EOCCO Clinics & Staff,
Welcome to the first issue of the EOCCO Monthly Newsletter. We know your days are busy caring for our members, and there is never enough time to keep up with dozens of email blasts. Each month, we plan to use this space to communicate important claims and payment information, metrics updates, new resources, training opportunities and important network-wide changes that may impact you and your clinic. In addition, we will continue to reach out to you if we need to communicate urgent issues, including those pertaining to individual providers, health systems or counties. You can expect to receive this newsletter on the third week of each month.
Thank you for all you do. We look forward to continuously improving this resource to best serve you.
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
2021 Incentive measure benchmarks
The COVID-19 pandemic has dramatically changed how members access care. In response, the Oregon Health Authority (OHA) has readjusted expectations in hopes of setting more realistic targets for CCOs. The 2021 metric year will use 2019 as a baseline measurement. We will roll forward the 2020 benchmarks with the caveat that individual incentive measures may be reviewed if a subset of predetermined pandemic-related criteria is met. If the predetermined criteria for a measure is met, the Metrics and Scoring Committee will consider revising the benchmark in November 2021. The 2021 incentive measures are the same as 2020, with the addition of one new measure that promotes Meaningful Language Access to Culturally Responsive Healthcare Services.
Upcoming data collection efforts for 2020 measures
As a reminder, 2020 is a report-only year. This means CCOs/PCP clinics will not be held accountable for achieving incentive measure targets. However, we will be asking for clinics to supply data for the chart review measure, and the clinical quality measures.
Chart review measure: Prenatal and postpartum care
We will send out charts at the beginning of February to gather data on prenatal and postpartum care visits for a sample of our EOCCO population.
Clinical quality measures
If you haven’t submitted your data proposal yet, please do so to EOCCOmetrics@modahealth.com. Within the next month, we will be reaching out with templates on data collection methods for the following incentive measures: diabetes poor control, cigarette smoking prevalence, depression screening SBIRT, controlling high blood pressure, and weight assessment and counseling.
REALD Office Hours for Providers
Office hours are open to providers who have questions on the Race, Ethnicity, Language, and Disability (REALD) demographic collection methods required for reporting COVID-19 encounter data.
Tuesday, January 26th, 2021, 12pm-1pm
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
Live Implicit Bias Training - 2 CME Credits Available!
EOCCO presents a live, virtual training on how implicit biases and microaggressions affect the workplace.
Thursday, February 4th from 10am-12pm
DMAP name change
Long ago, the Division of Medical Assistance Program (DMAP) name changed to be Health Systems Division (HSD). To fall in line with the definitions outlined in the Oregon Administrative Rules (OARs), we will no longer use the references to DMAP. We will use “HSD,” “Oregon Health Authority (OHA)-Health Systems Division” or “OHA-HSD” instead.
Oregon Health Plan provider enrollment:
All rendering and prescribing providers, groups and facilities must be registered and active with OHA-HSD in order to get reimbursed for the services provided to EOCCO members. Enrollment is for three years or until the business license lapses, whichever comes first.
Revalidation happens every three years, and OHA sends out letters 90-60-30 days from the termination date of the Medicaid ID#.
Claims explanation code (E/X) corner
84M - DMAP registration required for payment: The rendering or prescribing provider, group or facility is not active with OHA-HSD. Registration will be needed before we can pay the claim.
580 - OHP Non-duplication of Benefits Applied: The primary carrier paid more than what EOCCO allows for the service, thus no additional payment is made.
992 - Primary diagnosis is invalid for this setting. Please resubmit with valid primary diagnosis: The diagnosis in box 21A on CMS-1500 claims forms is not valid in the primary position. OHA-HSD has outlined specific codes that can’t be billed in this position. They can be found on the OHA website under the Medical-Surgical Oregon Administrative Rules.
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 the email list, please let us know at EOCCOProviderInquiry@modahealth.com