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MH Outpatient Provider Meeting - PowerPoint PPT Presentation

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MH Outpatient Provider Meeting. CBHNP. Presenters. Keven Cable, Provider Relations Trainer and Educator Kelly Lauer, Provider Relations Representative DJ Dunlap, Quality Management Clinician Rita Edley, Clinical Supervisor and Project Coordinator

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MH Outpatient Provider Meeting

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Presentation Transcript
  • Keven Cable, Provider Relations Trainer and Educator
  • Kelly Lauer, Provider Relations Representative
  • DJ Dunlap, Quality Management Clinician
  • Rita Edley, Clinical Supervisor and Project Coordinator
  • Wendy Carnes, Outpatient Authorization Coordinator


  • CIRs
  • Treatment Record Reviews
  • Complaints
  • CSS Surveys
  • COD Assessment Tool
  • Reinvestment Services
  • Provider Connect
  • Provider Portal
  • OP Requests Changes ~ Feedback from Providers and CBHNP
  • OP Discharges
  • Member Services Specialists
  • Discussion
  • Clarifications/Reminders


qi update
QI Update
  • Critical Incident Reporting
  • CSS (Consumer Satisfaction Services, INC.) Survey Process
  • Complaints
  • Treatment Record Reviews


cod assessment tool
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


reinvestment supplemental service offerings
Reinvestment/ Supplemental Service Offerings
  • Mobile Psychiatric Services

(Behavioral HealthCare Corporation)

          • (717)399-8288
  • Respite Services

(PA Mentor)

          • (717)657-2073


reinvestment supplemental services new
Reinvestment/ Supplemental Services - New

Buprenorphine Management- RASE Project

Community Treatment Teams (CTT)

Stevens Center in Cumberland/Perry

Philhaven in Lancaster/Lebanon

Transitional Support Services for Adolescents (The Jeremy Project)

CMU in Dauphin County

Stevens Center in Cumberland/Perry County



  • 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


provider portal
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


review of op changes
Review of OP Changes
  • Outpatient forms
  • Authorization Letter
  • Outpatient instructions
  • Website
  • Feedback from Providers
  • Feedback from CBHNP


op request guidelines
OP Request Guidelines
  • Check EVS or PROMISe eligibility prior to each appointment and prior to submitting the request ~ Retain a copy of your EVS printout
  • 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, service plans or matrix sheets
  • Check Member Info for accuracy


op request guidelines12
OP Request Guidelines
  • Note Co-Occurring and Dual Diagnosis
  • Use the provider address where Member receives treatment
  • Use provider name as credentialed with CBHNP
  • Receive authorization following a request…..if not, call or resubmit
  • Ask if Member is in treatment elsewhere
  • Check all services requested
  • Special forms for unique programs
  • Listing diagnosis information


op request guidelines13
OP Request Guidelines
  • 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
    • Faxes received 4:00 pm and after are date stamped for the next day
  • Do not request services more than 2 weeks in advance
  • Neuropsychological Evaluation requests are asked to be submitted two (2) weeks prior to evaluation. This is preference not policy. CBHNP has two (2) full business days to review for MNC.


op requests returned
OP Requests Returned
  • New fax cover sheet with codes
  • Outpatient requests returned if they are




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)


op discharges
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


member services
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


claims and billing
Claims and Billing
  • 60 day claims submission
  • Remember your NPI number on claims
  • Third Party Liability
    • Memo distributed
  • Submission of electronic claims



administrative appeals
Administrative Appeals
  • Administrative Appeal Process

See: June 8, 2007 Memo


administrative appeals19
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.



administrative appeals cont
Administrative Appeals Cont.

All requests for review of an administrative denial must be submitted in writing within 30 days of the receipt of the denial notification.



  • Quality indicators of OP LOC? - How do you know if you are providing quality services?
  • Recovery and OP - How are you using Recovery Principles in OP treatment?
  • General feedback- How are things going?
  • How often should we meet?


helpful resources
Helpful Resources


  • Please check the CBHNP website at for current forms and instructions which discuss all levels of care and provide procedural guidelines.
  • Provider Manual is on the web
  • Next Meeting: