Applied Behavior Analysis (ABA) Provider Update March 2015

Transcription

1 Applied Behavior Analysis (ABA) Provider Update March 2015

2 Objectives Overview of Horizon Blue Cross Blue Shield of New Jersey Behavioral Health Program AMA CPT Code Changes Impacted CPT Codes with New Rates Claim Submission and Authorization Procedures ProviderConnect SM Contact Information Questions CPT is a registered mark of the American Medical Association. 2

3 Overview of Horizon Behavioral Health CPT Code Changes Horizon Behavioral Health is increasing the reimbursement rates on four of the American Medical Association s (AMA) CPT codes. Two of the codes (0368T and 0369T) may now be used to provide a method for billing for supervision services. We are taking this action due to the lack of a distinct supervision code in the AMA s CPT temporary code set. The increased rates and the billing method are intended to provide appropriate compensation for both the technicians rendering ABA services and the physicians or Board Certified Behavioral Analysts (BCBAs) supervising the technician who actually provides the ABA service. Use of codes 0368T and 0369T for supervision services is temporary until such time as the AMA revises the code set to include distinct codes for that purpose. 3

4 Impacted CPT Codes with New Rates 4

5 Updated Rates Retroactive to 7/1/14 New AMA Code Description Rate 0364T +0365T 0368T +0369T Adaptive behavior treatment by protocol, administered by technician, face-to-face with one patient; first 30 minutes of technician time. Adaptive behavior treatment by protocol, administered by technician, face-to-face with one patient; each additional 30 minutes of technician time (list separately in addition to code for primary procedure). Adaptive behavior treatment with protocol modification administered by physician or other qualified health care professional with one patient; first 30 minutes of patient face-to-face time. Adaptive behavior treatment with protocol modification administered by physician or other qualified health care professional with one patient; each additional 30 minutes of patient face-to-face time (list separately in addition to code for primary procedure). $25.75 $25.75 $36.00 $36.00 A full listing of the new AMA codes, including definitions and fee schedules, can be viewed online at NaviNet.net. 5

6 Claim Submission & Authorization Procedures 6

7 Claims & Authorizations Claims for directly rendered ABA services using these four codes will be reprocessed with the new fee schedule retroactive to 7/1/14. You will not need to resubmit these claims. Any claims processed under the former H codes will not be reprocessed. The Horizon Behavioral Health Clinical Team will provide a listing to you with the number of direct hours provided for each member along with the recommended number of supervision hours. Once we receive confirmation from you that the number of supervision hours is accurate, the authorization will be created using the existing authorization number so you can submit claims for the supervision component. Claims for supervision services will need to be submitted as an initial claim. 7

8 Claim Submission Guidelines Submit claims electronically to Horizon BCBSNJ. After logging into NaviNet.net, mouse over Claim Management and select CMS 1500 Claim Submission If you are not able to submit electronically, you can send paper claims to our new address: Horizon BCBSNJ Horizon Behavioral Health PO Box Newark, NJ Reminder: Submit claims with the proper suffix based on tax ID to ensure claim is properly adjudicated. 8

9 ProviderConnect 9

10 ProviderConnect and Navinet Transaction NaviNet ProviderConnect Claim Submission View Member Benefit Information X X Verify Member Eligibility X X Access and Print Forms X X Download and Print Authorization Letters Request and View Authorizations Access to Message Center to Submit Customer Services Inquiries X X X Submit Recredentialing Applications X INCREASED CONVENIENCE, DECREASED ADMINISTRATIVE PROCESSES Disclaimer: Please note that ProviderConnect may look different and have different functionalities based on individual contract needs, therefore some functions may not be available or may look different for your specific contract. 10

11 ProviderConnect Registration Process New and current ProviderConnect users need to fax a completed Account Request form to Account Request form to register for ProviderConnect is located at Valueoptions.com/providers/Forms/Administrative/Online_Services_A ccount_request_form-editable.pdf Providers who already have a ProviderConnect account need to submit a new form to request an additional login ID to access Horizon BCBSNJ member information Horizon BCBSNJ providers need to mark the box for Horizon Behavioral Health Authorizations Providers who do not know their Provider ID can contact the Provider Services Line at , Monday through Friday, between 8 a.m. and 8 p.m., Eastern Time (ET) If there are any questions on the form, providers can contact the EDI Helpdesk at , Monday through Friday, between 8 a.m. and 6 p.m., Eastern Time (ET) 11

12 ProviderConnect Resources ValueOptions.com/Providers/Provider Connect Free demonstration: Valueoptions.com/PMC_prototype/ ProviderConnect/pvd.html Quick Start Guide and Comprehensive User Guide Short Video Tutorials: Viewing Member s Eligibility Submitting Authorizations Submitting an Inpatient or Higher Level of Care Request Responding to Requests for Additional Clinical Information Recredentialing 12

13 ProviderConnect - Horizon BCBSNJ Providers 13

14 ProviderConnect - Horizon BCBSNJ Providers 14

15 Contact Information 15

16 Provider Contacts Authorizations and Care Management ABA Treatment Request and Treatment Plan Report Submission: Fax: NaviNet or NaviNet.net 16

17 Provider Contacts, continued Provider Relations, Credentialing and Contracting Questions: Monday through Friday, between 8 a.m. and 8 p.m., Eastern Time (ET) Complaints, appeals and/or general inquiries or (for NJ State Health Benefits Program) 17

18 Helpful Links Network-specific Website: valueoptions.com/horizon valueoptions.com/horizon/aba NaviNet NaviNet.net 18

19 Questions? 19

20 Parking Lot 20

21 Fee Schedule 21