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P r o v i d e r Re l a ti o n s N ew s l e tte r
August 2020
I n s i d e Th i s I s s u e :
1 Community Health Direct
website link
1 ePower Provider Portal
1 New Provider Credentialing
1 New Providers, effective 8/1/2020
1 Termed Providers
2 Naming Conventions
2 Beacon Health Options
3 Imagine Health
4 Metformin ER Recall
5 Genetic Testing PA Updates
6 Provider Relations Staff
Directory
Credentialing of NEW Providers:
***PLEASE NOTE***
Credentialing through Community Health Direct for ALL
new providers can take anywhere from 90-120 days
from notification to completion.
Community Health Direct
Provider Relations Dept.
ePower Provider Portal:
Look up member claims, eligibility and more on
Community Health Direct’s Provider Portal (ePower) at:
https://www.ecommunity.com/community-health-direct/
providers/community-gold-and-silver-plans
Credentialing Corner:
NEW Providers joining Community Health Direct - Click HERE
TERMED Community Health Direct Providers - Click HERE
JUST IN: Effective 7/1/2020, Community Health
Direct has a NEW and improved website with
valuable info for members & providers!
Visit us at:
https://www.ecommunity.com/community-health-direct
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Naming Conventions Utilized in Cactus:
In an effort to ensure consistency with both internal and external organizations, your exact name on
your Medical License will be loaded into our enrollment system, Cactus. Timely, correct and con-
sistent enrollment is critical to ensuring that your orders, claims and many other activities are success-
ful.
Cactus interfaces with many systems including but not limited to the following:
EPIC: Referrals, Discharge Orders and Claims
All Commercial and Government Payors*
CAQH Application*
Malpractice Certificates*
NPDB*
NPI*
*Community-Employed/CPN providers only
We realize that you are required to enter your full legal name on your application for licensure. If you
would like to have your license displayed with a different name, you can submit a letter of explanation
via email to [email protected].
Community Health Network is now in-network for Beacon Health Options:
Effective August 1, 2020 all Community Health Network hospitals and practitioners will be participating
providers with Beacon Health Options. Beacon Health Options is a Behavioral Health Management
organization that provides over 4,700 employers with Behavioral Health Networks. Additional infor-
mation regarding Beacon Health Solutions can be located at https://www.beaconhealthoptions.com/
providers/.
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Voluntary Recall of Metformin Hydrochloride Extended-Release Tablets, USP 500 mg, 750mg & 1000mg
The US Food & Drug Administration (FDA) has asked several manufactures of generic Metformin Hydrochloride Extend-
ed-Release Tablets to recall their products voluntarily. Here is what you need to know about this recall:
Issue: FDA analysis has found these products to contain N-Nitrosodimethylamine (NDMA) levels in excess of the Ac-
ceptable Daily Intake limit (ADI) of 96 nanograms/day.
Risk: NDMA is classified as a probable human carcinogen (a substance that could cause cancer) based on results
from laboratory tests. NDMA is a known environmental contaminant and found in water and foods, including meats,
dairy products, and vegetables. Patients taking Metformin Hydrochloride Extended-Release Tablets, USP 500 mg, 750
mg, and 1000 mg are advised to continue taking their medication and contact their health care professional who can
prescribe a replacement. According to the FDA, it could be dangerous for patients with type 2 diabetes to stop taking
their metformin without first talking to their health care professionals.
What to do?
This is a voluntary recall. The pharmacies will no longer dispense these products. However, they are not obligated to
inform the patients of this issue. The pharmacies will try to obtain generic Metformin ER from other manufactures. If
they are unsuccessful, they will contact the provider to change the Metformin ER to a different formulation.
Caregivers: 1) This recall is limited to several manufacturers and a small number of products. There have not been
any adverse reports linked to this recall. The patients can remain on Metformin ER. Contact the pharmacy and request
a different manufacture of Metformin ER to be dispensed to patient OR 2) Change the patient to Metformin regular re-
lease with the correct dosing interval.
The following manufacturers have recalled some of their generic Metformin ER products: Teva, Amnela, Apotex, Granule,
Lupin, and Marksans Pharma Limited, India (Time-Cap Labs, Inc).
For more detailed information including NDC/lot numbers impacted and current up to date information visit:
https://www.fda.gov/drugs/drug-safety-and-availability/fda-updates-and-press-announcements-ndma-metformin
If you have questions or concerns, please do not hesitate to contact Community Health Direct Pharmacy Management Team at 317-621-7519.
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Genetic Testing and Prior Authorization:
In a review of the types of appeals received by the Community Health Direct in 2019, over 30% of them were for genetic testing. Half of the genetic tests were initially denied as ex-perimental and the other half for lack of obtaining a prior authorization. The genetic ser-vices that were not prior authorized were later reviewed for medical necessity as part of the appeal process; only one of these genetic services met medical necessity criteria re-sulting in continued denial of health plan coverage for the rest of these cases.
Prior authorization is required for ALL genetic test requests for Community Health Direct Gold, Silver and Bronze members to receive health plan coverage with two exceptions. The first exception to prior authorization for genetic testing is for prenatal testing that follows the American College of Obstetrician/Gynecologists (ACOG) guidelines. The second excep-tion is complicated and involves surgical tissue sent for genetic testing. Surgical tissue sent for testing of a specific gene or gene set, such as Lynch syndrome, does not require a prior authorization. Whole genome sequencing also called whole exome sequencing or molecu-lar profiling can be performed on both surgical tissue and on blood samples. The majority of the whole genome sequencing/molecular profiling tests are still considered experi-mental regardless of the sample submitted and therefore require a prior authorization. The specific indication where whole genome sequencing/molecular profiling may meet medical necessity is for stage IV or recurrent non-small cell lung cancer. Examples of ge-netic tests that involve whole genome sequencing/molecular profiling are FoundationOne, Target Now, Molecular Intelligence, MSK-IMPACT, GeneKey, and several more.
Prior authorization is necessary for genetic tests, as many of them are considered experi-mental or are only appropriate for patients with very specific symptoms or family histories. Please be aware of whether the tests you order for your patients include genetic tests. There are some test panels that include more routine labs along with genetic tests. Ge-netic testing is a rapidly expanding technology, you are always welcome to contact Medical Management at 317-621-7505 to determine whether a test panel includes a genetic test component or whether a whole genome sequencing/molecular profiling test is covered under the health plan.
Medical Management: Benefits/Eligibility:
Phone#: (317)621-7575 Phone#: (317)621-7565
Fax#: (317)621-7984
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Department Staff Manager Provider Relations:
April Woodruff, [email protected]
Jenna White, [email protected]
Lori White, [email protected]
Salena Woodson, [email protected]
Business Information Coordinator:
Hollie Putzback, [email protected]
Provider Relations Analysts:
Amanda Bobo, [email protected]
Carol Boyd, [email protected]
Dawn Widgery, [email protected]
Credentialing Coordinators:
Amy Walls, [email protected]
Denise Smith, [email protected]
Dianne Castillo, [email protected]
Ebony Elston, [email protected]
Jerrilyn Dixon, [email protected]
Kim Tibbets, [email protected]
Lori Jones, [email protected]
Michael Starks, [email protected]
Sarah Miller, [email protected]
Sharon Harlan, [email protected]
Provider Relations Department 6626 E. 75th St, #500 Indianapolis, IN 46250 Phone: 317-621-7581 https://www.ecommunity.com/community-health-direct
