September 18, 2022

Pennsylvania Medicaid: Important member updates

Please review following updates and reminders to services designed to support your patients who are UnitedHealthcare Community Plan of Pennsylvania members.

Updates

Electronic Visit Verification (EVV)

Beginning Jan. 1, 2023, all home health services for Pennsylvania Medicaid members will require Electronic Visit Verification (EVV) before claims for those services can be reimbursed. Previously, EVV was required only for personal care services. However, the Department of Human Services (DHS) expanded the requirement for all home health services starting Jan. 1, 2023, and beyond.

All home health claims must be submitted to UnitedHealthcare by HHAeXchange, UnitedHealthcare’s EVV vendor partner. That means:

  • Home health providers need to integrate with the HHAeXchange system before Jan. 1, 2023
  • Claims submitted directly to UnitedHealthcare by home health providers for dates of service after Jan. 1, 2023, will be denied payment
  • Providers can use the HHAeXchange application to electronically verify rendered services
  • Providers who have another EVV preferred vendor need to ensure that vendor can transmit verified visit data to HHAeXchange

For more information, please review the DHS EVV requirements. Providers can learn more about partnering with HHAeXchange by contacting them at 855-400-4429.

Suicide Prevention Hotline 988

The new, national 988 Lifeline launched July 16, 2022. This new, shorter phone number may make it easier for your patients to remember and access mental health crisis services. The previous lifeline, 800-273-TALK (8255), will continue to function indefinitely. Anyone in crisis or needing mental health help can call any time, at no cost. For more information, go to 988lifeline.org.

Reminders

Emergency room care

For an emergency, a member should seek immediate care at the closest ER. No referral is needed if a member needs help getting to the ER and calls 911. They pay no out-of-pocket costs for ER or emergency ambulance services.

Members have been told to call their primary care provider (PCP) as soon as possible after receiving emergency care. PCPs must promptly see members who did not require or receive emergency services for the symptoms prompting the attempted ER visit. UnitedHealthcare Community Plan covers these services regardless of the emergency care provider’s relationship with UnitedHealthcare Community Plan.

Lead screening in children

Please determine a child’s lead level on or before the second birthday. Any blood lead level > 3.5 mcg requires notification to DHS CONNECT Helpline at 800-692-7288 and referral to Accredited Environmental Technologies at 800-969-6238, 8 a.m.–4 p.m. ET, Monday–Friday. If a blood lead level is above 3.5, sibling(s) should also be tested.

Telephonic Psychiatric Consultation Service Program (TiPS)

Immediate consultative advice for children up to age 21 with behavioral health concerns is available through the Telephonic Psychiatric Consultation Service program (TiPS). This is a free service.

The TiPS team is available to PCPs and behavioral health clinicians working on-site in primary care practices who see children or adolescents covered by Health Choices, Pennsylvania’s Medical Assistance (Medicaid) Program. The TiPS team can assist with resources or even provide transitional support until the child and their family can access local behavioral health resources.

To enroll, contact the TiPS team in your zone:

  • Southeast Team: Children’s Hospital of Philadelphia: 267-426-1776
  • Northeast Lehigh/Capital: Penn State Hershey 800-233-4082
  • Southwest & Northwest: Children’s Community Pediatrics 844-WPA-TiPS (844-972-8477)

Questions?

Contact UnitedHealthcare Provider Services at 800-600-9007.

PCA-1-22-02730-C&S-News-08242022
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