SoonerCare Provider Changes: Master Provider Numbers and Individual Rendering Provider Information

Transcription

1 SoonerCare 2011 Outpatient Behavioral Health Agency Provider Changes: Master Provider Numbers and Individual Rendering Provider Information

2 Two upcoming changes in 2011 for OPBH agencies will be discussed today: Master Prior Authorization IDs Enrolling OPBH agency staff (individuals) with OHCA and listing the individual rendering provider number on all OPBH agency claims

3 Who to call (800) Provider Services Claims: Option 1 Provider Enrollment contract: t Option 5

4 Erin Meyer, LMFT Oklahoma Healthcare Authority (405) org Please feel free to call or if you Please feel free to call or if you have questions.

5 All of the OHCA changes for OPBH agencies will go into effect on 7/1/11. Unless otherwise notified.

6 7/1/2011: Master Provider ID versus Site Specific Provider IDs Authorizations: The Master PA ID is a no biller OPBH agency provider number and will be used for your prior authorizations only. Claims: The site specific OPBH Agency provider number will need to be listed on the claims as well as the OPBH Agency individual rendering provider number.

7 Wait for the green light to start Wait until 7/1/11: Do not start adding the individual rendering provider to your claims. Do not start using the master PA ID on your prior authorization requests. Start Now: Do start enrolling your staff now by completing the individual OHCA applications on EPE (Electronic Provider Enrollment).

8 Master Prior Authorization ID What is it? These ID #s will be automatically assigned by OHCA for all OPBH agencies. The Master IDs will be set up as No Billers in MMIS and no NPI will be required. Master IDs will be the agency # + a new site code which will be set as the specialty type: "Master PA ID".

9 Master Provider Number Information for OPBH Agencies The notification letter for the assignment of the Master provider number will say that you have a new contract with OHCA with a provider specialty type 124 "Master PA ID". This Master PA ID will be used on all prior This Master PA ID will be used on all prior authorizations effective 7/1/2011.

10 Master Provider ID Benefit: Agencies with multiple sites will no longer have to identify how the procedure code group dollar cap is going to be split by submitting letters of collaboration.

11 Master ID Prior Authorizations Effective 7/1/2011: In the web based prior authorization request system, the current OPBH agency site numbers will be disabled. They will not be available for generating prior authorizations. The only number that will be available for PAs will be the "Master PA ID".

12 EDI Vendors If you use an EDI vendor for your PA and Claims processes, then have them immediately begin to submit your claims with your Agency Site ID number in both the Billing Provider and the Rendering Provider fields on the 837.

13 If you file your claims in hard copy or using the provider s secured website, then you will make NO changes until July 1st.

14 Claims 7/1/11 OHCA will require the following information on claims: 1. No change: The billing information field will require: OPBH Agency NPI, OPBH Agency Taxonomy and OPBH Agency SC Provider. 2. New requirement for OPBH agencies: The rendering gprovider information be also be required on the claim: Rendering NPI and the SC Rendering.

15 Billing Information Section: OPBH Agency NPI OPBH Agency Taxonomy OPBH Agency SC Provider Detail Information Section: Rendering NPI SC Rendering

16 Back Billing Instructions for 6/30/2011 to 7/1/2010 Once the changes (Master PA ID and individual rendering provider IDs) go into effect on 7/1/2011, all claims submitted after this date will require the rendering provider information. Key Point to Remember: This will be applicable for any claims submitted after 7/1/2011 that have a service date of 7/1/2010 or greater.

17 OPBH Agency Individual rendering providers enrolled before 7/1/2011 All of these individual rendering gproviders enrolled up to 7/1/2011 will have their provider enrollment applications back dated to 7/1/2010. The purpose of this is to allow for any back billing. The exception to this rule is if the certification or license has an issue date that falls after 7/1/2010.

18 Electronic Provider Enrollment Have no fear. It is easy.

19 You can start now All individual rendering providers who work for an OPBH agency will need to complete a provider enrollment application.

20 Critical Step for OPBH Agencies There are two ways to add individuals to your OPBH Agency Contract: 1. The individual can add the agency when they are completing the individual application; or 2. After an individual has completed their individual enrollment application and they have been assigned an individual provider number, the agency can log on and add them as a member of the OPBH Agency group.

21 NPPES National Plan & Provider Enumeration System You will need an NPI. Welcome.do

22 NPI application will ask for a taxonomy Things to know about taxonomy: Definition: Taxonomy is the practice and science of classification. In the list of taxonomy choices for your profession or provider type, there may not be an exact match. It is acceptable to pick the closest description. It is up to you to decide which one you want to list. It does not have to be exact. Do not ask me to choose for you.

23 EPE can be used for the following: First-time applicants can use the online application to complete an enrollment application and sign a provider contract. Providers can renew their contract online. Providers can make updates or corrections to their contracts.

24 Choose Enrollment

25 Before you start your application (EPE) It is helpful to have the following information: NPI Licenses and/or certifications number, original issue date, effective date and expiration date. The OPBH agency s SoonerCare provider number. Service location, mailing address, and the pay to address, phone, fax and . For some providers, these will be different locations. Contact person for enrollment, clinical services and electronic payments. The first and last name, phone, fax and will be needed on the application.

26 4 easy steps to complete your application Complete Enrollment Form. Read Provider Agreement. Electronically sign your application. Fax copies of all requested documentation to OHCA.

27 First page of the Electronic Provider Enrollment (EPE) site.

28 You do not have to complete the application in one session. You will be able to save your information and return later. You will have 30 days from the time of the last save to submit the application.

29 Create a User Account A separate user ID for each individual who is enrolled is required. It is helpful l to create an excel spreadsheet.

30 Provider Contract Selection. Choose Individual.

31 OPBH agency individual providers have two application choices: Licensed Behavioral Health Practitioner Para-Professional

32 Next step: Choose the type of provider you are enrolling.

33 OPBH Agency Contract Types (Choices) Licensed BH Practitioner Advance Registered Nurse Practitioner Certified Clinical Social Worker (LCSW) LADC LMFT LBP LPC Physician Assistant *Physicians will complete a different contract. Para-Professional Behavioral Health Aide BHRS CADC CACD supervised Certified ASI CM I, II or III Certified CASI or TASI Certified Nurse Assistant RSS (Community Recovery Support Specialist) Employee Consultant Family Support and Training Provider Intensive CM II or III Licensed Practical Nurse MST Nationally Certified Gambling I or II Peer Recovery Support Specialist (PRSS) Prevention Specialist Registered Nurse Wrap Around Facilitator CM II or III

34 If you choose LHBP, this is what you will see next:

35 LBHPs need to choose Group/Corp FEIN when applying for their OPBH Agency: LBHPs have choices on how they will report payments to the IRS: Personal SSN, Personal FEIN Or Group/Corporate FEIN. FEIN: Federal Employer Identification Number Para-professionals do not have a choice regarding g their payments. The only choice is group/corporate FEIN. They only have one choice: OPBH agency. The agency s private banking information is not available. They do not have access to it. All group/corporate individual provider IDs are set up as No-billers. LBHPs need to choose Group if they are enrolling to work for an agency. They will be issued a no- biller provider number.

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37 LBHPs If you have an individual contract and report your payments to the IRS under your SSI or personal FEIN, and you work for an OPBH agency, you will need to have two OHCA provider ID numbers: 1. The private practice provider ID will be set up as a yes- biller ID; and the 2. OPBH agency individual provider ID will be set up as a no-biller ID. Important Point to Remember: Yes biller IDs can not be added to an OPBH agency s group. These individuals will need to submit an application to obtain a no-biller ID.

38 Para-Professional Screen Shot Read provider agreement

39 Provider Agreement for Para-Professionals: Here it is. Next slide will explain SPECIAL PROVISIONS FOR BEHAVIORAL HEALTH PARAPROFESSIONALS 1. THE PURPOSE OF THIS AGREEMENT IS FOR PROVIDER TO IDENTIFY HIMSELF/HERSELF AS A BEHAVIORAL HEALTH PARAPROFESSIONAL RENDERING SERVICES AT ONE OR MORE SOONERCARE-CONTRACTED OUTPATIENT BEHAVIORAL HEALTH AGENCIES. 2. PROVIDER STATES THAT HE/SHE HAS BEHAVIORAL HEALTH CERTIFICATIONS AS INDICATED IN THE PROVIDER INFORMATION. PROVIDER AGREES TO MAINTAIN ALL CERTIFICATIONS DURING THE TERM OF THIS CONTRACT. SHOULD PROVIDER?S CERTIFICATIONS BE MODIFIED, SUSPENDED, REVOKED, OR IN ANY OTHER WAY IMPAIRED, PROVIDER SHALL NOTIFY OHCA IN WRITING WITHIN THREE BUSINESS DAYS OF SUCH ACTION. IN THE EVENT PROVIDER S CERTIFICATIONS ARE MODIFIED, PROVIDER SHALL ABIDE BY THE TERMS OF THE MODIFIED CERTIFICATIONS. IN THE EVENT OF SUSPENSION, REVOCATION, OR OTHER ACTION MAKING IT UNLAWFUL FOR PROVIDER TO PROVIDE SERVICES UNDER THIS AGREEMENT, THE AGREEMENT SHALL TERMINATE IMMEDIATELY. A VIOLATION OF THIS PARAGRAPH, AT THE TIME OF EXECUTION OR DURING ANY PART OF THE AGREEMENT TERM, SHALL RENDER THE AGREEMENT IMMEDIATELY VOID. 3. PROVIDER AGREES THAT ALL SERVICES RENDERED BY PROVIDER TO SOONERCARE MEMBERS SHALL BE BILLED BY THE SOONERCARE-CONTRACTED OUTPATIENT BEHAVIORAL HEALTH AGENCY (IES) INDICATED IN PROVIDER S PROVIDER INFORMATION AND THAT PROVIDER SHALL NOT BILL ANY SERVICES INDIVIDUALLY. 4. THE TERM OF THIS AGREEMENT SHALL EXPIRE ON JUNE 30, 2013.

40 Para-Professional Provider Agreement Explained 1. Explains the agreement: The purpose p is identification of the provider. 2. Basically says that you will stay in compliance with your certifications. 3. Agreement to allow payment for your services to be billed by your agency. 4. Expiration date: 6/30/2013. You will need to re-enroll or renew your application.

41 This page begins the completion of the application Application sections to complete: 1. Personal 2. Professional 3. Location & addresses 4. Contacts 5. Payments

42 Para-Professional Professional Choices Choose the type.

43 Para-Professional: If there is no end date, then list 12/31/2299 This drop down box will list the different choices.

44 LBHP Under Supervision You will complete the LBHP application. You will need to fax to OHCA the board approved supervision agreement. When you become fully licensed, this information will need to be updated. In this section of the application, please add this information: License Number: 000 Issuing State: Oklahoma (This is a requirement) Original Issue Date: List the current date Expiration Date: 12/31/2299

45 List your addresses on the next screen: 1. Service location 2. Mailing address 3. Pay to address

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47 List your contacts Please tell us how to correspond with you if we have questions or information for you regarding your: 1. Enrollment application and contract: Who should we contact if we have questions about your enrollment application? This would be the person who can answer questions about anything in this application or for contract correspondence. 2. Clinical services: Who should we contact with questions or correspondence relating medical or clinical services? 3. Electronic payments: Who should we contact with questions or correspondence relating to electronic payments? t?

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49 The payment screen will require the OPBH agency SoonerCare e provider ID

50 Electronically sign your application and fax copies of all requested documentation to OHCA.

51 This screen gives you an opportunity to check your application for any errors.

52 Here is the screen for your electronic signature

53 Electronic Signatures: A person from the individual s staff can also sign the contract electronically if the individual provider has a written security policy that authorizes the person to do so.

54 OHCA fax cover sheet is required.

55 Important steps for successful individual provider enrollment: Use OHCA s fax cover sheet ONLY. Your fax will not be accepted unless this form is used. The fax cover sheet must be the top sheet. NO batch faxing. Each individual application must be faxed separately. You will get a letter when the application has been successfully processed. Notary is not required. Each application requires a new user ID and pass word. If you are going to enter multiple providers, you will need to create a spread sheet to keep track of the information.

56 Other details regarding individual provider enrollment: It is estimated to take 5 to 10 business days to process the application once the fax has been received. The faxed received date of the required materials is very important. The application start date can be retroactive 30 days from the fax received date. For example, the fax date is March 1, You can have a start date for the individual provider of January 30, 2011.

57 Other important points to note about the individual application: The individual provider number belongs to the individual. The individual provider number will be the same regardless of the location or if they work for different agencies. The individual needs to be able to access their application. The individual applications do not contain the OPBH agency s private information.

58 If the individual works for more than one OPBH agency: New Employees: The OPBH agency can add the individual to their group once the individual application exists in the system.

59 Questions, Comments