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Partial Provider Meeting - PowerPoint PPT Presentation

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Partial Provider Meeting

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  1. Partial Provider Meeting CBHNP 10-24-07

  2. 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

  3. 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

  4. 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

  5. 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

  6. OMHSAS Memo • Partial Hospitalization Policy Clarification • Memo included in your packet 10-24-07

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. Reinvestment/ Supplemental Service Offerings • Mobile Psychiatric Services (Behavioral HealthCare Corporation) • (717)399-8288 • Respite Services (PA Mentor) • (717)657-2073 10-24-07

  13. 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

  14. 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

  15. 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

  16. Claims and Billing • 60 day claims submission • Remember your NPI number on claims • Third Party Liability • Memo distributed • Submission of electronic claims edi@cbhnp.og 10-24-07

  17. Administrative Appeals • Administrative Appeal Process See: June 8, 2007 Memo 10-24-07

  18. 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

  19. 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

  20. 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

  21. Helpful Resources • http://psychcentral.com/library/id239.html • http://www.mentalhealthrecovery.com/ • http://www.copelandcenter.com/whatiswrap.html 10-24-07

  22. 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