EOCCO Clinics & Staff,
Welcome to the June issue of the EOCCO Monthly Newsletter. Below is a preview of the articles you will find in this month’s issue:
- Well Child Incentive Program
- Applied Behavior Analysis Program
- 2022-2027 Medicaid 1115 Waiver Draft Policy Concept Papers
- Upcoming Events & Trainings
- New Referral & Authorization Guidelines and Forms
- Provider Manual Update
- Reminders: Timely Filing & ICC Services
Please let us know if you have any questions, concerns or recommendations. We would love to hear from you!
Please contact: Kelly Watanabe at kelly.watanabe@eocco.com
Thank you,
Your EOCCO Team
Well Child Incentive Program
Children between the ages of 3 and 13 who complete a well visit by Dec. 31, 2021 are eligible to receive a $20 Amazon gift card. After completing a well child visit EOCCO members are able to claim their gift card by scanning the QR code on the back of the Well Child Visit Incentive Program postcard* or by visiting the EOCCO Member website. Members can also call us at 888-788-9821 (TTY users, call 711) to redeem their gift card.
*Well Child Visit Incentive Program postcards have been distributed to clinics upon request. To request these postcards at your clinic please contact eoccometrics@modahealth.com.
Applied Behavior Analysis Program
GOBHI’s Applied Behavior Analysis (ABA) Program has a NEW Referral process for interventions provided to families and children with autism. ABA is a covered service, for qualifying Members, that applies the science of learning and behavior to interventions in a way that helps increase useful or desired behaviors, or to reduce behaviors that may interfere with learning or skill development. ABA interventions are provided by Registered Behavior Interventionist (RBI) and Board Certified Behavior Analyst (BCBA) to members in a clinic setting located in Umatilla, Union, and Malheur county. Members must have a medical referral, by a qualified physician or psychologist with experience or training in the diagnosis of autism spectrum disorder, for ABA services, which indicates the ABA services are medically necessary to treat the Member’s autism symptoms. Members, physicians, or families requesting ABA services should be referred to their local Community Mental Health Program (CMHP), or GOBHI for more information.
Please visit https://www.gobhi.org/applied-behavior-analysis to submit a referral for Applied Behavior Analysis services. Select the link for the ABA Referral Checklist to submit the appropriate documentation to qualify for this service.
2022-2027 Medicaid 1115 Waiver Draft Policy Concept Papers
OHA has released a series of draft concept papers under consideration for the 2022-2027 1115 Medicaid Demonstration Waiver. OHA plans to develop proposals to the federal government for new approaches to create a more equitable and responsive Medicaid system by building health equity into all areas of Oregon’s Medicaid program. This will be met through four key areas:
- Ensuring access to coverage for all people in Oregon
- Creating an equity-centered system of health
- Encouraging smart, flexible spending
- Reinvesting government savings across systems
The next discussion of these concept papers will occur during the Medicaid Advisory Committee (MAC) on Wednesday, June 30, 9am -2p. For a complete list of upcoming engagement opportunities, please visit Oregon.gov/1115WaiverRenewal or contact 1115WaiverRenewal@dhsoha.state.or.us with comments or questions.
Upcoming Events & Trainings
Webinar: Diabetes metrics toolkit
Learn to apply quality improvement frameworks and tools for measurable change in diabetes, HbA1c poor control, and oral health evaluation for adults with diabetes. Open to everyone working with incentive measures in primary care and dental clinical settings.
Tuesday, June 22, 12 -1pm
Register here, or contact Laura Ferrara at ORPRN_TA@ohsu.edu for more details
Recorded webinar series: Preventing suicide in survivors of domestic violence
Mental health providers are invited to view a three-part webinar series on preventing suicide in survivors of domestic violence. Videos include introduction to domestic violence, domestic violence documentation, confidentiality and privilege practices, and domestic and sexual violence for mental health providers.
Click here to access the prerecorded webinar series
New Referral & Authorization Guidelines and Forms
EOCCO has updated its Referral & Authorizations guidelines document. We ask that you use the most updated version of this document and review regularly with new and existing staff. The guideline document can be found on our Referrals & Authorization page under the 'Guidelines' header.
The referral & authorization form has also been updated to now be a fillable pdf. Please ensure that your clinics begin utilizing the new form that can be found here.
Provider Manual Update
The EOCCO Provider Manual was updated on May 1, 2021. Please ensure that you are using the most recent version of the provider manual which can be found on our website.
Reminders
Timely Filing
Standard timely filing is 120 days from the date of service. However, EOCCO may waive the 120-day timely filing for the following:
- Eligibility issues, such as retroactive deletions or retroactive enrollments
- Pregnancy
- Medicare as the primary payer
- Third-party resources, including workers compensation
- Covered services provided by nonparticipating providers that are enrolled with HSD
- Other reasonable circumstances for delay
Claims received later than 12 months after the date of service shall be invalid and not payable. Providers (direct contract or secondary networks) may not balance bill the member for services that were denied for not meeting the timely filing requirements.
Please review the provider manual for more details.
Intensive Care Coordination (ICC) Services
EOCCO's Intensive Care Coordination (ICC) services is a program to eliminate barriers to remove gaps in care for members identified with high complexity or comorbidities including for members in Prioritized Populations. ICC services is a collaborative process of assessment, planning, facilitation and advocacy for options and services to assist members with complex conditions and help them access needed resources. Providers, community support staff, members and their representatives can make referrals to ICC services via any verbal or written means.
Providers can refer EOCCO members for ICC services by using the referral form available on our website.
Questions?
- Questions related to incentive measures, health equity, traditional health workers, SDoH, and HIT - Please email EOCCOMetrics@modahealth.com
- Questions related to claims and payment information - Please email EOCCOProviderInquiry@modahealth.com
- Need to verify if your provider or group NPI is active? Please use OHA’s verification tool
- Need to register your practitioner, group or facility? You can find forms on EOCCO.com/Providers/becomeaprovider
- If you would like to be added or removed from this email list, please let us know at EOCCOProviderInquiry@modahealth.com
