Important Optum Health Plan Update - April 2019

• AllWays Health Partners transition to Optum. The transition to Optum for AllWays (formerly Neighborhood Health Plan) occurred on January 1, 2019. AllWays includes the Partners ASO Plan (a plan for Partners employees and their dependents), as well as other plans. It's important to note that the rates, coverage, and pre-authorization requirements for the Partners ASO plan (see below) is different from other AllWays plans, which follow the usual Optum requirements. Providers are encouraged to refer to the AllWays Provider Resource page for additional information.

• For Partners ASO plans. This specific plan within AllWays Health Partners does not have any pre-authorization requirements or coverage caps for any services, including 60-minute psychotherapy sessions (90837) and any psychological or neuropsychological assessments. AllWays Health Partners is testing out an approach where they trust providers to use the services that are necessary and are in compliance with medical necessity criteria without undue oversight. Their hope is that it will reduce administration costs and barriers to access, as well as decrease medical spending through improved health outcomes. They will review the numbers annually but recognize that there will likely be a delay in seeing improved health outcomes so it is not expected that this will change next year unless expenditures significantly exceed highest estimates. There is also different rate for Partners ASO clients (see below).

• For new Optum providers. For providers who want to join the Optum network or who have joined in the last few months, there is an option to join the full Optum network or to join for the Partners ASO plan only. While the Partners plan is paying a higher reimbursement rate, we are told that the difference is small. You can request a fee schedule for the Partners network through the AllWays Health Partners website. You can also go to Optum's website to learn more about joining the full Optum network. New providers can also track the status of their application and credentialing online or call Provider Services at 877-614-0484.

• For existing Optum providers who are seeing Partners ASO patients. Providers who were in-network with Optum prior to their collaboration with AllWays Health Partners can request the increased Partners rate for their Partners ASO patients. Fill out the request form and email it to provider.services@optum.com. Optum network managers will review the request and respond within 15 business days.

• Transition of care for AllWays Health Partners. For providers who are following AllWays clients but who are choosing not to join Optum or the Partners ASO-only network, there is coverage for continuity of care at the in-network rate: Partners ASO is covering up to 6 months of ongoing care, and all other AllWays plans are covering up to 3 months of ongoing care. If you want to continue beyond those time frames, you can request a single case agreement (SCA).

• Important note for out-of-network providers with Partners ASO clients: Your clients must complete a Continuity of Care form and submit it to Partners. If a claim is rejected for not having this form, ask your client to submit it and then request that the claim be processed again.

• AllWays Health Partner member numbers. There was an issue in exporting the AllWays member identification numbers into the Optum system because Optum's system cannot accommodate AllWays 10-digit member number. Until this is resolved, providers can find member information by using the member's name and DOB, or the member's social security number.

• Billing and claims information. For claims with AllWays Health Partner members, providers should use the AllWays member number on your client's ID card. Optum's Claims Tips page includes a number of additional resources on billing and claim submission.

• Authorizations for 90837. Authorization for extended sessions is not required when the following conditions are met: the provider is in-network and the client is covered under a commercial or Medicare plan. All other situations will require authorization in advance.

• Coverage of 90837. For commercial or Medicare plans, providers must follow the Extended Outpatient Psychotherapy Policy when billing for 90837. It outlines the medical necessity criteria regarding which situations and diagnoses are covered.

• Testing code changes. See the Psychological and Neuropsychological Testing Guidelines for information on medical necessity and best practices.

• Testing code changes: Authorizations. An updated Psychological and Neuropsychological Assessment Supplemental Form is available. Note that there is a separate Optum Psych Testing Request on their website that is designed to be an electronic version of the Mass Collaborative form, but providers don't have to use it. There is no specific cap to the number of units that can be requested. Currently, providers must choose between requesting psychological or neuropsychological assessments instead of requesting both. We will continue to work on changing this policy.

• Testing code changes: Billing. Providers should submit all dates of service on one claim. However, their timely filing deadline is 90 days from the first date of services. If it appears that the process will exceed that time (ex. the feedback session is delayed), providers should submit all the claims they have at that time and submit any additional claims at a later date.

• Online resources. Providers can access the Optum Provider Express webpage for additional resources.

• Telehealth. Optum's telemedicine platform is now called Virtual Visits. You can find more information about their platform, resources, and training opportunities on their Telemental Health page. As a reminder, all Optum commercial and MassHealth plans cover teletherapy but providers must sign an attestation before offering telehealth services. Medicare plans are held to the usual Medicare limitations around telehealth (see Optum's Virtual Visits Medicare Policy).

• Merrimack Valley. Optum is particularly interested in recruiting providers who can see members in the Merrimack Valley region.

• Case and family consultation codes (90882, 90887). MPA continues to encourage Optum to include these codes on their fee schedule to assist in collaboration of care, and Optum is looking into it. If you have a good example of a time when you needed a code like this or where it would have provided for a better outcome, please email it to warkentin@masspsych.org.

We will continue to meet with Optum quarterly to raise your concerns and assist in improving all psychological services for Optum patients.