To assist providers as we work to address the COVID-19 crisis, we will regularly send answers to questions you submit. To submit a question to Eastpointe, please click here.

  1. Question: What is the final decision on what codes we are to use to bill. I received an e-mail from, I believe it was DHHS, stating we are supposed to use 98968CR. The CR indicates a crisis. My UM representative stated she thought we were supposed to use the GT if we are using audio and visual (I am) but it was not certain if we use the usual CPT plus the GT or the CR modifiers. I have received so many emails from different organizations that it is difficult to keep up with the changes.
    Answer: Telephonic Assessment and Management codes 98966, 98967 and 98968 should be submitted with the CR modifier only. (See Special Bulletin #34.)
    The GT modifier should only be used for services approved for provision using telehealth modalities (two-way, real time audio/visual).

 

  1. Question: Do Qualified Professionals still have to complete monthly face to face observation/supervision with workers and their consumers or because of the COVID-19 pandemic the face to face requirements are waived, worker and consumer can be assessed/monitored telephonically in accordance with HIPAA guidelines?
    Answer: Yes, face to face has been waived. Please review this document.

 

  1. Question: Can Psychosocial Rehabilitation, Substance Abuse Intensive Outpatient Program (SAIOP), and Substance Abuse Comprehensive Outpatient Program (SACOT) be provided via telehealth?
    Answer: We are continuing to work with DHHS for guidance on this. If providers have any recommendations, please send them to networkoperations@eastpointe.net.
    NC Medicaid has published, in Special Bulletin #20, enhanced services that can be provided remotely via telehealth modalities. Those services include IIH, MST, Mobile Crisis, ACTT, CST and PSS.

 

  1. Question: Good afternoon. I had some follow up questions based on your bulletins. Can you please assist.
    1. Will claims already submitted for processing with dates of service 3/10/20 through current be readjudicated by Eastpointe with the rate increases or do providers need to resubmit these claims at the temporary higher rates?
    2. Family Centered Treatment (FCT) with bill codes H2022 22 HE and H2022 P2 22 are not listed as having a temporary rate increase. Can you please confirm these services are included in the rate increase.
    3. Residential service Fostering Solutions for IDD (TFC Option) with bill code S5145 TF is not currently listed as having a temporary rate increase. Can you please advise.

 

Answer:

  1. Replacement claims will have to be submitted for claims already paid at the lower rate. Eastpointe will not be able to re-adjudicate claims billed at the lower rate.
  2. FCT is an Enhanced Service and is included in the Eastpointe’s 20% rate increase for Enhanced Services.
  3. S5145:TF is included in Eastpointe’s 15% rate increase for Residential Services.

 

  1. Question: I am inquiring if plans can be amended for RHA Health Services to be the Provider for RHA Health Services’ individuals who were attending another Day Program for the next 45 days.
    Answer: Yes, providers will need to work with care coordinators regarding revisions. Eastpointe is working on an internal process for tracking changes. Please make sure to maintain information regarding the change in order to complete a tracking spreadsheet we will publish in the coming days.

 

  1. Question: Hello, have the modifier codes been given out so that agencies may bill at the increased rate? If they have, could you please instruct me on where to find them. Thank you!
    Answer: There is no specific modifier requirement to receive the rate increases listed in Update #10. However, if you are submitting claims for one of the services for which we have increased rates, and that has been approved by NC Medicaid for telehealth, you will need to use the GT and CR modifiers as required in Special Bulletin #35. Those services include ACTT, CST, PSS, IIH, and MST.
    If you have already submitted and received payment for dates of service 3/10/20 and later, you will need to submit replacement claims with at least the increased rate as the billed amount. New claims should be submitted with the usual code with a billed amount of at least the increased rate.
    Our Contracts Department has posted a COVID-related rate sheet on our website above the normal rate sheet. It will be updated as additional services/rates are added.

 

  1. Question: Where is the Innovations waiver retainer payment form? Thank you.
    Answer: Eastpointe is awaiting guidance from the Division of Health Benefits. More information will be forthcoming.

 

  1. Question: For clarity Eastpointe wants providers to submit CPT codes (99201-99215, 90791, 90832-90853) with a GT and a CR modifier if done via telemedicine/telepsychiatry?
    Answer: Special Bulletin #34 requires submission of both modifiers when the codes you listed are provided using telehealth modalities. GT should be first: GTCR.

 

  1. Question: Good afternoon, I am requesting that our 2 opioid treatment programs in your network, the Lumberton Treatment Center and the Rocky Mount Treatment Center, be able to be reimbursed for H0020 take-home medication during the COVID-19 crisis. Eastpointe partners with us to treat patients using both Medicaid Insurance and State Funds. We will continue being open to serve patients 7 days per week but have been asked to reduce the numbers of patients in our facilities in order to prevent the spread of COVID-19. We have guidance from SAMHSA, SOTA and our Medical Director that our stable patients may benefit from 28-day take-home medication (or less on a case by case basis) and our less stable patients may benefit from 14 days take-home medication (or less on a case by case basis). We have been informed that we should prepare for disruptions to our normal services for up to 20 weeks. Under these circumstances we are requesting Eastpointe’s guidance and support on how to proceed.
    Answer:  Please review this document.

 

  1. Question: Here is what I mean. There are codes that support time frames for the service. For example:

A code for 5-10 minutes

A code for 11-20 minutes

A code for 21-30 minutes

If a provider or therapist sees someone for 45 or 55 minutes would they be able to use the code for 21-30 minutes and then “stack” another code to get to the 45 or 55 minutes? OR Would we just be reimbursed for 30 minutes even though the service and the documentation was for 45 or 55 minutes?
Answer: Thanks for clarifying. Yes, the new telephonic and management codes 98966 (5-10 min), 98967 (11-20 min) and 98968 (21-30 min) may be stacked.   however these codes are not used to provide therapy. Psychotherapy codes should be billed per usual times.

 

 

  1. Question: What is the process for the authorizations? If the client are out of units, do we still need to submit an authorization? Thank you so much!
    Answer: Please see this document for Service Authorizations.

 

  1. Question: Since we are going through the COVID-19, what is the measure regarding the authorizations? Will they be waived? Do we still need to request for units? What is the process? Thank you so much.
    Answer: Please see this document for Service Authorizations.

 

  1. Question: We received the Memorandum regarding reimbursement for take homes for East Pointe members. Does this include State Funded (IPRS) members for take home reimbursement? Thank you!
    Answer: Yes, this includes state-funded members, to the extent that state funding is available.

 

 

Reminder: COVID-19 Questions

Many providers have been asking us their COVID-19-related questions. Please keep the questions coming! You can use our COVID-19 Question Submission Form any time to submit yours. We will review and respond to all questions in a Question and Answer document.

 

General Questions and Feedback

For questions related to this memo, please contact your agency-assigned Provider Relations Account Representative (PRAR). If you do not know the PRAR assigned to your agency, please contact Network Operations at (888) 977-2160 or networkoperations@eastpointe.net.

 

As always, thank you to all our providers who continue to work diligently during this crisis to deliver the best possible care for our members. We appreciate all of your valiant efforts.

  1. Question: I wanted to reach out and ask if there will there be any changes to the authorization submission process? A current MCO has indicated that for the next 30 days initial or concurrent authorizations will not need to be submitted, that essentially all auths are automatically approved until April 30. Are there any indications Eastpointe will be doing that?
    Answer: Please reference the COVID-19 Provider Update #10 COVID Reimbursement to review our updated Service Authorization Request policy.

 

  1. Question: Are providers still required to submit a SAR when the 16 unmanaged visits have been exhausted? Is a SAR still required for patients who need reauthorization, who are in enhanced services? SAIOP/SACOT/Day Treatment
    Answer: Please reference the COVID-19 Provider Update #10 COVID Reimbursement to review our updated Service Authorization Request policy. 

 

  1. Question: Are we able to get an extension on the re-credentialing process due to the current issues? Our 90 days will be next Monday or Tuesday.
    Answer: We are currently reviewing this issue. We will issue additional guidance shortly.

 

  1. Question: We have a lot of consumers who are homeless. Can we be reimbursed for providing a place for them to stay and meals during the crisis
    Answer: To date, we have not been advised of special billing allowances outside of our service array.

 

  1. Question: Recently you put out a memo on March 23, 2020, regarding plan signatures. It was addressed as Care Plans. Does that include Person Centered Plans?
    Answer: Yes, that includes Person Centered Plans.

 

  1. Question: Has the provider funding plan been finalized? If not, when do you anticipate this will be finalized and shared with providers?
    Answer: Please reference the COVID-19 Provider Update #10 COVID Reimbursement for our plan.

 

  1. Question: Can we or can we not use virtual/telehealth services to delivery face to face to our IIH consumers due to the social distancing rule?
    Answer: Eastpointe has approved Intensive In Home to be billed for services provided under the social distancing mandate via video or telephonic presence. See this memo for additional details.

 

  1. Question: Is there a simple version or number members can call if they think they have symptoms of COVID-19? Provider is concerned that the current method in place is too complicated for members with a developmental delay.
    Answer: All North Carolinians can call 211 or 888-892-1162 for assistance with COVID-19 issues.

 

  1. Question: Given the stay at home order issued by Governor Roy Cooper for the state of North Carolina to go into effect on Monday March 30th, would my agency be considered an essential provider agency to remain open as it relates to all services to include outpatient, community services, enhanced services and office staff?
    Answer: All behavioral health providers are considered essential.

10. Question: Will there be rate increases for PRTF’s to help cover the extra cost to provide services during the COVID-19 crisis?
Answer: Yes, please see the COVID-19 Provider Update #10 COVID Reimbursement document.

Answer: Please reference the COVID-19 Provider Update #10 COVID Reimbursement to review our updated Service Authorization Request policy.

 

  1. Question 13: Can you tell me if SARs are necessary for members that have reached their unmanaged visit limit or has that been waived due to COVID19?
    Answer: Please reference the COVID-19 Provider Update #10 COVID Reimbursement to review our updated Service Authorization Request policy.

 

  1. Question: Does Eastpointe have a plan to help Providers with Authorizations since there may be potential issues with meeting with families and stakeholder to obtain signatures on documents?
    Answer: Please reference the COVID-19 Provider Update #10 COVID Reimbursement to review our updated Service Authorization Request policy.

 

  1. Question: Does Eastpointe have a plan in place to extend current authorizations in place for services without requiring additional paperwork. Alliance is extending their authorizations for 30 days with no additional requirements.
    Answer: Please reference the COVID-19 Provider Update #10 COVID Reimbursement to review our updated Service Authorization Request policy.

 

  1. Question: For OPT Services. With the addition of the ability to use telehealth services is Eastpointe wanting providers to use the regular OPT codes if we don’t have the GT modifier in our contract?
    Answer: Codes with the GT modifier have been added to provider contracts for use according to the telehealth modifications/guidelines published in DHHS’s Special Medicaid Bulletins. Regular codes should not be used for services provided using telehealth modalities, according to CCP 1H and the published modifications.

 

  1. Question: Can our QPs use the temporary codes for the telephone assessment to reach out to clients to check on them while they are unable to receive services? The agency clearinghouse is questioning if the codes can be used for non-licensed professionals. We have been making phone contact to verify clients are stable and well.
    Answer: Non-licensed staff are not listed as providers of the telephonic assessment codes 98966, 98967 and 98968 according to Special Medicaid Bulletin COVID-19 #2.

 

  1. Question: Are Providers under the same 5:00pm curfew as the general public?
    Answer: There is not a curfew for all of North Carolina. Providers would need to follow the rules for any local curfews established by any county or municipal governments.

 

  1. Question: Is there a reason that there was not a temporary rate increase for providers that are providing other services and supports? Innovations Waiver services such as SE, Community Living and Supports, Respite just to name a few?
    Answer: Appendix K addresses Innovations services and rates. We will be issuing a memo with more Appendix K guidance soon.

 

  1. Question: We are seeking direction on how services should be provided to our clients as more restrictions are being put in place. How should we provide IIH and Day Treatment services?
    Answer: See this memo for additional details.

 

  1. Question: If we’re able to provide enhanced services via telephone or video, is that minimum time-frame. Who do we bill for the codes? For IIH, can more than 12 team member make contact on the same day?
    Answer:
    Please reference the COVID-19 Provider Update #10 COVID Reimbursement.

 

  1. Question: In lay terms, please explain how EPSDT can be used for children authorized for IIH and Day Treatment during the COVID-19 pandemic?
    Answer: Please review our EPSDT memo.

21. Question: Any update as to how Eastpointe wants us to provide group services like PSR and SAIOP while practicing social distancing? Are they looking at allowing us to prove an alternative service with our PSR members?
Answer: Initial guidance has been provided in DHHS Special Bulletin #20. Eastpointe is continuing to review Substance Services and more information is forthcoming.

 

  1. Question: Will ALL children fall under EPSDT as the COVID-19 (state of emergency) is an extenuating circumstance that makes the children more vulnerable during this time? 2. If EPSDT was NOT select when the prior approval authorization request was submitted, does that disqualify that child from being serviced under the COVID-19 EPSDT service guidance referenced on the memo dated March 25, 2020?
    Answer: All children under Medicaid are reviewed under EPSDT. EPSDT does not typically apply to Medicaid B Services. The provider normally checks the box if asking for additional units or something that may be different than the service definition. The UM Care Manager will approve under EPSDT if warranted. The box must be checked to override the normal set up in the electronic system.
  1. Question: Thank you again for your timely updates. I was wondering as I did notice that DHHS has stated for providers to use place of service as 02 (Telehealth). Is this the place of services Eastpointe would like providers to use if telehealth is delivered? Thank you in advance for your assistance.
    Answer:
    Yes, POS 2 should be used for services provided that meet the telehealth guidelines and modifications issued by NC Medicaid.

 

  1. Question: I was wondering if you will be adjusting enhanced services claims sent over from 3/10/20. Or, will you need us to submit replacement claims with the new rate increase?
    Answer: Replacement claims will need to be submitted for claims submitted with a billed amount lower than the new rates. Please ensure any new claims are submitted with a billed amount at least equal to the new rates.

 

  1. Question: Can you tell me which codes my clinicians should be using to provide therapy over the phone or video? I am asking because there are codes for “Clinical”, “Counselor”, “Mental Health” and “Community/Mental Health Agency” on the attached list.

Can you clarify when a non-clinical person, ie Qualified Professional, can use any of the codes listed?
Answer: Therapy provided via telehealth modalities has been extended to include Licensed Associates in addition to LCMHC, LP, LCSW, LMFT, LCAS and a Physician (Special Bulletin #19). There has been no indication of staff in addition to these being able to provide the services.

 

  1. Question: Can our QPs use the temporary codes for the telephone assessment to reach out to clients to check on them while they are unable to receive services? The agency clearinghouse is questioning if the codes can be used for non-licensed professionals. We have been making phone contact to verify clients are stable and well.
    Answer:
    Non-licensed professionals are not listed as providers for the telephonic assessment codes 98966, 98967 and 98968 according to Special Medicaid Bulletin COVID-19 #2. A list of the providers can be found in the Bulletin.

 

  1. Question: Concerning “Telephonic Billing,” when can we submit claims in the Alpha?
    Answer: The telephonic codes can be billed to Eastpointe at this time.

 

Thank you to all of our providers who continue to work diligently during this crisis to deliver the best possible care for our members. We appreciate all of your valiant efforts.

  1. Question: I thought I read a memo that we are to bill in NC Tracks until Alpha is able to process the billing. I want to be sure because we are getting a lot of information and it is easy to get things mixed up.
    Answer: Eastpointe’s providers must submit claims to Eastpointe. Further guidance is forthcoming.

 

  1. Question: I am wanting to know if we need to use the codes sent to us for TeleHealth or can we use or regular codes? Also do I need to bill with the CR modifier?

CPT codes sent to us:

98966

98967

98968

Our regular CPT codes:

90791

90834

90837

90846

90847
Answer: CR should only be added to the new codes published for telephonic sessions. These codes and descriptions can be found at the following link:

Special Bulleting COVID 19 #9 Telehealth Provisions – Clinical Policy Modification. Previously used telemedicine and telepsychiatry codes listed in Clinical Coverage Policy 1H should still be used with the GT modifier.

 

  1. Question: I deeply apologize but I have attended several seminars by DHHS and sent my question into Q&A but it was not answered. I read a policy that we cannot have new clients (their information constantly changes) but there is a code for assessments. It was shown that 90791 was changed to another code. Assessments are indicative of a new client. We execute the assessment then begin routine sessions. I know you are busy, and I apologize but I have three people waiting to become my clients since last week.
    Answer: The Division has reported face to face remains the optimal service delivery method and, in this case, 90791 would still be used. It was stressed telephonic and virtual service delivery were to be used if face to face could not be done, per CDC-recommended guidelines. The telephonic assessment codes and descriptions may be found in Special Medicaid Bulletin #2. The codes should be used with the CR modifier. Telehealth codes may also be used.  For example, use 90791GT for assessments done using audio visual modalities.

 

  1. Question: I forgot to add this to my previous question. I apologize. If I understand correctly, we cannot see new clients but can only see current clients for 30 minutes. This causes us to lose money and no way to compensate for the reduction since we cannot add to our caseloads. Please let me know if I am misunderstanding.
    Answer: Referrals for new members can be accepted.

 

  1. Question: I am reaching out in regards to service guidance in response to the COVID-19 virus that supports flexibility in service delivery that protects both the public while ensuring our most vulnerable citizens receiving their enhanced services. Has Eastpointe for adopted enhanced services (i.e. intensive in home, day treatment, etc.) social distancing service delivery through video or telephonic presence as a way to honor social distancing while continuing to provide continuity of care. Thank you in advance for your assistance.
    Answer:  The Division has intensive in-home under consideration for telephonic/virtual service delivery when face to face cannot be completed. They continue to stress the optimal and preferred response is face to face and telephonic/virtual should be used as a last resort for these enhanced services.

Unfortunately, at this time, the Division has not provided clarity on Day Treatment. We are working internally to strategize on solutions and will have an update soon.

 

  1. Question: 1. What services are in place to assist SAIOP, SACOT & Psychosocial Rehabilitation? 2. Can we continue to take new consumers? 3. Are you accepting proposals for “In Lieu of Services”? The proposal would include alternatives to the present services consumers are authorized for and how it would be beneficial to the consumer and the agency?
    Answer: 
  1. 1. Unfortunately all of these things are still being worked on by the Division. Dr. Brown they were still thinking through options for PSR and SU Services. We are hopeful to have additional guidance soon.
  2. Providers can continue to accept new members.
  3. If a provider has a suggestion during this most difficult time that will assist us with ensuring no disruption of services, we would welcome the feedback.

 

  1. Question: How are providers expected to deliver enhanced services such as ACTT, IPS, CST, etc at this time? There has been information available for medical services as well as outpatient BH services, but I have not seen any information about enhanced BH services. Can you provide some information regarding service provision, virtual service provision, as well as billing information for enhanced services and how these things will be affected by Covid-19? Also, for staff such as ACTT nurses who are not able to do their jobs while maintaining appropriate physical distance, is Eastpointe doing anything to source PPE to protect such direct care staff?
    Answer: At this time ACTT and CST are “under consideration” for use of telephonic and virtual service provision as a result of COVID-19. We are hopeful the Division will provide final approval on this soon. The Division has already reported face to face remains the optimal service delivery method, after proper screening, per CDC-recommended guidelines. It stressed telephonic and virtual service delivery as a last resort option.

At this time, we do not have access to PPE however we are aggressively pursuing options/resources.

 

  1. Question Good Afternoon! I just attended the “North Carolina Department of Health & Human Services: COVID-19 Provider Call”. I didn’t see Day Treatment services listed. Could someone please give me clarification.
    Answer: Day treatment services were not listed. Dr. Brown reported they are still working on Day Treatment and PSR.  Eastpointe is strategizing internally on these services and we hope to receive additional guidance soon.

 

  1. Question: Concerning “Telephonic Billing,” when can we submit claims in the Alpha?”

Answer: The telephonic codes can be billed to Eastpointe at this time.

 

  1. Question: What is Eastpointe’s stance on providing child/adolescent day treatment services via HIPPA compliant telepsych app/portal in the event government imposes mandated confinement?
    Answer: Eastpointe is strategizing internally on this service and we hope to receive additional guidance soon.

 

 

As always, thank you to all of our providers who continue to work diligently during this crisis to deliver the best possible care for our members. We appreciate all of your valiant efforts.

  1. Question: Is Eastpointe accelerating the credentialing time for practitioners currently in the credentialing process?
    Answer: We are seeking guidance from DHHS about this process. As soon as we receive any information, we will follow up with you.

 

  1. Question: I am confused by the codes. The site code for telephonic Contacts is 2. There isn’t a 2 in the drop-down box in Alpha. We are an outpatient therapy provider. Can we still bill 90832, 90837, 90834 etc. with the CR modifier if we make Phone contact with the consumer?
    Answer: 90832, 90837 and 90834 are not services that can be provided telephonically. However, these codes can be provided using telehealth modalities according to CCP 1H and the modifications to the policy as listed in DHHS Special Bulletin COV-19 #9. If provided using these modalities, the GT modifier should be used with them. POS 2 is not a valid option for these codes.

Providers can bill for allowed services as described in this Medicaid Bulletin beginning March 23, 2020, for dates of service on or after March 10, 2020. NC Medicaid will continue to release telehealth policy provisions and will continue to evaluate this policy throughout the state of emergency period.
There are three telehealth modalities referenced within this policy bulletin, defined as:

  • Telemedicine: Telemedicine is the use of two-way, real-time interactive audio and video to provide and support health care when participants are in different physical locations.
  • Telepsychiatry: Telepsychiatry is the use of two-way, real–time interactive audio and video to provide and support psychiatric care when participants are in different physical locations.
  • Virtual Patient Communication: Virtual Patient Communication is the use of technologies other than video to enable remote evaluation and consultation support between a provider and a patient or a provider and another provider. Covered virtual patient communication services include telephone conversations (audio only); virtual portal communications (e.g., secure messaging); and store and forward (e.g., transfer of data from beneficiary using a camera or similar device that records (stores) an image that is sent by telecommunication to another site for consultation).

Here is some additional detail on the provision of telemedicine and telepsychiatry services:

Coverage and Payment Parity: Consistent with its existing policy, telemedicine and telepsychiatry have coverage and payment parity with in-person care. Medicaid and NC Health Choice will continue to cover and reimburse all telemedicine interactions at a rate that is equal to in-person care as long as they meet the standard of care and are conducted over a secure HIPAA-compliant technology with live audio and video capabilities.

The following are policy modifications related to telemedicine and telepsychiatry:

  • Eligible Technologies
    • NC Medicaid has eliminated the restriction that telemedicine and telepsychiatry services cannot be conducted via “video cell phone interactions.” These services can now be delivered via any HIPAA-compliant, secure technology with audio and video capabilities, including (but not limited to) smart phones, tablets and computers.
      • In addition, the Office of Civil Rights (OCR) at Health and Human Services (HHS) recently issued guidance noting that “covered health care providers may use popular applications that allow for video chats, including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype, to provide telehealth without risk that OCR might seek to impose a penalty for noncompliance with the HIPAA Rules related to the good faith provision of telehealth during the COVID-19 nationwide public health emergency.”
    • Service Sites
      • Originating Site: There are no restrictions on originating sites (formerly known as spoke sites). Originating sites may include health care facilities, school-based health centers, community sites, the home or wherever the patient may be located.
      • Distant Site: There are no restrictions on distant sites (formerly known as hub sites). Distant sites may be wherever the provider may be located. Providers must ensure that patient privacy is protected (e.g., taking calls from private, secure spaces; using headsets).

 

  1. Question: Are we able to get verbal consents for treatment or release of information during this time and follow the same instructions as with the care plan signatures?
    Answer: Yes, please see this memo that went out on Listserv dated March 23, 2020 Re: COVID-19 Provider Update #3 Care Plan Signatures.

 

  1. Question: When performing teletherapy, now are we to just use the regular cpt codes (90834, 90832, 90847 for example) and change the place of service code to O2?
    Answer: 90832, 90834 and 90847 are not services that can be provided telephonically.  See answer provided for question #2 above.
  1. Question: We wanted to clarify the below statement in the last communication bulletin

“Eastpointe will accept a qualified professional/para-professional or clinician signature in place of the member or legally responsible person’s (LRP) signature, along with a notation that the member/LRP gave consent for the provider representative to sign the document on his or her behalf.”

Are staff to put their own names in the place of the patient’s name, on the patient’s line, and then indicate how consent was given? Or are staff writing the patient’s name on the patient’s line, and then indicating that they had consent to write it? Any clarification would be appreciated.  Thanks.
Answer: Staff should put their own names in place of the patient’s name, along with the notation that the patient/LPR gave consent for the provider representative to sign the document on his or her behalf. The provider should document whether the consent was made via telephone, email or other means.

 

As always, thank you to all of our providers who continue to work diligently during this crisis to deliver the best possible care for our members. We appreciate all of your valiant efforts.

  1. Question: What is the process Eastpointe wants implemented when: 1) Parents request no services for several days due to COVID-19 (Innovations primarily); 
    Answer: If a parent requests to cease services due to COVID-19, the parent should notify the care coordinator and provider. While not yet approved by CMS, Appendix K does speak to the absence of services.

 

  1. Question: If a Provider decides to stop certain services again due to COVID-19, how frequently would reports to Eastpointe be expected? Daily or can we designate a time period?
    Answer: Please use the Temporary Impact to Service Delivery Form (TISD). As we continue to experience the impact of COVID-19, Eastpointe recognizes that there may be an impact to service delivery. In the event your agency’s ability to provide services is affected, please complete TISD Form. It is imperative that Eastpointe is made aware of these situations in order to support our providers and help ensure our members receive the best possible care.

 

  1. Question: Is Eastpointe accelerating the credentialing time for practitioners currently in the credentialing process?
     Answer: Eastpointe is processing credentialing applications as quickly as possible following requirements for URAC and NCQA. Effective March 16, 2020, Eastpointe will no longer accept licensed practitioner applications for credentialing or recredentialing. Only applications submitted to the Council for Affordable Quality Healthcare (CAQH) will be accepted. Utilizing the CAQH should speed the application process. Practitioner applications will need to be submitted to the following link: http://proview.caqh.org/pr.

If you need technical assistance with the application process with CAQH their Help Desk number is 1-888-600-9802.

 

  1. Question: In response to the national emergency is Eastpointe modifying policies related to the credentialing and enrollment of non-psych certified NPs?
     Answer: At this time, we have not received any guidance related to changes in the requirements for non-psych certified NPs. They must have three years of supervised prescribing experience under the supervision of a psychiatrist. If we receive any updates, we will share those with our network.

 

  1. Question: As a large portion of my clinicians are working from home now, due to technological restrictions, many of them do not have the ability to print, sign and return credentialing documents. Will you be allowing digital signatures during the current crisis?
    Answer: Yes, we can accept digital signatures.

 

  1. Question: Can I bill Eastpointe for seeing members on a webcam/HIPPA compliant platform?
     Answer: Yes. Providers can bill for allowed services as described in this Medicaid Bulletin beginning March 23, 2020, for dates of service on or after March 10, 2020. NC Medicaid will continue to release telehealth policy provisions and will continue to evaluate this policy throughout the state of emergency period. There are three telehealth modalities referenced within this policy bulletin, defined as:
  • Telemedicine: Telemedicine is the use of two-way, real-time interactive audio and video to provide and support health care when participants are in different physical locations.
  • Telepsychiatry: Telepsychiatry is the use of two-way, real–time interactive audio and video to provide and support psychiatric care when participants are in different physical locations.
  • Virtual Patient Communication: Virtual Patient Communication is the use of technologies other than video to enable remote evaluation and consultation support between a provider and a patient or a provider and another provider. Covered virtual patient communication services include telephone conversations (audio only); virtual portal communications (e.g. secure messaging); and store and forward (e.g. transfer of data from beneficiary using a camera or similar device that records (stores) an image that is sent by telecommunication to another site for consultation).

Please also refer to the link below; Special Medicaid Bulletin posted Friday regarding telehealth modifications to Clinical Policy 1H. Special Bulleting COVID-19 #9 Telehealth Provisions Clinical Policy Modification

https://medicaid.ncdhhs.gov/blog/2020/03/20/special-bulletin-covid-19-9-telehealth-provisions-clinical-policy-modification

 

  1. Question: Does Eastpointe have any long-term contingency plan as far as financial reimbursement to agencies? Without funding during a period of shutdown it could prove to be financially disastrous for agencies.
    Answer: Eastpointe is continuing to operate and is working with our providers so that they can continue to operate using telehealth and telephonic codes.

 

  1. Question: “We’ve gotten delayed and varied information about telephonic vs. teleconference sessions with our clients and coding. We have been told to just add CR to our normal billing code by your rep then that was changed.
    Answer: CR should only be added to the new codes published for Telephonic sessions.  These codes and descriptions can be found at the following link:

Special Bulleting COVID 19 #9 Telehealth Provisions – Clinical Policy Modification. Previously used telemedicine and telepsychiatry codes listed in Clinical Coverage Policy 1H should still be used with the GT modifier.

 

  1. Question: Are we limited to a max of 21-30 min. on a telephonic session?
     Answer:  Anything over 30 minutes would still be billed to the appropriate 21-30-minute code.

 

  1. Question: Are there different codes to use if we do an audio/visual on-line session using Zoom, etc.?
    Answer: Audio/visual sessions should be billed using the appropriate telemedicine or telepsychiatry code.

 

  1. Question: Are the rates for telephonic AND Zoom meetings identical or different?
     Answer: The rates are different. Rates for telephonic codes can be found at the link below. Rates for telemedicine or telepsychiatry codes would be the same as they have always been. Modifications to Clinical Coverage Policy 1H can be found at the link below.

 

  1. Question: With regard to your 3/23/20 memo about care plan signature requirements, I would like to clarify these two sentences:

“Always try and obtain express consent for disclosure of any substance use information. Member/LRP consent or approval should be clearly documented in the service note.”

Does the QP/Para/clinician signature apply to patient written consents for releasing information or records and not only to care plans? In other words, provider agency staff completes (with patient’s cooperation) consent form for patient so agency can release certain records to a certain party or individual for certain purposes, and patient provides verbal consent over the phone. The agency employee obtaining patient’s consent documents on the consent form that it was given over the phone. Of course, this will apply not only to substance use information but also to mental health information. I would appreciate your response. Thank you.
 Answer: Yes, this may also be used for a consent to release information.

 

  1. Question: Why are the rates for telephonic code significantly lower and we are allowed to bill the regular rates with other health plans such as BCBS?
    Answer: Eastpointe is following the published DHB rate schedule.

 

  1. Question: What do we do when we need a client’s signature?
    Answer: A memo was sent out March 23, RE: COVID-19 Provider Update #3: Care Plan Signatures. This memo confirms that Eastpointe will accept a qualified professional/para-professional or clinician signature in place of the member or legally responsible person’s (LRP) signature, along with a notation that the member/LRP gave consent for the provider representative to sign the document on his or her behalf.

The provider should document whether such consent was made via telephone, email or other means (e.g. through a window). Any provider relying upon email consent should follow up via telephone communication with the member/LRP to secure verbal consent if possible.

To verify you are speaking with the member/LRP, best practice is to ask for another identifier (besides name and date of birth), such as a Social Security number or Medicaid number. Always try and obtain express consent for disclosure of any substance use information. Member/LRP consent or approval should be clearly documented in the service note.

 

As always, thank you to all of our providers who continue to work diligently during this crisis to deliver the best possible care for our members. We appreciate all of your valiant efforts.