Children’s Community Health Plan will require Day Treatment authorizations (H2012) to be separated by the levels of care - Partial Hospitalization Program and Intensive Outpatient Program. They will no longer be reviewed under the same episode effective September 1, 2019.
Providers will need to create and submit the separate episodes into the CareWeb Qi Authorization Tool.
Previously, providers could request one level of care and if the member stepped up or down in care the provider notified CCHP in the same episode.
This is being implemented to simplify the requests. This will help the utilization management team review authorizations when members are frequently moving from one day treatment level of care to another or for members who may have multiple changes in diagnosis throughout their participation in day treatment. It will also allow the providers to submit a claim after each level of care rather than requiring the provider wait until the member completes all levels of day treatment before submitting a claim.
Effective July 1, 2019: These codes were added to the Together with CCHP's non-covered list: J7318, J7320, J7321, J7322, J7323, J7324, J7325, J7326, J7327, J7328 and J7329.
Effective July 1, 2019: The Specialty Medications codes J7318 and J7329 were added to BadgerCare Plus prior authorization list.
The following changes were made to HCPCS code E0156, for a walker's seat:
This code was removed from Together with CCHP's Non-covered code list and moved to Together with CCHP's Prior Authorization List. This code will require authorization only if the retail cost for the code on the claim is $500 or greater.
Effective on June 1, 2019- These codes were added to Together with CCHP's Non-covered code list: G2001, G2002, G2003, G2004, G2005, G2006, G2007, G2008, G2009, G2013, G2014, and G2015. These codes are for in-home visits post-discharge and care plan oversights. These lab codes were added to the non-covered code list: 0001U; 0002U; 0003U; 0005U; 0006U; 0007U; 0008U; 0009U; 0010U; 0011U; 0012U; 0013U; 0014U; 0016U; 0017U; 0018U; 0019U; 0021U; 0022U; 0023U; 0024U; 0025U; 0026U; 0027U; 0029U; 0030U; 0031U; 0032U; 0033U; 0034U; 0035U; 0036U; 0037U; 0038U; 0039U; 0040U; 0041U; 0042U; 0043U; 0044U; 0045U; 0046U; 0047U; 0048U; 0049U; 0050U; 0051U; 0052U; 0053U; 0054U; 0055U; 0056U; 0058U; 0059U; 0060U; 0061U; 0062U; 0063U; 0064U; 0065U; 0066U; 0067U; 0068U; 0069U; 0070U; 0071U; 0072U; 0073U; 0074U; 0075U; 0076U; 0077U; 0078U; 0079U; 0080U; 0081U; 0082U and 0083U.
Effective April 29, 2019- CCHP has added a new authorization request status to the CareWebQI Authorization Tool. The Status of voidedcan be found in the Authorization Queue under the status column of the Summary of Submitted Requests.
Voided means that CCHP has not reviewed the authorization request and the request is being returned to the provider’s attention for resubmission.
An authorization request will be voided for the following reasons:
- Requesting and/or Attending Provider is listed as "Unknown, Provider"
- Invalid diagnosis code type selected (ICD-10 only)
- Invalid diagnosis (ICD-10) code entered
- Invalid procedure/service/item code type selected (CPT/HCPCS only)
- Invalid procedure/service/item code (CPT/HCPCS) code entered
Please open and review the authorization request for a message explaining why the authorization was voided. Please note that voided requests cannot be resubmitted. Providers will need to create a new authorization request.
When creating an authorization you should not choose unknown for requesting provider or attending provider. If the providers name does not appear when searching then build this authorization using the facility in these spots. Then tell us the providers name in the “Are there any other details?” field. If you use unknown provider this authorization will be voided and you will receive a message that you will have to resubmit.
The Durable Medical Equipment code E2300 was added to the prior authorization list with an effective date of June 1, 2019.
The Durable Medical Equipment code E0465 was added to the prior authorization list with an effective date of May 1, 2019.
These behavioral health codes were added to the no prior authorization list: 96121, 96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139, and 96146. In addition, the intravascular ultrasound code 37252 was added to the no prior authorization list.
Together with CCHP:
Prior Authorization List:
These new skin substitute codes have been added to the prior authorization list: Q4183; Q4184; Q4185; Q4186; Q4187; Q4188; Q4189; Q4190; Q4191; Q4192; Q4193; Q4194; Q4195; Q4196; Q4197; Q4198; Q4200; Q4201; Q4202; Q4203; and Q4204.This is effective March 1, 2019.
These Diabetic and Neuropathy Procedure Codes for DME and Foot Care, A5513 and A5514, have been added to the prior authorization list. This is effective March 1, 2019.
These DME codes have been added to the prior authorization list: E0447, E0467 and L8698. Prior authorization is required if the purchase price or the monthly rental price is greater than $500. This is effective March 1, 2019.
No Prior Authorization List:
The following codes have been added to the no prior authorization required list: A9589; B4105; C9407; C9754; C9755; G2011; and J0841.This is effective March 1, 2019.
These codes were added to the non-covered list: A4563; C1823; C1890; C8937; C9751; C9752; C9753; L8701; L8702; J3591; G0068; G0069; G0070; G0071; G0076; G0077; G0078; G0079; G0080; G0081; G0082; G0083; G0084; G0085; G0086; G0087; G2010; G2012; A6460; A6461; J7318; J7329; L8608; M1000; M1001; M1002; M1003; M1004; M1005; M1006; M1007; M1008; M1009; M1010; M1011; M1012; M1013; M1014; M1015; M1016; M1017; M1018; M1019; M1020; M1022; M1023; M1024; M1025; M1026; M1027; M1028; M1029; M1030; M1031; M1032; M1033; M1034; M1035; M1036; M1037; M1038; M1039; M1040; M1041; M1042; M1043; M1044; M1045; M1046; M1047; M1048; M1049; M1050; M1051; M1052; M1053; M1054; M1055; M1056; M1057; M1058; M1059; M1060; M1061; M1062; M1063; M1064; M1065; M1066; M1067; M1068; M1069; M1070; M1071; T4545; V5171; V5172; V5181; V5211; V5212; V5213; V5214; V5215; and V5221.This is effective March 1, 2019.
- These behavioral health codes will be added to the prior authorization list and removed from the no prior authorization list with an effective date of March 11, 2019: H0005 and H0047.
- These genetic codes will be added to the prior authorization list with an effective date of March 1, 2019: 81163; 81164; 81165; 81166; 81167; 81173; 81174; 81177; 81178; 81179; 81180; 81181; 81182; 81183; 81184; 81185; 81186; 81187; 81188; 81189; 81190; 81204; 81233; 81234; 81239; 81271; 81274; 81284; 81285; 81286; 81289; 81305; 81312; 81329; 81336; 81337; 81518; 81595; and E0470.
- These codes will be added to the no prior authorization list with an effective date of March 1, 2019: 10004; 10005; 10006; 10007; 10008; 10009; 10010; 10011; 10012; 11102; 11103; 11104; 11105; 11106; 11107; 20932; 20933; 20934; 33275; 33286; 33440; 36572; 36573; 43762; 43763; 50436; 50437; 82642; A5514; E0447; V5171; V5181; V5211; V5221; and 99344.
1099 Forms Notice
Together with CCHP's update to Medications that fall under the Pharmacy or Medical Benefits
Together with CCHP's 2019 Prior Authorization Lists Updated
As of September 20, 2018, providers will not be able to send this request through a secured message for transplant and mechanical cardiac support requests. View this release.
08/01/2018 Community Paramedics Release
Members will receive an initial visit with one of the Community Paramedics during their hospital stay to introduce themselves and explain the program. View this release.
Children's Community Health Plan has updated the Prior Authorization and No Prior Authorization lists for BadgerCare Plus - CCHP. View this release.
Effective July 1, 2018, a prior authorization is required for narcotic analgesics prescribed for all Commercial and Exchange members age 18 and older. Starting August 1, there will be a transition period for members already taking a quantity limit of less than 200 mg per day. This applies to Together with CCHP members not BadgerCare Plus - CCHP members. View this release
Children's Community Health Plan has updated the Authorization lists for BadgerCare Plus - CCHP and Together with CCHP. View the release.
06/01/18 New Telehealth Policy
Effective June 1, 2018, CCHP has implemented a telehealth credentialing policy. Please contact CCHP at 844-229-2776 to schedule an onsite visit. View the policy
NICU Notification: Effective June 1, 2018, providers need to create a separate authorization for NICU. Providers should create an authorization with the mother's ID for the baby's information. In the notes section, the provider enters the baby's date of birth, weight, gestational age, and documentation. CCHP will then create an episode with the baby temp ID and send you notification of new episode number via CareWeb message system in the original episode created using the mother's information. When looking to add clinical or verification of authorization please reference newly created baby episode as original NICU notification episode will have been canceled. Due to system constraints, CCHP will continue to use the temporary ID for the baby through the entire hospital stay. The baby will not be assigned a permanent ID until after discharge. When the baby is discharged, please make sure to message the Utilization Management reviewer by attaching clinical and messaging the discharge date. Please make sure to choose the right admission date and check to see the authorization was submitted. CCHP has created this guide to help providers submit this notification.
01/01/18 - Prior Authorization - Patient Admissions
Please review the Patient Admissions Notice.
12/29/17 - New Years Hours
Our offices will be closed on Monday, Jan. 1, 2018. We will reopen on Tuesday, Jan. 2 at normal business hours.
12/20/17 - Christmas Hours
Our offices will be closed on Monday, Dec. 25, 2017. We will reopen on Tuesday, Dec. 26 at normal business hours.
11/29/17 - Drug Testing for Substance Use Disorders and Chronic Pain Treatment
CCHP has completed a review, revision, and adoption of an updated Drug Testing policy.
11/17/17 - Thanksgiving Hours
Our offices will be closed on Thurs. Nov. 23, 2017. We will reopen on Fri., Nov. 24 at normal business hours.
11/06/17 Credentialing Notice
On October 6, Children’s Community Health Plan completed a review, revision, and adoption of CCHP Credentialing Policies and Procedures. View these policies and procedures on CCHP's credentialing page. Read the full notice here.
The policy Practitioner and Organization Provider Suspension, Termination, and Appeal Rights has been revised and clarified. Section III B. Clarifies the processes for imposing a summary suspension when there are potential issues of quality or safety (page 3). Section IV A and B lists circumstances that will result in Automatic Termination from CCHP’s practitioner network (page 4 and 5). Section IV C does provide for a process to request a waiver of automatic termination when the request is submitted along with written explanatory and supporting information to the Credentialing Committee (page 5).
Practitioners who are terminated from CCHP’s network for cause and are not provided a waiver of the termination by the Credentialing Committee are not eligible to reapply for participation in CCHP’s network for 24 months. The process and procedure for appealing a termination action by the Credentialing Committee, and for rendering an appeal decision has been clarified (pages 5-10).
11/01/17 - Synagis Enrollment Form
Synagis Season Respiratory Syncytial Virus Enrollment Form (2017 - 2018)
10/23/17 - CareWeb Upgrade
CareWeb will be migrating hosted applications and services to a new network segment in our data center. These activities are expected to have performance and availability impacts to all hosted interactive solutions, including CareWebQI AutoAuth and their supporting services.
Work will begin on Nov 11, 2017 at 5:00 p.m. CST and work is expected to be complete no later than Nov 12, 2017 at 1:00 a.m. CST (8 Hours).
Client IT Department Alert
- The IP address of our interactive solutions is going to change, but the URL will not. Check to make sure to update IPs if you are using IP filtering for CareWeb solutions.
- HL7 interfaces will not change, but HL7 traffic will not be flowing during this maintenance window. The channel will be restarted when the maintenance is complete.
To monitor this maintenance, navigate to http://status.mcg.com where you can see the status of our solutions and optionally subscribe to email updates.
10/16/17 - Open Enrollment Period
Open Enrollment runs November 1 - December 15, 2017. Unlike in years past, Open Enrollment will only be a six-week period. Your patients may ask you if you are a member of the network, please be aware if you are provider in our Together with CCHP network. Learn more here.
10/01/17 - ICD-10 CM diagnosis codes
On 10/01/17, the new ICD-10 CM diagnosis codes for 2018 become effective for service dates of 10/01/2017 and beyond. Please view the Auto Authorization Guide for support.
10/01/17 - NICU Notifications Faxed
Effective November 1, 2017, all NICU notifications must be submitted via the CCHP Auto Authorization tool. We will no longer accept faxed NICU notifications. This can be accessed through the CareWeb.
Please view the NICU Auto Authorization Guide if you have any questions on how to provide notification or an authorization request. If you need further assistance on how to attach documents, please call 414-266-5747.
07/01/2017 - Important Security Update
Please upgrade your TLS protocol to 1.1 or higher before July 22, 2017 to make sure your provider portal access will not be interrupted.
Please share the TLS Protocol letter with your IT staff.
04/01/17 - Goodbye fax! Hello Auto Auth Tool
Effective May 1, 2017, all clinical documents submitted, for any service that requires notification or prior authorization, must be attached to our auto auth tool. Faxing will no longer be accepted.
Please read the announcement for more information.
01/01/17 - J Codes Requests
Effective immediately, please fax J-code requests directly to 844-201-4675.