El Paso Health | About Your Health | Winter 2022

3 resources Provider updates for COVID-19 telemedicine and telehealth services As we continue to face the COVID-19 pandemic, El Paso Health promotes the continuity of care during the pandemic response. Providers should continue to use modifier 95 and Place of Ser vice (POS) 02 when rendering telemedicine and telehealth ser vices. El Paso Health Providers can render telemedicine and telehealth ser vices for cer tain medical and behavioral ser vices to ensure the continuity of care to our members. For additional information regarding telemedicine or telehealth, you may contact our Provider Relations Depar tment at 915-532-3778 . Received a request for records? Don’t delay! T he state of Texas requires all managed care organizations, like El Paso Health, to regularly audit providers and members to ensure payment integrity. We must verify that providers are billing correctly and that members are receiving the services we are being billed for (Texas Administrative Code Rule §353.502). Additionally, we are required to audit all inductions and C-sections prior to 39 weeks of gestation to verify medical necessity. Please respond promptly to a request for records. When submitting records, ensure that they are complete. If some information but not all is included, the entire claim may be recouped for insufficient documentation for service provided. Examples of common items left out of a record include, but are not limited to: x-rays, MRIs, ultrasounds, progress notes, history of present illness, etc. Please refer to the latest Texas Medicaid Provider Procedures Manual for what information is required for the specific codes you are billing. If you don’t respond to a request for records or if you fail to submit appropriate documentation for an identified claim, the entire claim will be recouped. This type of finding cannot be appealed, due to Office of Inspector General guidance that post- audit submission could be suspect as being potentially altered or created after the fact. If you have any questions about auditing procedures and requirements, please do not hesitate to reach out to our Compliance Department at 915-298-7198, ext. 1039 . If you suspect fraud, waste, or abuse (FWA), report it through our FWA hotline: 1-866-356-8395 .