The Alliance is excited to announce an enhancement to the Data Submission Tool (DST) on the Alliance Provider Portal. Now, providers can use the DST to confirm completion of Initial Health Assessments (IHAs) to assist in compliance with the Care-Based Incentives (CBI) program. The Department of Health Care Services requires that providers conduct a comprehensive exam and complete an IHA for new members within 120 days of enrollment with the Alliance. The IHA must include an age-appropriate Staying Healthy Assessment (SHA) form.
The IHA must be sufficiently comprehensive to assess and diagnose acute and chronic conditions, including but not limited to:
- History of present illness
- Past medical history
- Social history
- Review of organ systems
- Diagnoses and plan of care
What can be submitted via the Data Submission Tool?
- CPT and ICD-10 codes showing an IHA was completed; or
- If two phone calls and one written attempt were made to schedule an IHA, and the provider site was unable to schedule the member, the provider may submit CPT and ICD-10 codes via the DST on the Alliance Provider Portal indicating the inability to schedule member. In this case, the following coding combination is required:
- Procedure code: 99499
- Modifier: KX
- ICD-10 Code: Z00.00
All three attempts to reach the member must be documented in the medical record, and will be subjected to random audits through medical record review. For more information, please reference the IHA Tip Sheet document on the CBI Resources page of the Alliance provider website at http://www.ccah-alliance.org/cbi-resources.html.
Deadline to submit data for Q4 2018
|Measurement Period||Submission Due Date|
|Jan. 1, 2018 – Dec. 31,2018||Feb. 28, 2019|
A Data Submission Tool Guide is available on the Alliance Provider Portal, which includes a list of accepted codes, step by step instructions, required information, and how to upload. An email confirmation will be sent within one business day after each data submission.
If you have questions regarding the DST, please contact a Provider Relations Representative at (800) 700-3874, ext. 5504 or email [email protected].