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Provider Digest | Volume 104

Date: 12/06/23

Administration of Behavioral Health Services Transitions to Health Net & Wellcare By Health Net in January 2024

Beginning in January 2024, behavioral health services for Health Net Commercial members and Wellcare By Health Net Medicare members will no longer be administered by MHN, Health Net's behavioral health administrator. Instead, these services will be arranged by Health Net and Wellcare By Health Net. Members will not experience any changes to their behavioral health benefits as a result of this change. 

Certain functions, such as eligibility and benefit checks, claims submission, referrals, prior authorizations, provider portal and websites, and more may be affected. For more information, please visit our Behavioral Health Services Transition webpage.

Thank you for your partnership in helping our members stay healthy.

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Community Discussion About Fetanyl

Springfield’s Academy of Arts & Academics High School and Lane County Public Health are hosting a student, family, and community presentation on overdose risk and prevention. The discussion, led by Alexander LaVake, Overdose Prevention Coordinator with Lane County Public Health, is open to the public and will address topics including fetanyl, prevention, and Narcan. Questions are welcome!

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2024 Medicaid Behavioral Health Provider Directed Payment Attestation/Increase

Effective January 1, 2024, the Oregon Health Authority (OHA) is implementing the annual attestation process required for all BH providers for the four behavioral health directed payments (BHDPs) within the CCO contracts that further the goals and priorities of the Medicaid program. All Trillium Medicaid Behavioral Health/Substance Abuse providers who submitted OHA attestations in 2023 are required by OHA to resubmit 2024 attestations to CCOs in order to continue qualifying for certain BH Directed Payment rate tier increases.

For 2024, providers will want to review the criteria for each category again to confirm if they qualify for possible additional increases based on the four health directed payments:

  1. Tiered Uniform Rate Increase Directed Payment
  2. Co-Occurring Disorder Directed Payment
  3. CLSS Directed Payment
  4. Minimum Fee Schedule Directed Payment

To be eligible for a 2024 tier rate increase, OHA asks that Medicaid providers complete the "Primarily Medicaid Provider Attestation" found on their Behavioral Health Rate Increase webpage.

If you have any questions, please contact your assigned Health Plan Provider Relations Representative.

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Trillium Providers: Important Pharmacy Claims Processing Change, Effective January 1, 2024

We are pleased to announce that, effective January 1, 2024, Express Scripts® will begin processing pharmacy claims for our Trillium plan members.

Express Scripts is a pharmacy benefit management (PBM) company serving more than 100 million Americans. Express Scripts Pharmacy delivers specialized care that puts patients first through a smarter approach to pharmacy services.

Members have been notified in advance and will receive a new ID card with updated pharmacy information, so that they are prepared to begin having their prescriptions filled at participating network pharmacies when this change occurs. 

Providers can direct members to call the Member Services phone number listed on their ID card should they have questions about this change. 

Please contact your Provider Relations Representative with any additional questions.

Thank you for the care you provide to our members.

Express Scripts Transition FAQs

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Clinical Documentation Improvement (CDI) Webinars

Trillium, Health Net and Wellcare invite providers to attend upcoming CDI webinars on "2024 CMS Model and ICD-10 Updates." Each webinar includes an overview of Risk Adjustment (RA) and Hierarchical Condition Categories (HCCs). To register, please click on the Zoom link next to the webinar you would like to attend.

2024 CMS Model and ICD-10 Updates

Thank you for your partnership!

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