Partial provider meeting
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Partial Provider Meeting. CBHNP. Presenters. Keven Cable, Provider Relations Trainer and Educator Kelly Lauer, Provider Relations Representative Amy Reeder, Provider Relations Representative DJ Dunlap, Quality Management Clinician Julie Shearer, UR CCM, Capital Region

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Partial Provider Meeting

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Partial provider meeting

Partial Provider Meeting

CBHNP

10-24-07


Presenters

Presenters

  • Keven Cable, Provider Relations Trainer and Educator

  • Kelly Lauer, Provider Relations Representative

  • Amy Reeder, Provider Relations Representative

  • DJ Dunlap, Quality Management Clinician

  • Julie Shearer, UR CCM, Capital Region

  • Kelly Preston, Capital UR Supervisor

10-24-07


Agenda

AGENDA

  • CIRs

  • CSS Surveys

  • Complaints

  • COD Assessment Tool

  • Capacity Concerns

  • Continued Stay Reviews

  • Discharge Planning

  • Reinvestment Services

  • Provider Connect

  • Provider Portal

  • Member Services Specialists

  • Claims and Billing

  • Administrative Appeals

  • Discussion

  • Clarifications/Reminders

10-24-07


Qi update

QI Update

  • Critical Incident Reporting

  • CSS (Consumer Satisfaction Services, INC.) Survey Process

  • Quality Improvement QuickTip #1

    • Handout provided in your packet

  • Complaints

    • Responding to requests to resolve complaints

10-24-07


Cod assessment tool

COD Assessment Tool

  • Recommended by DOH & DPW

  • OMHSAS is encouraging BHMCOS to develop Integrated Treatment programs

  • Credentialing requires use of tool starting 9/15/07

  • See PA Bulletin OMHSAS-06-03

  • Roxbury is willing to host any mental health Providers interested in learning the day to day operations of an inpatient D &A

    • Contact Michelle Snyder, Community Relations Representative

    • Phone # (717) 729-6643

10-24-07


Omhsas memo

OMHSAS Memo

  • Partial Hospitalization Policy Clarification

    • Memo included in your packet

10-24-07


Capacity concerns

Capacity Concerns

  • Availability

    • Currently no problems for children and adults accessing MH PHP as step down from MH IP

    • Currently 1 – 2 week wait to access children’s MH PHP for initial admissions from the community

    • There is no wait list to access adult MH PHP for initial admission from the community

10-24-07


Continued stay reviews

Continued Stay Reviews

  • Axis I – Axis V Diagnosis Information

  • Medication

  • Ancillary services with contact information

  • Current functioning/progress/goals

  • Substance Abuse screen and outcome (DAST or AUDIT tool)

  • Substance Abuse treatment recommendations if determined to be needed

  • Family sessions / natural support involvement

  • Family psychiatric history

  • Relapse triggers / prevention plan/ crisis plan

10-24-07


Continued stay reviews cont

Continued Stay Reviews- cont.

  • Community based alternatives

  • Coordination of care

    • Family Based

    • BHRS

    • When any recommendations are made for BHRS or Family Based, please notify the CBHNP reviewer

  • Discharge plan

  • Continued stay reviews are due no later than the last covered day; however, can be done a day or two prior to due date if necessary.

10-24-07


Discharge planning

Discharge Planning

  • Partial Hospital Programs should work collaboratively with Inpatient units by providing appointments to Members who are being discharged from IP level of care.

  • Partial Hospital Programs need to plan aftercare appointments for Members who are being discharged from their program.

  • Discharge reviews must be live

  • Members are to be seen within seven (7) days of discharge from PHP

  • CBHNP reviewers will be discussing discharge appointments during reviews to ensure discharge appointments are scheduled

10-24-07


Discharge planning cont

Discharge Planning – cont.

  • The following information is needed:

    • Date of discharge

    • Axis I, II and V

    • Discharge plan / aftercare plan

    • Community based alternatives

    • Family / natural supports involvement

    • BHRS or Family Based ~ are they being recommended

      • If so, has a prescription been sent to CBHNP

    • Discharge residence

    • Risk / safety status

    • Member’s clinical symptoms

10-24-07


Reinvestment supplemental service offerings

Reinvestment/ Supplemental Service Offerings

  • Mobile Psychiatric Services

    (Behavioral HealthCare Corporation)

    • (717)399-8288

  • Respite Services

    (PA Mentor)

    • (717)657-2073

  • 10-24-07


    Providerconnect

    ProviderConnect

    • Provider Web Access

      ProviderConnect allows authorized providers in

      network to:

      • Check status of all authorizations

      • Check status of claims

      • Review Provider Profile and Address Information

    10-24-07


    Provider portal

    Provider Portal

    • Easy access to latest news, events, forms, policies, frequently asked questions and contact information Providers need

    • You may register on CBHNP’s website

      www.CBHNP.org

    10-24-07


    Member services

    Member Services

    • Member Services Specialists are the first line of Clinical and are responsible for screening all calls that come in to CBHNP. To ensure your call is processed correctly, please be prepared to give the following information.

      • County Member resides

      • Is the Member an Adult or Child

      • Mental Health or Substance Abuse

      • Inpatient or Partial

    10-24-07


    Claims and billing

    Claims and Billing

    • 60 day claims submission

    • Remember your NPI number on claims

    • Third Party Liability

      • Memo distributed

    • Submission of electronic claims

      [email protected]

    10-24-07


    Administrative appeals

    Administrative Appeals

    • Administrative Appeal Process

      See: June 8, 2007 Memo

    10-24-07


    Administrative appeals1

    Administrative Appeals

    Administrative Appeal Request form needs to be completed for each Member

    Administrative Appeals are not for denials due to Medical Necessity Criteria

    Administrative Appeals are for failure to get authorization, failure to submit claims timely due to circumstances beyond the control of the Provider or other unique circumstances.

    10-24-07

    18


    Administrative appeals cont

    Administrative Appeals Cont.

    All requests for review of an administrative denial must be submitted in writing within 30 days of the receipt of the (EOB) remittance advice.

    10-24-07

    19


    Discussion

    Discussion

    • Quality indicators of PHP LOC? - How do you know if you are providing quality services?

    • Recovery and PHP - How are you using Recovery Principles in PHP treatment?

    • General feedback- How are things going?

    • How often should we meet?

    10-24-07


    Helpful resources

    Helpful Resources

    • http://psychcentral.com/library/id239.html

    • http://www.mentalhealthrecovery.com/

    • http://www.copelandcenter.com/whatiswrap.html

    10-24-07


    Reminders

    Reminders:

    • Please check the CBHNP website at WWW.cbhnp.org for current forms and instructions which discuss all levels of care and provide procedural guidelines.

    • Provider Manual is on the web

    • Next Meeting:

    10-24-07


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