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Amerigroup Testing Discussion with GPA

Monday, July 18, 2016   (0 Comments)
Posted by: Dr. Frank Harbin

This article is a summary of a recent discussion between GPA and Amerigroup about testing issues.

GPA Representatives, Drs. Michael Johns, Kyle Raque and Frank Harbin, met with multiple Amerigroup (AGP) officials and representatives from both DCH and DFACS.  They had some legitimate concerns (e.g. requests that included an MMPI for an eight year old, 18 hours of testing requested for a fairly routine evaluation, an alcohol assessment for nine year old and multiple other inappropriate or illegitimate uses of tests).  We did not agree with the expectation that treatment should be provided before testing is requested and pointed out that that is an explicit red flag (per the Labor Department memo) of a likely Parity violation.  They have had a surge in request for testing for four year olds and will do further research to determine if this is related to autism assessments or other issues.

Discussed trend findings –

  • GPA representatives discussed clinical case info and acknowledged AGP concerns related to:
    • Excessive list of tests
    • Excessive hours when compared to test publisher guidelines
    • Requests for non-age appropriate tests
    • Expectation of psychological testing before any treatment has commenced
    • Also noted ADOS for autism screening can take approximately 10 hours per the Autism training protocols
    • Licensed Psychologists should be aware of testing standards, GPA does ongoing training
  • Acknowledged benefit of Peer to peer review in advance of denial, noted post move to state mandated three day turnaround  time this service will be discontinued
  • Discussed issue of Trauma Assessments routinely noting Psych testing as first recommendation despite lack of clinical indication
  • Discussed need for ongoing Provider training at provider townhalls (quarterly) and webinars

Kristen Toliver (DFACS) advised:

  • It is the expectation of DFCS that all children under five years old would have developmental screen in advance of any testing request. The screenings are typically provided by Babies Can’t Wait through Public Health.
  • Advised often times DFCS Case Managers should not be making referral requests to Testing provider. Therefore, if providers are getting requests from DFCS they should forward the information for retraining. Kristen’s email is Her telephone number is 678-727-3172.

Follow up Action Items

  • AGP to review name of providers sending inappropriate requests and review with PR if they can be shared with GPA for determination if the providers are part of GPA and targeted outreach/coaching by GPA regardless of affiliation
  • AGP to review under children under four years old denied testing to check if this is being driven by ADOS screenings
  • AGP to review PT FAQ to determine if updating to incorporate “coaching” regarding negative trends – work directly with DCH in advance of submitting to CMAP to expedite. Kristen to provide bullet point regarding concerns related to Providers requesting reimbursement form DFCS when testing does not meet Med Nec requirement.
  • Check with Dr. Khalifeh on status of Testing catalog of Measures Guideline document –related to administration timelines/age/purpose
  • GPA to send recap of meeting discussion to GPA Committee on Independent Practice Listserv
  • GPA to outreach Emory Autism program leadership and coordinate a meeting along with Bhavini
  • AGP to review trauma assessments for providers that are, by standard, recommending Psych testing regardless of clinical findings noted in the TA and coordinate training efforts to discontinue this practice.

Frank Harbin, PhD
GPA Insurance and Managed Care Committee Chair