CURRENT EVENTS

Change Healthcare Cyber Incident Update

Update: May 31, 2024

As you are aware Change Healthcare experienced a cyber incident on February 21st, impacting a sizable portion of their operations as well as Medical Associates Health Plans (MAHP), Health Choices, and Live360 operations.

We continue to work closely with Change Healthcare to resume operations to pre-attack levels.

Claims Submission

Our claims volumes have returned to close to pre-cyber attack volumes. We are receiving electronic claims from multiple clearinghouses: Optum, Apex EDI, Smart Data Solutions, Relay Exchange, and Availity. Our Payer ID is MAHC1. Many clearinghouses route claims through one of the above options. If you are struggling with electronic claim submission, please reach out to MAHP EDI at MAHPedi@mahealthcare.com for assistance.

Claims Payment

We have resumed weekly claims payments. Currently, we continue to issue payments directly to providers from our office.

We are in the testing phase with Change Healthcare to resume production of the Explanation of Payment (EOP). We will begin producing EOP’s for payments that were already sent to provider offices in the next week. We will be producing the payment documentation in the order the claims were paid. At this time, all payments will remain in check form as Change Healthcare will not be resuming EFT or ACH payments. The electronic remit or 835 will also not be available at this time. We are researching other alternatives for EFT/ACH and the 835 remittance.

Change Healthcare will first focus on payment production and member communications (Explanation of Benefits) will follow. If a patient questions their cost share on a claim, please direct them to call Member Services at 866-821-1365 or to access their member portal.

We appreciate your patience and apologize for your inconvenience as we navigate this difficult time.

EDUCATION

Documentation and Coding Guidance: Cancer and/or Malignant Neoplasms

Documentation and coding of Cancer and/or Malignant Neoplasms has been a source of many errors in ICD-10-CM coding and reporting. The biggest issue with coding for this condition is correctly assigning codes for “active cancer” vs a “history of cancer” based upon the patient’s current treatment status. How ICD-10-CM classifies this differs from how you as a provider may perceive cancer and its treatment.

When can an active cancer be coded?

Cancers can be coded as an active condition if the documentation in the medical record demonstrates active treatment of the disease for the purpose of curing the illness, palliative treatment, when the cancer is not responding to the treatment, treatment is refused, or the current treatment plan of “watchful waiting” is documented. 

When does an active cancer become “history of?

Per the ICD-10-CM Official Guidelines for Coding and Reporting FY2024: “When a primary malignancy has been previously excised or eradicated from its site, there is no further treatment directed to that site and there is no evidence of any existing primary malignancy at that site, a code from category Z85 (Personal History of Malignant Neoplasm) should be used to indicate the former site of the malignancy.”

The key take-away? Do not describe active cancer as a “history of,” and do not describe historical cancer as “active.”

If you would like any additional information concerning documentation improvement, you may contact Kari Pace, MAHP Clinical Documentation Improvement at 563-584-4849.

Reference: ICD-10-CM Official Guidelines for Coding and Reporting FY2024-Updated 10/1/23, Chapter 2: Neoplasms (C00-D49).

QUALITY IMPROVEMENT

Wellness Visits & Preventive Screenings

Wellness and preventive care screenings allow practices to gain information about a patient, including medical and family history, health risks, specific vitals, and social determinants affecting health (like housing, transportation, and food). The purpose of these visits is to review each patient's overall physical health and psychological well-being and then develop a personalized wellness plan. These screenings provide an opportunity for providers to assess and improve the quality of care, assist in patient engagement in their care, and help foster healthy communities.

The following screenings provide an opportunity for wellness discussions, early intervention, and care planning at those visits:

• Blood Pressure Screening: Ensure blood pressure is taken at each visit and that a repeat blood pressure is obtained for high readings (>140/90) to ensure accuracy.
• Colorectal Cancer Screening: Such a screening should be recommended for men and women age 45-75. The standard of care is a colonoscopy screening every 10 years or sooner, based on risk factors and results.
• Breast Cancer Screening: The USPSTF recommends that women who are 50-74 years old and are at average risk for breast cancer get a mammogram every 2 years. Women who are 40-49 years old should talk to their healthcare provider about when to start and how often to get a mammogram.
• BMI: Obtain a BMI each year, and discuss ways to improve health with physical activity and nutritional changes. Ensure all child and adolescent visits have BMI percentiles identified and plotted on a growth chart  
• Depression Screening: Obtain a PHQ-2 each year, at a minimum. If your patient scores higher than 2, complete a PHQ-9 and provide interventions to help decrease depression.
• Anxiety Screening: Obtain a GAD-7 each year. If your patient scores higher than 9, further assessment is warranted while providing interventions to help decrease anxiety.
• Unhealthy Alcohol Use Screening and Follow-Up: Obtain an AUDIT each year or administer a single-question screening such as: “How many times in the past year have you had 5 (for men) or 4 (for women) or more drinks in a day?” Provide feedback on harms, high-risk situations, and help motivate reduced drinking.
• Social Determinants of Health (SDoH): This tool from the American Academy of Family Physicians can be used to screen patients for SDoH, identify community-based resources to help them, and work with patients to develop an action plan to help reduce health risks and improve outcomes.
• Tobacco Screening: Ask about and provide resources to patients to assist in tobacco cessation.
• Immunizations: Become familiar with provider resources as they relate to immunization schedules for children, adolescents, and adults.

CREDENTIALING

Recredentialing Reminder

To expedite recredentialing, please log into CAQH, update your data, verify your current malpractice insurance certificate is uploaded, and attest every 120 days. For new providers, please confirm the data at CAQH is updated, uploaded documents are current and attested prior to submitting the provider for initial credentialing. 

Coming Soon: Facility Provider Directory Validation

Facilities, please watch your email for provider directory validation information. MAHP is required to validate provider directory information every 90 days. We have been validating the provider office information for some time and will be rolling out the same process for facilities. Facilities will review the information, make the applicable updates, and return the completed form. Detailed information will be sent prior to the first validation request.

RESOURCES