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MH Provider Meeting

MH Provider Meeting. CBHNP. Presenters. Keven Cable, Senior Care Manager of Adult & Substance Abuse Services DJ Dunlap, Quality Management Clinician Rita Ricci, Clinical Supervisor and Project Coordinator Kelly Lauer, Provider Relations Representative

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MH Provider Meeting

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  1. MH Provider Meeting CBHNP 5-10-07

  2. Presenters • Keven Cable, Senior Care Manager of Adult & Substance Abuse Services • DJ Dunlap, Quality Management Clinician • Rita Ricci, Clinical Supervisor and Project Coordinator • Kelly Lauer, Provider Relations Representative • Don Stiffler, Provider Relations Manager • Wendy Carnes, Outpatient Authorization Coordinator • Stan Huddy, Provider Relations Representative 5-10-07

  3. AGENDA • Future provider meetings • CSS survey information and training • Treatment Records reviews for 2006-07, audit and DAST • Recovery Model • Continued Stay and Discharge Reviews • Enhanced Care Management (High Risk) • Reinvestment Services • NPI (National Provider Index) • Provider Connect • OP Requests Changes • OP Discharges • Complaints and Grievance • Quality Improvement • Clarifications/Reminders 5-10-07

  4. Future Provider Meetings Moving forward these meetings will be specific to OP providers and OP services. 5-10-07

  5. CSS Survey Information and Training • Consumer and Family Satisfaction Surveys • CSS (Consumer Satisfaction Services, INC.) Survey Process • Other points 5-10-07

  6. Treatment Records reviews • Treatment record reviews are completed for 2006-2007 • Audit and DAST-10 screens • Treatment record review for 2007-2008 5-10-07

  7. Recovery Model The 10 Fundamental Components of Recovery (handout) • Self-Direction • Individualized and Person-Centered • Empowerment • Holistic • Non-Linear 5-10-07

  8. Recovery Model • Strengths-Based • Peer Support • Respect • Responsibility • Hope 5-10-07

  9. Inpatient and Partial Hospitalization 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) 5-10-07

  10. Inpatient and Partial Hospitalization Continued Stay Reviews, continued • Substance Abuse Treatment Recommendations if determined to be needed • Family Sessions/Natural Support Involvement • Family Psychiatric History • Relapse Triggers/Prevention Plan/Crisis Plan • Community-Based Alternatives: Natural supports 5-10-07

  11. Inpatient and Partial Hospitalization Continued Stay Reviews, continued • Coordination of Care • Discharge Plan • Aftercare Plan • DOH requires patient to be seen daily by attending physician **Continued Stay Reviews are due no later than the last covered day. 5-10-07

  12. Inpatient & Partial Hospitalization Discharge Reviews • Discharge reviews must be live • The following information is needed: • Date of discharge • Axis I- Axis V Diagnosis information • Discharge Plan/Aftercare plan • Community-based alternatives/ Family/Natural Supports involvement • Discharge residence • Risk/Safety Status • Member’s clinical symptoms 5-10-07

  13. Discharge/Aftercare Appointments • Members are to be seen within 7 days of discharge from inpatient. • CBHNP reviewers will be discussing this during reviews to ensure discharge appointments are scheduled. • Discharge information/reviews must contain Member’s address and phone number discharged to. 5-10-07

  14. Enhanced Care Management (High Risk) • Utilize Reinvestment Services • Link Member with TCM • Develop and implement diversionary plans • Increase and improve natural and community supports 5-10-07

  15. Reinvestment/ Supplemental Service Offerings • Mobile Psychiatric Services (Behavioral HealthCare Corporation) • (717)399-8288 • Peer Support Services (Philhaven/The Dauphin Clubhouse) • (717)221-9610 • Respite Services (PA Mentor) • (717)657-2073 5-10-07

  16. NPI – National Provider Index • Replaces all legacy numbers for all health payer systems • CBHNP is requiring all enrolled providers to get an NPI (Medicare is also requiring this.) • May 23, 2007 – All electronic files must contain and only contain the NPI number to identify the provider • CBHNP will also require the NPI on all paper claims 5-10-07

  17. NPI – National Provider Index • 10 digit number that the provider must request from CMS • Individual providers may only have one NPI • Organizations may need multiple NPIs • It is entirely up to the provider to understand how to identify its subparts • Must get an NPI for each of its subparts if the subpart would meet the tests for being a covered health care provider themselves if they were separate legal entities • May qualify for additional NPIs for subparts that do not meet these tests based on such factors as the subpart having a location and licensure separate from the parent organization • Group practice only needs an NPI if it conducts transactions 5-10-07

  18. NPI – National Provider Index • It is entirely up to the provider to get the number before May 23, 2007 • Provider must declare at least one and up to 15 taxonomy codes for each NPI • Can apply online at https://nppes.cms.hhs.gov/NPPES/Welcome.do • Website for more information: http://www.cms.hhs.gov/NationalProvIdentStand/ 5-10-07

  19. NPI – National Provider Index • Providers must communicate their NPI to CBHNP • Include Taxonomy codes when reporting NPI • Send by faxing to Provider Relations at 717-671-6522 • PHP and IP may leave!!! 5-10-07

  20. ProviderConnect • Provider Web Access ProviderConnect allows authorized providers in network to: • Check status of all authorizations • Request OP authorizations • Update clinical information with OP auth request • Submit or check status of claims • Review Provider Profile and Address Information 5-10-07

  21. ProviderConnect ProviderConnect is designed to: • Reduce duplicate data entry • Limit unnecessary phone communication between affiliate providers and CBHNP • E-business functionality allows information to flow 24 hours a day 7 days a week, between CBHNP and contracted affiliate providers • Real time data - no lag in information currency created by data entry 5-10-07

  22. Review of OP Changes • Outpatient forms • Authorization letter • Outpatient instructions • Website 5-10-07

  23. MH OP Services Authorized for 1 year • 90806 – individual therapy 60 units • 90846, 90847- family therapy 240 units • 90853 group therapy – 480 units • Methadone - 52 units • 90862, 90862HE, H0034 -Medication checks- 18 units • H0034HK, H2010HK - Clozaril – 40 units • 90801-Diagnostic Interview – 1 event • 90801-Psychiatric Evaluation – 1 event 5-10-07

  24. Diagnostic Interviews Based on access: • 90801U7 Access within 7 days-Masters • 90801U8 Access within 7 days-Doctorate • 90801HO 8 days or more-Masters • 90801HP 8 days or more-Doctorate Provider MUST complete the following 3 dates if 90801 request for psychiatric evaluation or diagnostic interview. Date Member Requested: Date 1st Available Appt Offered: Date First Seen: 5-10-07

  25. OP Duplication of Services • One session 90806, 90804, 90807, 90808 per day • One 90862, HOO34 on same day • One 90801 on same day • May do group therapy and individual therapy same day (90853 and therapy codes) • May do outpatient medication checks and outpatient therapy same day 5-10-07

  26. OP Duplication of Services • Duplications: Need CCM approval • Partial Hospitalization (PHP) and medication checks • Partial Hospitalization (PHP) and MH individual/group outpatient therapy • MH Outpatient therapy and Mobile Therapy (MT) • MH Outpatient therapy and Residential Treatment Facility (RTF) • MH Outpatient therapy and Community Residential Rehabilitation (CRR-HH) • Specialized outpatient therapy for Substance Abuse, Eating Disorders, Sexual Abuse/Offenders is not a duplication of services. • Specialized outpatient therapy may be a duplication if a Member is in RTF and these services can be provided in that setting. 5-10-07

  27. OP Request Guidelines • Check EVS or PROMISe eligibility prior to each appointment and prior to submitting the request • List Contact Person • Requested start date if reauthorization request is date following expiration date of current auth • OP forms available in PDF- Fill In format on the web • Do not alter forms • Do not submit treatment plans 5-10-07

  28. OP Request Guidelines • Check Member Info for accuracy • Note Co-Occurring and Dual Diagnosis • Use the provider address where Member receives treatment • Use provider name as credentialed with CBHNP • Ask if Member is in treatment elsewhere • Check all services requested • Special forms for unique programs 5-10-07

  29. OP Request Guidelines • Listing diagnosis information • Do not use the outpatient treatment request form for BHRS/RTF evaluations or recommendations or referrals. • Make sure you are licensed to provide services requested • Provide 3 access dates for code 90801 • Note on OP request if Member has permission for duplicative services OR if they are to be discharged from a duplicative service • Submit within 10 calendar days of start date requested • Do not request services more than 2 weeks in advance 5-10-07

  30. OP Requests Returned • Outpatient requests returned if they are Incomplete Inaccurate Illegible Member is not eligible or cannot be identified as a Member • Problem is circled on the OP request form and faxed back to the provider • Track these returned requests • Track pattern of returned requests • Use Correction form for existing authorizations only • 30 days to correct authorizations • After 30 days use Administrative Appeals process (Please see Provider Info AD03-007) 5-10-07

  31. OP Discharges • Fax to CBHNP within two weeks of discharge • Include two forms of identifying the Member (DOB, SS#, MAID#) • Specific service Member is being discharged from and MH or SA …...for example: MH Family therapy, Individual therapy, SA Group • No specific form for OP discharges 5-10-07

  32. Complaint and Grievance • Provider filing grievance on behalf of Member • Member needs to sign the authorization for the representation form. (available on the website) • Providers must post the C & G brochures in the main waiting areas. • Continuation Rights • Requesting continuation rights of a service and it was denied. 5-10-07

  33. Provider Performance • Provider Performance • New indicators in provider performance 5-10-07

  34. Claims and Billing • 60 day claims submission • Group authorization billing - separate out June and July as units are changing • Submission of electronic claims • edi@cbhnp.og 5-10-07

  35. Reminders: • OP may not require Members to obtain services with them in order to obtain other services. Members can access psychiatric evaluations or medication checks without entering therapy. • Send CIRs to the attention of QI Department. • “For profit” OP MH clinics are required to have JACHO accreditation- 55 PA.code 5200.7 Program Standards • Outpatient clinics for medication injections • If you provide treatment to sex offenders please notify PR. • Please check the CBHNP website at WWW.cbhnp.org for current forms and instructions which discuss all levels of care and provide procedural guidelines. To be updated for 7/1/07. • Drexel Training Stipend • Provider Manual is on the web • Next Meeting: September 2007 5-10-07

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