing to see all covered topics.

Adolescent Immunizations

You Are the Key to HPV Cancer Prevention (recorded webinar)

What: The Oregon Pacific Area Health Education Center invites you to its recorded “You are the Key to HPV Cancer Prevention” webinar to learn about the adolescent HPV vaccination schedule and how to communicate with parents about the HPV vaccine.

Audience: Physicians, pharmacists, nurse practitioners, physician assistants, nurses or any other staff who work with children, adolescents and their parents in primary care settings.

Access: The recording, along with other upcoming or recorded OPAHEC webinars are available on the OPAHEC website or the OPAHEC YouTube channel.

Tobacco Cessation Training

Free, quick, online training for tobacco cessation counseling to address higher COVID-19 risk for cigarette smokers (includes CME).

What: With cigarette smokers at higher risk for COVID-19, this short online course will improve your care team’s ability to help patients quit tobacco. The course focuses on brief tobacco intervention and motivational interviewing techniques.

Who: All members of the care team committed to supporting their patients in quitting tobacco.

When: The course is self-paced and takes approximately 45 minutes. The course can be started, paused and resumed later as needed.

CMEs: This training has been reviewed and is accepted for up to 1.0 prescribed credit from the American Academy of Family Physicians. For other licensing boards that may not pre-approve continuing education credits (for example, the Board of Licensed Professional Counselors and Therapists), please submit the certificate of participation to your accrediting body.

Access the training.

Questions? Contact Anona Gund at Anona.E.Gund@dhsoha.state.or.us or 971-673-2832.

Screening, Brief Intervention and Referral to Treatment (SBIRT) Webinar

SBIRT webinar training series (February through September)

This SBIRT webinar training series is supported by the Oregon Rural Practice-based Research Network’s (ORPRN) ANTECEDENT project. ANTECEDENT focuses on addressing unhealthy alcohol use in Oregon. The project team intends to work with more than 80 primary care clinics and provide each clinic with the evidence and tools they need to help patients with moderate to severe alcohol use disorder through screening, brief intervention and medication assisted treatment training.

When and topics covered:

July 6, 2021, and Oct. 26, 2021, from noon to 1 p.m.: Unhealthy Alcohol Use Motivational Interviewing.
Aug. 12, from noon to 1 p.m.: Brief Intervention with Unhealthy Alcohol Use.
July 6, from noon to 1 p.m.: Unhealthy Alcohol Use-SBIRT 101.
June 23 and Aug. 25, 2021, from noon to 1 p.m.: Unhealthy Alcohol Use Screening via Telehealth.
June 7, and Sept. 22, 2021, from noon to 1 p.m.: Medication Assisted Treatment (MAT) for Unhealthy Alcohol Use.

See flyer for details.

Contact: antecedent@ohsu.edu or Alissa.Robbins@dhsoha.state.or.us

Technical Assistance for Clinics: Addressing the Increased Prevalence of Unhealthy Alcohol (SBIRT) and Opioid Use

What: The OHA Transformation Center is partnering with the Oregon Rural Practice-based Research Network (ORPRN) to support clinics with technical assistance related to SBIRT for unhealthy alcohol and drug use. SBIRT is a “must-pass” incentive measure for CCOs in 2021.

This collaborative project, ANTECEDENT, can provide primary care clinics with 12 months of tailored support to implement changes to address unhealthy alcohol use at no-cost to the participating clinics. Additionally, ORPRN is offering a complementary technical assistance opportunity regarding chronic pain management and opioid prescribing (aka PINPOINT).

See flyer for details.

Audience: Clinics across Oregon are invited to participate in these free technical assistance opportunities. CCOs are encouraged to share details with clinics in their network.

Questions? Contact Alissa Robbins at Alissa.Robbins@dhsoha.state.or.us or the program at ANTECEDENT@ohsu.edu.

Value-based Payment Webinar Series Offered

Value-based payment (VBP) webinar series for providers (with no-cost CME).

Primary care, behavioral health and maternity care providers are invited to participate in a five-part webinar series focused on increasing readiness for VBP and taking advantage of the additional flexibility VBPs offer for innovatively redesigning care models.

When and Topics Covered:

April 21, from noon to 1 p.m.: What do you need to know to negotiate VBP agreements?
May 19, from noon to 1 p.m.: Learnings from COVID-19 and how they may impact the adoption of VBPs.
June 1, from noon to 1 p.m.: VBP for behavioral health providers — How do we keep from being left out?
June 16, from noon to 1 p.m.: VBP and maternity care — What have we learned so far?

Speakers: Art Jones, Jeanene Smith and Janet Meyer (Health Management Associates).

See flyer for full details and registration.

Contact: OHA.VBP@dhsoha.state.or.us

Check Out These Important Reminders & Notices

Providing Care With the Prioritized List

Last quarter we published an article explaining how the Oregon Health Plan’s (OHP) Prioritized List of Health Services is used to determine if a service and/or diagnosis is part of the OHP benefit package. While the information presented was correct, we want to make sure providers understand that pairing of the treatment and diagnosis plays a significant role in determining coverage.

If you have questions regarding pairing, please see the Additional Resources for Providers in the Providing Care With the Prioritized List document or call Provider Relations at 541-768-5207 or 888-435-2396, 8 a.m. to 6 p.m., Monday through Friday.

Credentialing Takes Time

Remember to allow 90 days from the time we receive a completed Oregon Practitioner Credentialing application and supporting documents for the Credentialing department to complete its new practitioner process.

Keep Your Provider Information up to Date

Do you need to update your practice or provider information? The forms on our website have been updated to provide easy access to keep your information up to date. We’ve even added the Update Panel Availability form so you can let us know when availability has changed. The forms available are:

Add a provider to group. *
Remove a provider from group.
Update panel availability.
Update provider information.

*Completion of this form is preliminary and you will be contacted for further information.

If you have any questions about provider forms, please call Provider Relations at 541-768-5207 or 888-435-2396, 8 a.m. to 6 p.m., Monday through Friday.

Providers Can Opt Out of Telehealth Services

Members will soon be able to view which providers offer telehealth services in our provider directory. If you have offered telehealth services in the past year and would like to opt out of this service, please contact Provider Relations at 541-768-5207 or 888-435-2396, 8 a.m. to 8 p.m., Monday through Friday.

The Provider Manual Has Been Updated

The Provider Manual has been updated to incorporate valuable information that will assist you when working with Samaritan Health Plans and IHN-CCO. Make sure to bookmark the manual so you can use it as a reference. Updates include:

Section 1.3: Added Silver & Fit membership to Samaritan Advantage Premier Plan Plus (HMO).
Section 3.3: Added section on Oregon Medicaid registration requirements.
Section 3.13: Claims submission for IHN-CCO and Samaritan Choice Plans was updated from eight to 18 months.
Section 5.5: Replaced “on-site visits” with “audit review”.
Section 6.2: Added verbiage on punitive action.
Section 6.2: Updated contact information for filing grievances.
Section 7.6: Added information on tier lowering.
Section 7.7: Added pharmacy electronic authorization information.
Section 7.8: Added prescription adherence information.
Section 12.13: Added section on public health emergency.

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