EOCCO Clinics & Staff,
Welcome to the February issue of the EOCCO Monthly Newsletter. Below is a preview of the articles you will find in this month’s issue:
- Final 2020 Incentive Measure Reporting
- Health-Related Services – Flexible Services Program
- COVID-19 Vaccine
- eviCore Update
Please let us know if you have any questions, concerns or recommendations. We would love to hear from you!
Please contact: Kelly Watanabe at email@example.com
Your EOCCO Team
Final 2020 Incentive Measure Reporting
CCOs and PCP clinics will not be held accountable for achieving incentive measure targets for the 2020 measurement year. However, EOCCO is still responsible for reporting on the EHR-based measures and chart review measures to the Oregon Health Authority.
Clinical quality measures
Diabetes HbA1c Poor Control, Depression Screening, Cigarette Smoking Prevalence, Drug and Alcohol Screening (SBIRT), Controlling High Blood Pressure, and Weight Assessment and Counseling
Reporting on the EHR-based clinical quality measures has two phases, the Data Proposal and the Data Submission. Last month, EOCCO worked with clinics to gather information on which measures our PCP clinics plan to report on and how. EOCCO has submitted this Data Proposal to OHA, and, pending OHA’s approval, will soon move on to the Data Submission process. The Quality team will be distributing Data Submission templates to PCP clinics in mid-February to return to EOCCO by Friday, March 5th.
Chart review measures
Prenatal and Postpartum Care & Colorectal Cancer Screening
The OHA has selected a sample of 411 patients for both incentive measures. The EOCCO Quality team is working to qualify prenatal and postpartum visits as well as colorectal cancer screenings through claims and repository data. Individual clinics may be contacted for additional support between Wednesday, February 24th and Friday, March 5th.
Please contact EOCCOmetrics@modahealth.com with any questions about the 2020 reporting process.
Health-Related Services - Flexible Services Program
As part of the Health-Related Services program, EOCCO offers Flexible Services; an OHP benefit that helps provide individual access to non-covered services and equipment needed to improve a member’s health status. These member-level interventions are designed to complement the member’s service plan and address social determinants of health by providing services that can positively affect the health of the member but are not covered by traditional health benefits. This may include items such as short-term or emergency housing, homeless support (tents, sleeping bags), personal use items, smoke detectors, transportation, etc.
For an item to qualify as a flexible service it must at minimum:
- Be designed to improve health delivery, patient health, and overall quality of care
- Be consistent with the patient’s treatment plan
- The service or item does NOT have a traditional billing or encounter code (CPT)
Additional requirements can be found on the OHA's Health-Related Services webpage. Flexible Services can be requested by the member, a provider, or someone from the member’s care team. Applications are reviewed on a case-by-case basis depending on a member’s need. Blank forms can be requested by contacting the EOCCO Customer Service department: 888-788-9821 (TTY users, please dial 711), or emailing GovtRNLeads@modahealth.com. They are also available on the EOCCO website under the ‘Resources’ tab.
Patient-Centered Counseling Trainings
Choose from one of five full-day trainings focused on strengthening motivational interviewing and other patient-centered counseling skills.
Trainings are held April 7, April 29, May 18, June 10, or June 29, from 9am – 4pm.
Follow this link to register or add yourself to a waitlist.
SBIRT Webinar Training Series
A webinar series focused on addressing moderate to severe Alcohol Use Disorder (AUD) using Screening and Brief Intervention (SBI) and Medication Assisted Treatment (MAT).
March 9, May 12, or August 11, from 12pm – 1pm
COVID-19 Response ECHO for Oregon Clinicians – Part III
This 12-Session program will support healthcare professionals during the COVID-19 pandemic with a focus on the latest in treatment and prevention and guidance to practices adapting to systems change. CMEs available!
1st and 3rd Thursdays, 12pm – 1pm
OHA COVID-19 Health Care Provider Webinars
A venue for COVID-19 information sharing, hosted by OHA’s Chief Medical Officer, Dana Hargunani, M.D
2/11, 3/11 and 4/8, 12pm -1pm
Visit the OHA’s COVID-19 Healthcare Partner Resources webpage for more information or to register.
Technical Assistance for Primary Care Diabetes Control and Dental Care for Patients with Diabetes
Training and technical assistance opportunity for those interested in quality improvement for type II diabetes patient management and/or improving HBA1C poor control.
Thursday 1/28, or Thursday 3/11, plus 5 hours of tailored support
Contact ORPRN_TA@ohsu.edu or call (971) 413-9585 for more information or to register
Interprofessional Solutions for Racism in Primary Care
Enjoy a creative adult learning experience facilitated by healthcare professionals who personally represent Black, Indigenous & People of Color (BIPOC) communities
Thursday, February 18th, 8:30 am.-12:45 pm
For more information, or to register click here
As of February 17th, the vaccine is available to those who are in Phase 1A and part of Groups 1-3 in Phase 1B. We have posted information on our website regarding enrollment, billing and reimbursement related to the COVID-19 vaccine: www.eocco.com/news/Current/COVID-19-Vaccine-Information-for-Providers. Please check this page often as updates will be made frequently.
Additional resources from OHA regarding vaccine billing, sequencing, and other information can be found in following links:
- Vaccination sequencing in Oregon
- Oregon Medicaid COVID-19 Provider Guide
- OHA – COVID-19 Vaccine in Oregon
- OHA – COVID-19 Vaccine Info for Providers
Effective 4/1/2021 eviCore will separate EOCCO from Moda Health business on the prior authorization portal. EOCCO will now be added to the list of Health Plan drop-downs to choose from when requesting a prior authorization in the eviCore portal.
If you choose Moda Health as the health plan option for a member on EOCCO you will receive a message “member not found / ineligible member”.
EOCCO will host eviCore prior authorization trainings in the near future and we will communicate the dates and times of these sessions as soon as we have more information.
Claims Explanation Code (E/X) Corner
PS0 - This service is not covered under the plan. This denial is seen on a range of services that may not be covered under the Oregon Health plan but is more commonly being used when members are on a CCOG plan. CCOG plans only cover behavioral health services under the CCO. Physical Health Services are covered under regular Medicaid also known as Fee-for-Service or Open Card.
TR5 - Services in excess of benefit maximum: This denial code represents a member who has exhausted their benefits. This is the most common denial for Community Health Worker Service as members only get 8 units in a calendar month.
z60 - A non-primary diagnosis code was submitted as the primary diagnosis code. This denial is used when an ICD-10 code is used as the primary diagnosis when the ICD-10 coding book advises the diagnosis can’t be used as the primary diagnosis.
- 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