report to the transitional sub committee february 10 2006
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Report to the Transitional Sub-Committee February 10, 2006. CT BHP Provider Network. CT BHP Provider Network. CT BHP Provider Network. Disruption Analysis Methodology. Pulled paid claims from MCO’s Slight variation in time frames (i.e., 8/1/05-10/31/05; 8/1/05-11/30/05)

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report to the transitional sub committee february 10 2006
Report to the

Transitional Sub-Committee

February 10, 2006

disruption analysis methodology
Disruption Analysis Methodology
  • Pulled paid claims from MCO’s
  • Slight variation in time frames

(i.e., 8/1/05-10/31/05; 8/1/05-11/30/05)

  • Claims lag, possibly reflecting 1st or 2nd Quarter information
  • Anticipate that many clients now would now have completed episode of care
disruption analysis cont d
Disruption Analysis cont’d
  • 15 inquiries, no complaint filed, referrals given
  • 4 complaints
    • 2 closed
      • provider enrolling
      • member choosing to continue in care
    • 2 open
      • provider enrolling
      • no application located at EDS
disruption analysis
Disruption Analysis

Providers Clients

drilldown decline
Drilldown(Decline)

Providers Clients

ct bhp activity
CT BHP Activity
  • Over 1000 outreach calls to providers
  • Consulted the following resources:
    • Yellow and white pages
    • ValueOptions commercial provider file
additional resources reviewed
Additional Resources Reviewed
  • http://www.dph.state.ct.us
  • http://www.ct-clic.com
  • http://www.ctnurses.org
  • http://www.ctmedicalprogram.com
  • http://www.physicians.dph.state.ct.us
  • http://www.schoolnurse.vserver.com/
  • http://connecticut.uscity.net
  • http://www.vnasc.org
  • http://www.yellowbook.com
  • http://therapists.psychologytoday.com/
  • http://connecticut.uscity.net
next steps
Next Steps
  • Will compare providers against DCF contract list
  • Continue to work with EDS (performer not enrolled)
  • Manually check for:
    • Additional phone numbers
    • Providers embedded in group practice (10%)
a phased in approach to authorization based on level of care
A Phased in Approach to Authorization Based on Level of Care
  • Residential and Group Home Treatment
  • Inpatient/Acute Levels of Care

(23 hour observation, inpatient, PRTF)

  • Intermediate Levels of Care (Resi Detox, Partial Hospital, Intensive Outpatient,Extended Day Treatment)
  • Home-Based Services (IICAPS, FFT, MST, MDFT) and Outpatient Services
phase 1 rtc and group home authorizations
Phase 1RTC and Group Home Authorizations
  • Effective 2/1/06
  • 28 packets received
  • 19 packets reviewed
  • 13 authorizations to 10 programs
  • On-site reviews to be scheduled
  • Census information collected and entered
phase 2 inpatient acute levels of care
Phase 2 Inpatient/Acute Levels of Care

Effective March 1, 2006

(New Admissions)

  • All new members presenting for inpatient/acute levels of care will need to be pre-authorized for service.
  • These members will also be subject to continued stay reviews (CCR).
phase 2 inpatient acute levels of care cont d
Phase 2 Inpatient/Acute Levels of Care – cont’d

Effective March 1, 2006

(Members in Care)

  • Submission of a modified review form for all members in care as of March 1, 2006
  • Fax between March1, 2006 – March 15, 2006
  • In order to receive an authorization, providers must call on the day of discharge, or by March 15, 2006, whichever is sooner
ad