Provider Newsletter Masthead

Alliance provider e-newsletter

November 30, 2020

Mental health care is even more essential now.
Here's how the Alliance is supporting our communities.

As we continue to navigate a pandemic, we are also faced with a holiday season where many of us are isolated from loved ones. Now, more than ever, it's important to take care of our mental health and well-being. That's why the Alliance has focused on spreading awareness of behavioral health support and resources during the holidays to our members, providers and communities.

Updated materials are currently available on the Alliance website's behavioral health page for members, including a new flyer with support info.

Also in the works:


National Influenza Vaccination Week: 12/06/20-12/12/20

The COVID-19 pandemic has underlined the importance of reducing the number of flu illnesses and hospitalizations in our communities. December 6-12, 2020 is Influenza Vaccination Week, and the Alliance is here to support your efforts to vaccinate members 6 months and older against the flu. As we move through this unique holiday season, it is not too late to get or give a flu vaccine.

For members two years and younger, the Alliance offers an Alliance Health and Wellness raffle reward of a $100 Target gift card for members completing all immunizations required in the HEDIS Childhood Immunization Status (CIS) – combo 10 measure. Reminder: members under two years of age are required to have two doses of the flu vaccine – the second dose administered four weeks after the first.

Childhood Immunization Status – Combo 10

Childhood Immunization Status - Combo 10

*Rotavirus – two-dose (Rotarix, GSK) and three-dose (RotaTeq, Merck) series available

** Second dose of flu needs to be given 30 days after initial dose given to child. Then continue with one flu shot annually.

For more information, please visit our Alliance Immunization Resources page at: https://www.ccah-alliance.org/immunizationresources.html

If you have questions about the Alliance Health and Wellness Rewards, call the Alliance Health Education Line at 800-700-3874, ext. 5580.


Documentation Requirements for Billing Telephonic Initial Health Assessment Visits

In normal, non-pandemic times, the California Department of Health Care Services (DHCS) requires the Initial Health Assessment (IHA) exam, as well as a Staying Healthy Assessment (SHA) form to be performed within the first 120 days of enrollment with Medi-Cal. These guidelines dictate the provider must attempt to contact and schedule a member at least three times in order for the IHA to be considered compliant.

However, during the public health emergency, DHCS is temporarily suspending the requirement to complete an Initial Health Assessment (IHA) within the 120-day timeframe. Once the public health emergency is over, DHCS will once again require IHA completion for members.

If a provider’s clinic has capacity to see new members and is interested in incorporating telephonic visits, please see the below documentation requirements for billing telephonic IHA visits.

Documentation Requirements for Billing Telephonic IHA Visits

CPT Code

99204

99205

HPI

  • History of present illness, 4+ (location, quality, severity, etc.)
  • Review of symptoms, 10+
  • Past, family, social history - all three
  • History of present illness, 4+
  • (location, quality, severity, etc.)
  • Review of symptoms, 10+
  • Past, family, social history - all three

Exam

8+ Organ systems examined

8+ Organ Systems examined

Medical Decision Making

  • Number of diagnosis
  • Complexity of data reviewed (labs, imaging, medicine)
  • Risk, moderate
  • Number of diagnosis
  • Complexity of data reviewed (labs, imaging, medicine)
  • Risk, high

Time Spent

45 Minutes

60 Minutes

 

Best practices:

 

Please contact your provider Relations Representative with any questions 800-700-3874 ext. 5504.