Utilization Management Update for COVID-19 Flexibilities Update

On June 18, 2020, Partners released Provider Communication Bulletin #106 regarding service authorization request (SAR) flexibilities. This communication provides additional guidance on submission of SARs using CR and GT CR modifiers and also provides revised tables to replace the tables from Provider Communication Bulletin #106:

• Initial Requests Only: Medical Necessity Review
• Concurrent/Reauthorization Only: Notification SAR (SAR only, no clinical documentation)

Please reference the following link to view the full communication bulletin: https://providers.partnersbhm.org/provider-bulletin-106/

Providers may request up to five service codes on each SAR. This will give the provider the ability to use different service code modifiers based on what is needed for the member. The units requested for COVID-19 codes (CR, GT CR) can mimic the base code requested. Please note proper uses of the CR and GT CR modifiers:

• GT CR modifiers used for two-way audio and visual, telehealth services
• CR modifier should be used for additional COVID-19 flexibilities, including telephonic services
• FL modifier should be used for Appendix K flexibilities

The Treatment Plan/Service Plan does not have to be updated for use of the modifier codes during the COVID-19 crisis period. If an In Lieu of Service is being used for COVID-19, that service should be reflected on the member’s Treatment/Service Plan. All note documentation should reflect the reason for use of the COVID-19 flexibilities. Authorization of service is not a guarantee of payment.

When a modifier code is available, providers must use those codes to denote use of flexibilities when requesting authorization. Base codes will be reviewed for medical necessity. All clinical documentation should be submitted with the request of a base code.

If a modifier code is not available and a flexibility has been granted, providers must document the flexibility and reason in the member’s note documentation. If you have additional questions regarding SAR submissions, please contact:

MH/SU Utilization Management Workgroup: 704-842-6436
I/DD Utilization Management Workgroup: 704-884-2605

NO PRIOR AUTHORIZATION

INITIAL Requests Only: Medical Necessity Review – REVISED

Concurrent/Reauthorization Only – Notification SAR (SAR only, no clinical documentation) – REVISED

Innovations Guidance Effective 7/1/2020:

Appendix K Waiver Flexibilities and FL modifier codes:

The FL ​modifier codes will be used when the provider is billing ​for services above the approved ISP using Appendix K flexibilities. The FL modifier codes are unmanaged (no SAR/authorization is required).

Reminder: if the member needs to use Appendix K flexibilities, submit the Appendix K Reporting form by email to the assigned Care Manager and innovationsexceptions@partnersbhm.org. The provider will follow the Appendix K reporting process and bill using the FL modifier codes.

Innovations ISP Updates created 7/1/2020 and beyond for non-COVID 19 related changes will be submitted to UM and reviewed for medical necessity.

Additional Provider Information Sessions

Partners is continuing to host Provider Information Sessions that are focused on provider input and brainstorming. To register for a session, click on the date and time listed below. You may submit your questions to questions@partnersbhm.org in advance; we also recommend that you review the FAQs from past information sessions.

Information Sessions will be held:

July 8, 2020, 1:30 p.m., Innovations and I/DD specific

Register in advance for this meeting. After registering, you will receive a confirmation email about joining the meeting:

https://partnersbhm.zoom.us/meeting/register/tJApdeGsqTIpG9xs0hP5iVqL_MlkCzz1VByS

July 23, 2020, 2 p.m., MHSU provider specific

Register in advance for this meeting. After registering, you will receive a confirmation email about joining the meeting:

https://partnersbhm.zoom.us/meeting/register/tJckce2pqjIoGN3WirW8gvnVYyCkP3NIkN3L

August 2020 Provider Council Meeting

There is no Provider Council meeting in July. Meetings will resume in August with a virtual format:

Friday, August 28, 2020, 9:30 a.m.

Register in advance for this meeting. After registering, you will receive a confirmation email containing information about joining the meeting:

https://partnersbhm.zoom.us/meeting/register/tJAofuyoqzkuE9NKeJ3E6adZGM4B44sV7mCt