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 l.jpg

Report to the

Transitional Sub-Committee

February 10, 2006





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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


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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


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Disruption Analysis

Providers Clients


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Drilldown(Unable to Locate, further research occurring )

Providers Clients


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Drilldown(Decline)

Providers Clients


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CT BHP Activity

  • Over 1000 outreach calls to providers

  • Consulted the following resources:

    • Yellow and white pages

    • ValueOptions commercial provider file


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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


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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%)



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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


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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


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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).


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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