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Preparing for BH Integration into Medicaid Managed Care PowerPoint Presentation
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Preparing for BH Integration into Medicaid Managed Care

Preparing for BH Integration into Medicaid Managed Care

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Preparing for BH Integration into Medicaid Managed Care

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  1. Preparing for BH Integration into Medicaid Managed Care February 15, 2018

  2. OAHP – Provider Outreach and Readiness Efforts Preparations Leading to July 1 • BH Collaborative – standardized PA form, proactive identification of provider challenges and solutions, created BH provider resource document* • Provider Communications – MITS BITS, EDI meetings, Trade Association newsletters • Rapid Response Team – individual plan claims monitoring & outreach augmented with all MCP meetings to determine opportunities for training and outreach. • Seven (7) Winter Regional Provider Forums • In-person opportunity for discussion of payment issues and contracting or credentialing questions ODM Reporting • Testing Activity and Results • Prompt Pay/Denial Rate Reporting • Contracting/Credentialing status *All provider resources can be found at: http://bh.medicaid.ohio.gov/Provider/Medicaid-Managed-Care-Plans

  3. OAHP – Transitions of Care and Prior Authorizations Transitions of Care • MCPs must allow the member to continue with out-of-network providers for 3 months post carve-in. • To ensure continuity of care, MCPs will: • Work with the service provider to add the provider to their network; • Implement a single case agreement with the provider; and/or • Assist the member in finding a provider currently in the MCP’s network. Prior Authorization • The MCP shall follow the Medicaid fee-for service (FFS) behavioral health coverage policies through June 30, 2019. The MCP may implement less restrictive policies than FFS. After one year, the MCP may conduct a medical necessity review pursuant to OAC rule 5160-26-03.1. • MCPs must honor PA approved by ODM through expiration of the authorization.

  4. OAHP – Credentialing and Contracting – Provider Panel Requirements Credentialing and Contracting ODM Provider Panel Requirements • Medicaid Managed Care Plans are required to contract with a total of: • 238 Provider Type (PT) 84s • 216 Provider Type (PT) 95s • The MCP contracting process can take up to 90 days. In instances when a contract is not established prior to July 1, 2018, transition of care requirements are in place for 3 months. • The plan may execute a single case agreement with the provider or the plan can suggest in-network providers.

  5. OAHP – Credentialing and Contracting Data

  6. Current Testing Opportunities Contracting Information Allow 90 days for the contracting/credentialing process-please start now Contact: https://www.buckeyehealthplan.com/providers/become-a-provider/join-our-network.html • Testing of claims begins again March 1st through June 30th at https://sites.edifecs.com/index.jsp?centene • Click here for a list of trading partners Buckeye works with https://www.buckeyehealthplan.com/providers/resources/electronic-transactions.html • Weekly Webinar opportunities on Tuesdays at 9:00AM and Thursdays at 12:00PM. RSVP at https://www.buckeyehealthplan.com/providers/behavioral-health.html

  7. Current Testing Opportunities Contracting Information Complete the New Health Partner Contract Form @ https://www.caresource.com/providers/join-our-network/ Allow 90-days for the contracting/credentialing process Be prepared with the following materials: W-9 tax form CAQH ID number Tax ID number NPI number(s) for both Provider Type 84 and/or 95 related certifications Questions/Concerns: Call CareSource’s Rapid Response Team - 800.488.0134 • Join us on Wednesdays from 3 to 4pm ET for instructions and status updates • CareSource is accepting test EDI files through our trading partners • Use the ODM Beta Testing Scenarios • Use active CS Members • Use DOS > January 1, 2018 • Submit test EDI files before June 1 2018.

  8. Current Testing Opportunities Contracting Information Allow 90 days for the contracting/credentialing process-please start now Contact: Ellen Landingham at (614) 557-3041 or Ellen.Landingham@molinahealthcare.com • Contact BHProviderServices@MolinaHealthCare.com to obtain an intake form and testing guidance • We work with all participating clearinghouse to submit EDI claims • Webinar opportunities to be scheduled end of February • Testing is currently open

  9. Current Testing Opportunities Contracting Information Allow 90 days for the contracting/credentialing process-please start now Contact: PHCProvider.Contracting@ProMedica.org • Contact PHCBehavioralHealthTesting@ProMedica.org to engage in claims testing • We work with all participating clearinghouse to submit EDI claims http://www.paramounthealthcare.com/documents/provider/clearinghouse-list.pdf • Intensive provider consultation available upon request (prior/post testing) • Testing claims are currently being accepted and will remain open through July 1, 2018 BH Redesign Implementation

  10. Current Testing Opportunities Contracting Information Allow 90 days for the contracting/credentialing process-please start now Be prepared with the following materials: W-9 tax form Tax ID number NPI number(s) for both Provider Type 84 and/or 95 related certifications Contact: OhioNetworkManagment@optum.com • Contact Ohionetworkmanagment@optum.com to get member assignments-begins now • We work with all participating clearinghouse to submit EDI claims • Three (3) live webinar opportunities scheduled: 2/19; 2/21; 2/23 with one recorded/posted end of Feb. • Testing Medicaid claims begins week of March 7th through June 30th