El Paso Health | About Your Health | Spring 2024

Provider Newsletter Spring • 2024 CHANGE SERVICE REQUESTED PO Box 971100 El Paso, TX 79997-1100 Nonprofit Org. U.S. Postage PAID Yakima, WA Permit No. 157 If you are finding that El Paso Health members are not showing up to their appointments due to lack of transportation, we can help. El Paso Health partnered with Access2Care (A2C) to provide our Medicaid, CHIP, and CHIP Perinate members with transportation to their medical appointments. This benefit applies locally or out of town when the services are not available in town. (Services must have prior authorization.) Members can call A2C directly 48 hours in advance for in-town appointments or 5 days in advance for out-of-town appointments. If there is an unexpected or urgent appointment that does not allow advance notice, our staff can assist in getting the transportation approved. How to request a ride Members can call A2C toll-free at 1-844-572-8196 at least 2 work days before their appointment or 5 days before the appointment if it is outside their county. Phones are answered 24 hours a day, 7 days a week, 365 days a year. When requesting a ride, members should have the following information: ■Medicaid ID number for the person with the appointment. ■Address and phone number of their pickup location. ■Address and phone number of their appointment location. ■Name of the medical professional the member or their child will be seeing. ■Date and time of the appointment. Is your practice being affected by patient no-shows? ■Any unique needs the member may have, like using a wheelchair or walker, so the right vehicle can be sent. They may also be asked for more information about the appointment. WE UNDERSTAND THAT YOUR TIME IS VALUABLE, and it's important for our members to keep their appointments. If you or our members need information about our transportation services, please call Member Services at 915-532-3778 or toll-free at 1-877-532-3778.

2 stay informed In accordance with the Texas Health and Human Services Commission (HHSC) and Texas Department of Insurance (TDI) mandates, El Paso Health must monitor our Providers on an annual basis for 24-hour availability and office accessibility compliance. At right is a chart showing our appointment standards. After-hours surveys are conducted after and / or before regular office hours and during weekends to verify 24-hour availability. Availability standards ■Calls can be answered by a recording, an answering service, or an on-call staff member. ■Calls must meet the language requirements for major population groups. ■Providers or designated medical practitioners must be able to be reached to return calls to patients. ■Calls must be returned within 30 minutes. If you have any questions on the requirements, please contact Provider Relations or the Quality Improvement Department at 915-532-3778. The THSteps online Provider education offers free, accredited courses online that are short but interactive to provide targeted information and resources. Case studies also test knowledge and offer helpful tips, and it’s all available on your time for free! Course formats include CE / CME, which have been developed by clinical and state program experts. Sign up for a free account to further your knowledge, train staff, or simply take a refresher course. ■ Acute Chronic Medical Conditions ■Adolescent Health ■ Behavioral Developmental and Mental Health ■Case Management ■Emerging Trends ■ Injury and Substance Abuse ■Ethics ■ Maternal and Infant Health ■ Medicaid and State Services ■ Medical Office Management ■ Texas Health Steps Check Ups ■ Trauma Informed Care ■ Nutrition and Healthy Habits ■Oral Health ■Pharmacy ■ Required Courses for THSteps Nurses ■ Screenings and Immunizations ■ Special Healthcare Needs The THSteps education program also collaborates with a wide variety of HHSC programs to provide up-to-date, free continuing education courses, program information, and resources for our Provider community. Visit txhealthsteps.com/courses to get started! Course topics Appointment type Standard (calendar days from time of request) Emergency services Upon member presentation Urgent care Within 24 hours Routine primary care Within 14 days Specialty routine care Within 21 days Specialty therapy (PT / OT / ST) evaluations Within 21 days of signed referral Initial outpatient behavioral health Within 14 days Referrals for specialty care Within 5 days Case management for children and pregnant women services Within 14 days Prenatal care: low-risk pregnancy Within 14 days Prenatal care: high-risk pregnancy or new member in 3rd trimester Within 5 days Preventive health: children (less than 6 months) Within 14 days Preventive health: children (6 months to 20 years) Within 60 days Preventive health: adults (21 years and older) Within 90 days Accessibility and Availability Provider education at your fingertips Courses are offered by profession ■Physician ■Nurse ■Social Worker ■Pharmacist ■Dentist ■Case Manager

3 stay informed Reminder: 2024 coding updates As new CPT, HCPCS, and ICD-10 codes are released, it is important to update all of your systems that relate to codes used for your claims submissions. 2024 ICD-10-CM updates include 395 new billable diagnosis codes for external causes of morbidity, social determinants of health (SDOH), and osteoporosis. Also, there are 25 deletions in 17 different chapters for ICD-10-CM codes. HCPCS updates for 2024 include 66 codes for stockings, compression garments, sleeves, gloves, wraps, and bandages, and there are 33 codes for injections. 2024 CPT updates include 230 new codes, 70 revised codes, and 49 deleted codes. Monitor your claim denials frequently; this will allow you to replace any codes that are invalid. When resubmitting corrected claims, enter the appropriate bill frequency code and original reference number. If information is missing in this field, the claim will deny as a duplicate claim. As a reminder, the corrected claim deadline is 120 days from date of EOB. How to request a pharmacy authorization Pharmacy prior authorizations can be requested for drugs that are non-preferred or require clinical edits by calling 1-877-908-6023 or faxing 1-855-668-8553. Staff is available 24 / 7. Prescribers are notified of determination 24 hours after receipt. Forms can be found at txstarchip.navitus.com/priorauthorizationforms. Special services for children of traveling farmworkers El Paso Health has special Medicaid services for the children of traveling farmworkers. The services include assistance with scheduling their upcoming Texas Health Steps exams as well as vision, mental health, and transportation benefits for them. If you have any questions or would like to receive more information about these services for children of traveling farmworkers or would like for the program coordinator to provide an in-service to your staff, please call the Outreach Coordinator at 915-532-3778, Ext. 1075. Make time for yourself From family obligations to work responsibilities, chances are you have a lot on your plate. But one thing you can't afford to skimp on is self-care. Here are a few ways to be good to your body and your mind—tips to help improve both your physical and your mental health. For your body Eat healthy foods. Along with giving you energy to focus, good nutrition may help reduce your risk of some chronic conditions. One simple change is to eat vegetables and fruit every day. Other good foods include whole grains, lean proteins, and low-fat or nonfat dairy products. Get enough sleep. Snooze at least seven to nine hours at night. Help yourself to a good night's rest by sticking to a sleep schedule and avoiding watching TV or scrolling through your social media feed close to bedtime. Be active. Aim for at least 150 minutes of moderate physical activity each week. For your mind Try a relaxation technique. Here's one: When you feel stress coming on, find a quiet place to close your eyes and take several deep breaths. Take a break. Do your best to set aside time each day (even just a few minutes) to do something you enjoy. Maybe that's listening to music, reading a book, or spending time working on a hobby. Reach out. Having social connections is good for our mental health. Talk with close friends and family about any stress in your life. Ask for their support. Say thanks. Try writing down one thing you're grateful for each day. Daily expressions of gratitude may boost your mood. Ask for help if you need it If you need help maintaining or improving your well-being, don't hesitate to talk to your primary care Provider—even Providers need help sometimes. Doing so is especially important if you're feeling overwhelmed. And if you are in crisis and need to talk with someone right away, you can call or text 988 (the national Suicide & Crisis Lifeline) to connect with a trained counselor. Sources: American Heart Association; American Psychological Association; Centers for Disease Control and Prevention; National Alliance for Mental Health; National Institute of Mental Health

Provider Newsletter ABOUT YOUR HEALTH is published as a service for members of the EL PASO HEALTH Provider network. EL PASO HEALTH Executive Offices are located at 1145 Westmoreland Drive, El Paso, TX 79925, 915-532-3778 or 1-877-532-3778, elpasohealth.com. Information in ABOUT YOUR HEALTH comes from a wide range of medical experts. If you have any concerns or questions about specific content in this newsletter, call 1-877-532-3778. Models may be used in photos and illustrations. Member Services 1-877-532-3778 EPHP8362402 – EPH-PR-Spring 2024 Provider Newsletter 2024 © Coffey Communications, Inc. All rights reserved. stay informed In the world of health care, ensuring that patients receive the appropriate medical equipment is crucial for their well-being and recovery. However, the process of ordering durable medical equipment (DME) presents unique challenges, particularly when determining medical necessity. Providers may encounter various challenges when ordering DME. One significant obstacle is navigating the complex documentation requirements and insurance policies associated with DME ordering. These requirements can be complex and time-consuming, often leading to delays and uncertainty in the ordering process. Providers must ensure that they have all the necessary documentation and meet the specific criteria outlined by insurance companies to obtain approval for DME orders. To improve the ordering of DME while mitigating the risk of fraud, waste, and abuse (FWA), health-care Providers should adhere to several best practices. Here are some tips: ■Conduct comprehensive patient assessments to modify DME orders to individual needs. ■Stay informed about insurance coverage policies to prevent billing errors. ■Document medical necessity clearly in patient records. ■Verify the credentials of DME suppliers. Best practices in ordering durable medical equipment ■Educate staff on FWA awareness. ■Implement internal controls. ■Foster transparency and accountability within the organization. By following these practices, Providers can ensure appropriate DME utilization, minimize the potential for fraudulent activities, and uphold the integrity of the health-care system. Additionally, if you suspect potential FWA, particularly related to DME, reach out to report to the El Paso Health FWA hotline at 1-866-356-8395. It is a confidential hotline where individuals can report suspected instances of FWA related to programs like Medicare and Medicaid. Reference: Huff, C., Colwell, J., Weekly, A. I., Monthly, A. D., Monthly, A. G., Connection, C., ... & Regulations, D. M. E. (2018). DME requests pose practice problems. ACP Internist.

RkJQdWJsaXNoZXIy MjI2MTU5NA==