IHCP Workshop: Combined Behavioral Health Presentation. Quarter 2, 2017

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1 IHCP Workshop: Combined Behavioral Health Presentation Quarter 2, 2017

2 Introduction Agenda Policy Updates Hoosier Care Connect transition MCE s contact information Roundtable discussion

3 Introduction

4 Policy Updates IOP: Effective Feb. 1, 2017, all four MCEs will begin covering Intensive Outpatient Services. These services will require Prior Authorization (PA). Facility Services UB04 use: CPT Code Rev Code 905 Psychiatric and 906 Chemical Dependence Professional Services CMS 1500 use: CPT Code S9480 Psychiatric and H0015 Chemical Dependency Rev Code - None

5 Policy Updates PA Reminder For majority of outpatient services, PA is not required for contracted participating providers Applied Behavior Analysis (ABA) therapy - Codes , (with modifiers U1, U2, U3) require PA.

6 Prior Authorization and Screenings Anthem: Does not need PA: PA required: All BH screenings are considered routine services Inpatient, ABA services, and do not require a PA. neurological/developmental/psychological testing, Neurological and Psychological testing does not PHP, IOP require a PA, unless out of network and greater Confirmatory test for drug screens, not dip sticks than 8 hours of testing. require a PA. MDwise: Does not need PA: PA required: All the BH screenings will fall under routine Inpatient, ABA services, services for BH, they require notification if they neurological/developmental/psychological testing, will continue to see the Anthem member, not PA. PHP, IOP Screenings do not require PA. Does not need PA: CareSource Screening & Brief Intervention Services (SBI) - To locate Urine Drug Screen Policy: Drug/Alcohol Abuse ( ) Urine Drug Screens Medical benefit and do not Specific policies: require PA MHS mm-0054/ PA required therapy, Inpatient, Detox, ABA services, ECT, in-home PA required: neurological/developmental/psychological testing, Inpatient, ABA services, PHP, IOP PHP, IOP

7 Where to find PA lists Go to the appropriate MCE PA guide to verify which services need PA Anthem CareSource For HIP: For HHW: MDwise MHS

8 Behavioral Health vs Medical Anthem BH follows same Appeals/Disputes as Medical Anthem: Indiana Provider Disputes/Appeals PO Box Virginia Beach, VA PA forms found at: CareSource Use the Universal PA Form Claims submitted same as Medical P.O. Box 3607, Dayton, OH for HIP and HHW Appeals: MDwise Use the Universal PA form Follow PA Quick Contact Guide to know where to send PA and Claims Follows same Appeals/Disputes process as Medical MHS Cenpatico Website: Claims Address: Cenpatico PO Box 6800, Farmington, MO Appeals Address: Cenpatico PO Box 6000, Farmington, MO Medical Necessity Appeals: Cenpatico, Appeals Coordinator, Research Blvd, Suite 400, Austin TX OR fax to Claims Support: Payor Id: Cenpatico s Secure Web Portal: Credentialing

9 Hoosier Care Connect (HCC) Effective April 1, 2017, MDwise HCC members have transitioned to Anthem and MHS. Please verify authorizations for those members Members had until March 15, 2017 to select either Anthem or MHS as their new MCE. When member chose their MCE would determine effective dates of either March 1, March 15 or April 1 Members who did not choose either Anthem or MHS by March 15, 2017 were auto-assigned to one of the MCE s effective April 1, Please refer to IHCP Bulletin BT for more details.

10 MCE Behavioral Health Contacts

11 Donnica Hinkle, LMHC Statewide Behavior Health Network Education Rep. Sr. (317) Additional contact information

12 Denise Edick Manager Health Partnerships: (317)

13 Nichole Young, RN Statewide Behavioral Health Provider Relations Representative (317) Holli Mahoney, LMHC Behavioral Health Manager (317) for Behavioral Health questions

14 Kelvin Orr Director, Network Operations x m Richard Elliott Manager, Network Development x Provider representative by territory Mary Schermer - West Provider Relations Specialist x Mschermer@mhsindiana.co m LaKisha Browder - East Provider Relations Specialist x lbrowder@mhsindiana.com

15 Roundtable Discussion Questions?