GHI Providers: Applied Behavior Analysis (ABA) Coding Change Update ValueOptions, Inc. is a Beacon Health Options company.

Transcription

1 GHI Providers: Applied Behavior Analysis (ABA) Coding Change Update 2015 ValueOptions, Inc. is a Beacon Health Options company. 1

2 Objectives Overview of AMA CPT Code Changes Impacted CPT Codes Authorization Procedures & Claim Submission Contact Information CPT is a registered mark of the American Medical Association. 2

3 Overview of CPT Code Changes American Medical Association s (AMA) CPT codes are meant to reflect services as they are actually rendered Two codes may now be used to provide a method for billing supervision services New services have been added for severe behavior Meaning child is at risk for hurting him or herself, others or property These codes carry higher rates and are intended to have support built into the service to protect the patient and provider Indirect services (case management) will no longer be covered Additional new services include parent training without the child (single and multiple families) 3

4 Association of Professional Behavioral Analysts (APBA) Recently an agreement was reached for ABAI, APBA, the Behavior Analyst Certification Board, and Autism Speaks to be co-applicants on a proposal to modify the codes before they become permanent. APBA will be represented on the Steering Committee that will guide development of the code change proposal by Executive Director Gina Green, with Board member Bryan Davey serving as the alternate. APBA has also nominated several providers and health plan representatives to the workgroup that will develop the proposal, and will make every effort to solicit input from others. If you have suggestions for modifying the Category III CPT codes, please send them to ggreen@apbahome.net. 4

5 Impacted CPT Codes ValueOptions, Inc. is a Beacon Health Options company. 5

6 AMA ABA Code Crosswalk effective for GHI January 1, 2016 This crosswalk is also posted on our ABA Network-Specific page 6

7 AMA ABA Code Crosswalk Cont d 7

8 AMA ABA Code Crosswalk Cont d Additional information, included an updated FAQ, is posted on our ABA Network- Specific page 8

9 Summary AMA CPT codes are meant to reflect services as they are actually rendered Note new services added Indirect services (case management) will no longer be covered PLEASE NOTE: CPT code interpretations are meant for applicable ValueOptions contracts ONLY New CPT codes may not apply to all ValueOptions contracts Other health plans may interpret codes differently Billing with the new codes may begin for dates of service on or after January 1,

10 Authorization Procedures & Claim Submission ValueOptions, Inc. is a Beacon Health Options company. 10

11 Authorizations & Claims Authorizations through December 31, 2015 will be created using the existing ABA coding structure New or continued authorizations dated January 1, 2016 will be created using the new AMA ABA coding Billing with the new codes may begin for dates of service on or after January 1, 2016 NOTE: All billing should be based on the coding used on the specific authorization, unless otherwise noted. Follow existing claim submission process 11

12 Paper ABA Forms For forms, visit and click on Providers and Forms, and then look for Clinical Forms on the right side of the page ABA forms are at the bottom of the page on the left 12

13 Contact Information Provider Service Line (General Questions) Monday through Friday, 8:00 a.m. 8:00 p.m. ET Phone: (800) New York Provider Relations (GHI ABA coding Questions) GHI ABA Claims Information Electronic Payer ID: Claims Mailing Address: EmblemHealth PO Box 2832 New York, NY If you have suggestions for modifying the Category III CPT codes, please them to Gina Green at 13

14 Thank you 14