Provider Digest | Issue 50

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Depression screening updates, CBI and vaccination trainings + APL update  

Don’t forget! Register for our upcoming Child & Adolescent Vaccinations Lunch and Learn

The Alliance is hosting a virtual Child & Adolescent Vaccinations Lunch and Learn in collaboration with Merck & Co., Inc. We are excited to have Reena Gulati, MD, MPH from Merck & Co., Inc., who will present on building vaccine confidence and addressing vaccine hesitancy.

The event will take place Wednesday, July 10, 2024, from noon to 1p.m. Please register and find more information about the event on our provider event webpage.    

Incentive updates: Depression Screening for Adolescents and Adults

As announced at the CBI 2024 Workshop, the Care-Based Incentive (CBI) Screening for Depression and Follow-up Plan Measure changed to Depression Screening for Adolescents and Adults.   

This measure examines the percentage of members ages 12 years and older who are screened for clinical depression using an age-appropriate standardized tool.   

Crucial updates include:  

  • The measure now includes adolescents (members 12 years of age) and older. 
  • Depression screening tool results are a required field. If the field is left blank, the row will be rejected.  
  • The National Committee for Quality Assurance (NCQA) now requires Logical Observation Identifiers Names and Codes (LOINC) codes and results. These cannot be submitted through claims. LOINCs are designed for electronic exchange of clinical health information. They often contain a dash (-), which is not allowed in most claims systems. As such, LOINCs must be submitted through the Data Submission Tool (DST).   
  • The screening must be completed by Dec. 1. 

You can find relevant LOINC codes in the following locations:  

Please submit the appropriate LOINC code and result for the individual that received the depression screening. Entries submitted under a child’s member ID number will not be credited to the parent.   

For more information on the CBI program, see the CBI Technical Specifications. If you have any questions, please email us at [email protected].   

Thank you for partnering with us to increase screenings and improve use of Alliance behavioral health services!   

Watch the new Care-Based Incentive Introduction training!   

We have a new training available for providers and staff to learn about the Care-Based Incentive (CBI) Program, Provider Portal Reports and Data Submission Tool.   

The training provides:   

  • An introduction to CBI, including a program overview, payment timelines and payment structures.   
  • A high-level overview of programmatic measures, like the Care Coordination, Quality of Care and Fee-For-Service measures, among others.   
  • An overview of the Provider Portal Reports and how they relate to CBI.    
  • An overview of the Data Submission Tool and how providers can use it to submit data to the Alliance to receive HEDIS and CBI credit.  
  • Information about CBI Forensic visits.  

Please visit our CBI Resources webpage for more information about these tools and measures.   

If you have questions about the webinar, please reach out to your Provider Relations Representativeat 800-700-3874, ext. 5504.  

All Plan Letter (APL) update for Street Medicine

The Department of Health Care Services has made a coding update for street medicine providers who address the clinical and non-clinical needs of Medi-Cal members experiencing homelessness. This change is important to know, as it may impact how you provide services.

  • See DHCS APL 24-001: Street Medicine Provider: definitions and participation in managed care.  

Under this APL, street medicine providers should bill Place of Service (POS) code 27 (outreach site/street) to Medi-Cal Fee-For-Service (FFS) or MCPs when rendering services for street medicine as of Oct. 1, 2023.

For more information about this APL and others, you can visit our All Plan Letters webpage. You can also find related Alliance policies and procedures in the Alliance Provider Manual.