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Provider Digest | Issue 57

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Prepare for upcoming audits, fellowship opportunity + CBI workshop details

Prepare for 2024 IHA and EPSDT audits

Starting Oct. 1, 2024, the Alliance will begin conducting our Initial Health Appointment (IHA) and Early and Periodic Screening, Diagnostic and Treatment (EPSDT) medical record audits. We will begin contacting provider offices to request specific medical records.   

Best practices and requirements  

  • Include all the required documentation listed on the request.   
  • Return all medical records within 5-7 business days of the request via fax to 831-430-5685.  
  • Submit medical records for all services that were submitted on the claim.  

Medical records the Alliance will request  

  • Office visit notes for requested date of service.  
  • Screenings from any date of service. This might include:  
  • Lead screening and results (members 6 to 72 months).  
  • Developmental screenings.  
  • Depression and drug/alcohol screening (11 years and older).  
  • Prenatal depression and drug/alcohol screening.  
  • Maternal depression screening.   
  • Risk assessments.   
  • Social determinants of health (all ages).  
  • Adverse Childhood Experiences (ACE) (1-20 years of age).  
  • Cognitive screening IHA only (for members 65+ years without Medicare only).  
  • Documentation supporting use of dummy code.  
  • Documentation of referral follow up (EPSDT only).  

Questions?  

If you have any questions regarding the audits, please email us at [email protected].   

We thank you for your office’s time and cooperation in submitting the requested information!  

Apply for the Champion Provider Fellowship   

The University of California, San Francisco Division of General Internal Medicine and the California Department of Public Health are recruiting dentists and physicians to join a new cohort of the Champion Provider Fellowship.   

The Champion Provider Fellowship is a two-year program that teaches health care professionals skills and knowledge around preventing obesity, dental disease and chronic disease.   

Fellowship benefits  

  • Free CME/CDE-certified training.   
  • Technical assistance from UCSF faculty.   
  • Connections with local health departments.   
  • Networking with other health professionals.   

How to apply   

Applications open Oct. 1, 2024. For more information on the application process or to apply, visit the Champion Provider Fellowship website.  

 

Join us for the 2025 Care-Based Incentive workshop!     

We are hosting our annual Care-Based Incentive (CBI) workshop on Oct. 30. The CBI program consists of provider incentives that are paid to qualifying contracted provider sites.   

We will present:  

  • An overview of the CBI program and payment structures.  
  • A description of 2025 measure changes, retired measures and new measures.  
  • Resources such as the Data Submission Tool (DST) and grant opportunities. 

Details and registration  

When: Wednesday, Oct. 30, 2024 from noon to 1:30 p.m.  

Where: Online via Microsoft Teams.   

To register, sign up online or contact a Provider Relations Representative at 800-700-3874, ext. 5504.