UNITED BEHAVIORAL HEALTH

1. UNITED BEHAVIORAL HEALTH ALERT® (Algorithms for Effective Reporting and Treatment) How to Implement Click here to view entire presentation Click here to select to view a specific section of presentation

2. Table of Contents UBH Commitment to Outcome-Informed Clinical Interventions ALERT: An Overview The Wellness Assessment (2 slides) How to obtain Wellness Assessments (3 slides) Notes on the Wellness Assessment forms Wellness Assessment – Instructions and Sample Who should be offered a Wellness Assessment Who is Not be offered a Wellness Assessment Submitting the Wellness Assessment (2 slides) The ALERT Process Resources View Entire Presentation Select any of the below topics to go directly to that section

3. UBH’s Commitment to Outcome-Informed Clinical Interventions ALERT is • A care advocacy model that is consumer-driven and outcome-informed • Strengthening our partnership with network clinicians to achieve optimal therapeutic outcomes • Enhancing the ability to assess a person’s experience of care • Incorporating outcome-informed interventions into evidence-based treatment What this means to you • Maintains reduced administrative burden and increased clinical autonomy • Fosters early identification of members identified with a potential risk that may affect routine outpatient therapy Return to Table of Contents

4. ALERT: An Overview • Member calls UBH or accesses liveandworkwell.com, our Member Web site, to request certification (when the benefit plan requires prior certification for outpatient treatment). If the benefit plan does not require prior certification for outpatient services, member will still be able to call for referrals. • UBH provides referrals to in-network clinicians based on clinical and geographic needs. An open certification is generated, allowing the member to see any UBH-contracted clinician for routine outpatient psychotherapy services. • Member calls the clinician directly to schedule an appointment. When applicable, the UBH member brings a copy of the certification letter or the Certification Request document to the initial appointment. If the member does not bring the letter or has not already obtained certification (and certification is required), you should contact UBH to obtain a copy or to initiate an open certification. Registered users of ubhonline, may use the certification inquiry and certification request functions. Alternately, you may call the number on the back of the member’s insurance card. • Clinician provides the one-page Wellness Assessment (WA) to each new UBH member, or to the parent/guardian of a child or adolescent patient. • Clinician promptly returns each completed WA to UBH as instructed on the form. • A second WA is administered at session 3, 4, or 5. • UBH reviews the WA and alerts the clinician if a targeted risk is identified. The treating clinician will either be notified by letter or contacted by a Care Advocate to discuss the case or assist in coordinating additional services. • Some targeted risk factors identified after the review of the second WA, may result in your being asked to administer a third WA at a later point in treatment. • A follow-up WA will also be sent directly to the member approximately four months after the initial evaluation. Return To Table of Contents

5. The Wellness Assessment The Wellness Assessment is A one page instrument which you ask the member to complete at the first visit (or prior to the first visit) and then review with the member during the first session • Administered again by you and completed by the member in session 3, 4 or 5 and again reviewed by you with the member in session • Completed a third time (in some cases) based on identified risks • Returned by the clinician to UBH by fax or by mail Note that a follow-up WA is sent to the member by UBH at 4 months after the first visit. The member returns this WA directly to UBH. Return To Tale of Contents

6. The Wellness Assessment The Wellness Assessment (WA) is the cornerstone of ALERT WA Forms and Handouts that are available: Adult Wellness Assessment (English) Youth Wellness Assessment (English) Adult Wellness Assessment (Spanish) Youth Wellness Assessment (Spanish) WA Instruction Page (English-only) Sample completed WA WA Client Education Sheet (English-only) Tips for Introducing the Wellness Assessment Return To Table of Contents

7. How to obtain Wellness Assessments (1) Wellness Assessments are available at www.ubhonline in two locations: 1. Secure-transaction section for registered users In this section you are able to print out Wellness Assessments that can be pre-populated with the member and/or clinician name. A clinician number will be pre-populated on the form. For the confidentiality of those clinicians whose Tax ID is their social security number, all clinician numbers presented on the form are UBH-assigned numbers. Return To Table of Contents

8. How to obtain Wellness Assessments (2) Wellness Assessments are available at www.ubhonline in two locations: 2. From the ALERT page, click on “WA Forms” Here are all the Wellness Assessments and supporting forms (directions, sample form, member education sheet). The Wellness Assessments on this page can be printed blank or with the editable form you can type in the information for the top section before printing the form. Return To Table of Contents

9. How to obtain Wellness Assessments (3) Wellness Assessments will be mailed to you upon your request Forms Hotline (800) 888-2998 ext. 5759 Return To Table of Contents

10. Notes on the Wellness Assessment forms Notes about the Wellness Assessment forms: • It is advised that you download each Wellness Assessment rather than photocopy because routine copying will deteriorate the quality of the form which could affect the automated and therefore, the speed of processing the forms once faxed to UBH. • There is only one WA form; therefore, the same form is utilized with members at both the first and second time that the form is offered. Return To Table of Contents

11. Wellness Assessment – Instructions and Sample WA Instructions: • Print clearly and use all capital letters • Shade circles completely • Keep letters and numbers inside the boxes • Only fill in 1 answer per question • If questions 16, 20 and/or 21 are not applicable or the response is “zero”, leave the answer boxes blank • Avoid stray marks or comments • Do not write comments in the margins • Clinician ID means Tax ID • If you do not have an Authorization number, leave these spaces blank • In the event that a member does not complete the form, please complete both the member and the clinician information and fill in the “MRef” bubble Return To Table of Contents

12. Who should be offered a Wellness Assessment A Wellness Assessment is offered to the following: • All members of United Behavioral Health (UBH)/U.S. Behavioral Health Plan, California (USBHC) that begin routine outpatient therapy with you, this includes: • Members who may be former clients and are returning to care. Offer them a WA in the first or second session. • Employee Assistance Program (EAP) • MEDICA members • Blue Cross/Blue Shield members • Anytime a 90801 CPT code is filed followed by routine outpatient services (e.g. 90806, 90847 or 90853) When a family is in treatment, only one WA is offered for the member under whom the billing is to be filed. Return To Table of Contents

13. Who is NOT offered a Wellness Assessment A Wellness Assessment is not offered to the following: • Anyone receiving strictly psychological testing services from you • Anyone receiving strictly medication monitoring is welcome, but not required, to participate in ALERT • Anyone engaged in a program that is a higher level of care than routine outpatient therapy (e.g. a partial hospitalization program) • An adolescent seeking confidential care (submit a blank WA with top section complete- we will not make outreach in this case) • Anyone receiving Home Health services • Anyone receiving Nursing Home services Return To Table of Contents

14. Submitting the to WA (1) Once the WA is completed by the member and you make sure the top portion is complete, fax the form to UBH at the following number: 1-800-985-6894 Do not use a cover fax sheet. This is a dedicated fax line. The first time you use any particular fax machine in your office to UBH, print a fax verification form. This is not necessary with each WA, but is wise with the first one to ensure a proper connection to UBH.

15. Submitting the to WA (2) If you do not have access to a fax, the Wellness Assessment can be mailed to UBH: United Behavioral Health/USBHPC Attention: Wellness Assessments P.O. Box 27430 Houston, Texas 77227

16. When to offer the Wellness Assessment A Wellness Assessment is offered to a member early in treatment at two points: Once at the first or the second session and again at either session 3, 4 or 5

17. Follow-up Letters and Phone Calls • For the majority of Wellness Assessments, after you submit to UBH, no further action will occur. • For members whose responses on the WA and/or claims information indicate potential targeted risk, UBH will contact you in one of two ways: • A letter addressed to the treating clinician indicating the potential risk that has been identified. No further interaction with UBH is required if you receive a letter • A phone call from an ALERT Care Advocate to the treating clinician. It is important for the clinician to return this phone call and speak with the Care Advocate

18. The ALERT Process In some cases, a 3rd WA will be requested by a Care Advocate to be reviewed, & returned to UBH 4 month follow-up WA sent directly to patient Annual Open Certification A second WA is completed at session 3, 4, or 5, reviewed & faxed or mailed to UBH ALERT Claims Data Wellness Assessments are completed at initial session, reviewed with member and faxed or mailed to UBH or UBH Care Advocate makes an outreach call UBH mails you an ALERT letter

19. To consult on any case To e-mail comments or questions to the Clinical Network Services ALERT Team Questions or Additional Information ubhonline® (request a user ID and password or for technical issues) . . . . . . . . . . . . . . . . . . . . . UBH Care Advocate (Call the number on the back of the UBH member’s insurance card) . . . . . . . . . . . . . . . ALERT_CNS_Ref@UHC.com . . . . . . . . . . . . . . . . . . Network Management . . . . . . . . . . . . . . . . . .www.ubhonline.com Support Center at 1-866-209-9320 (toll-free) 7 a.m. to 9 p.m. Central time Chat with a representative online by clicking on “Contact Us” and utilizing the Live Chat feature Resources Return to Beginning