LETTER OF INTENT TO CONTRACT WITH AMERIHEALTH CARITAS VIRGINIA FOR THE PROVISION OF SERVICES TO VIRGINIA MEDICAID RECIPIENTS
|
|
- Cora Reynolds
- 6 years ago
- Views:
Transcription
1 LETTER OF INTENT TO CONTRACT WITH AMERIHEALTH CARITAS VIRGINIA FOR THE PROVISION OF SERVICES TO VIRGINIA MEDICAID RECIPIENTS AmeriHealth Caritas Virginia, Inc., a member of the AmeriHealth Caritas Family of Companies, is currently developing a network of hospital, physician and ancillary healthcare providers in order to qualify as a Virginia health maintenance organization, with the ultimate goal of entering into a contract with the Virginia Department of Services ( DMAS ). The goal of partnering with DMAS is to arrange for the delivery of health care services to individuals under DMAS proposed Managed Long Term Services and Supports ( MLTSS ) initiatives. Please sign below to indicate your intent to enter into contract negotiations with AmeriHealth Caritas Virginia for the provision of health care services to recipients who will be enrolled with AmeriHealth Caritas Virginia if we enter into a contract with DMAS. Please also complete the Provider Information Attachment. Providing specific information regarding your practice(s) and/or facility will help AmeriHealth Caritas Virginia demonstrate provider network adequacy as well as provide you with the appropriate provider contracts in the near future. This Letter of Intent is non-binding; signing this Letter of Intent does not obligate you to sign a contract with AmeriHealth Caritas Virginia. Either you or AmeriHealth Caritas Virginia can terminate this Letter of Intent at any time by notifying the other party in writing. By signing this Letter of Intent, you agree to allow AmeriHealth Caritas Virginia to identify you to DMAS and to the Virginia Bureau of Insurance ( BOI ) as a potential provider in the AmeriHealth Caritas Virginia provider network. AmeriHealth Caritas Virginia will not otherwise identify you as being affiliated in any manner with AmeriHealth Caritas Virginia until you have signed a definitive provider agreement with AmeriHealth Caritas Virginia. DMAS and BOI may use this Letter of Intent to evaluate AmeriHealth Caritas Virginia s qualification as a health maintenance organization. Please check all boxes that apply: Provider Identified below is a Virginia Provider Provider is not currently a Virginia Provider but intends to apply This Letter of Intent may be subject to review or approval by DMAS and may be amended by AmeriHealth Caritas Virginia to comply with the requirements of DMAS. Please fax the signed Letter of Intent and completed provider information attachment to or mail/ it to AmeriHealth Caritas Virginia, PO Box 406, Essington, PA ProviderEnrollment@AmeriHealthCaritas.com no later than June 6 th, 2016 Contact Provider Network Management at or AmerihealthCaritasIntake@amerihealthcaritas.com for questions. 1
2 Group/Entity Information: Contract entity name: Entity taxonomy number: Entity tax ID number Entity NPI number: NPI not applicable Yes No Waiting for NPI: Yes No Virginia number: Entity mailing address: Primary contact Phone number: Authorized signature: Printed name: Title: Date: By providing your address above, you grant AmeriHealth Caritas Virginia permission to contact you via regarding participation in our provider network. Please let us know, at any time, if you wish to stop receiving communications from AmeriHealth Caritas Virginia via . 2
3 Main Provider Name (as written on W9): Entity type: Individual Group Facility Provider TIN/EIN # (9 characters): 24 Hour Access: Yes No 24 Hour Answering Service: Yes No Primary Contact Name: Primary Contact Primary Contact Phone: Primary Language Spoken: Other Languages Spoken: Location Main Location 1 Name (as it will appear in Provider Directory) Street Address Bldg # and/or Ste # City State Zip + 4 Digits Facility Type (ex., SNF, Case Mgmt., Hospice) Taxonomy Code Site/Group NPI Telephone w/ Area Code *Waiver Type (1,2,3,4,5,6,7,8) Location 2 Location 3 Location 4 Location 5 Location 6 Location 7 Please feel free to attach an additional document if more space is required. *HCBS Providers Only (Please add which waivers you serve at each location above.) Day Support (1) DD (2) EDCD (3) ID (4) Tech (5) AAL (6) HIV/AIDS (7) Other: (8) Page 1 of 3
4 Practitioner Roster If you will be credentialed as an organization/facility and will not credential your clinicians/practitioners separately you do not need to complete this page. Initial here if leaving this page blank Location (From # listed above) First Name Last Name MI Degree Specialty CAQH Reg. # Individual NPI Number and Primary Taxonomy Code (10 characters) ID and ID Numbers PCP Yes Page 2 of 3
5 Long Term Services & Supports, Substance Use Disorder and Community Based Mental Health Providers only. Please mark procedures you offer, and indicate the location (# from page 1) where the service is provided. Please use more than one form if there are multiple locations with differing services. Location where these procedures are offered (from page #1, example: Main, 1, 2, 3, etc.) Billed Procedure and Revenue Codes By Location Substance Use Disorder (SUD) Proc/Rev Code Description 0906 Intensive OP Svcs Chemical Dependency 0913 Partial Hospitalization - Intensive 1002 Residential Treat Chemical Dependency SA Out Patient, Interactive Complexity 90791HO Psychiatric diag eval, no Medical, Masters 90791HP Psychiatric diag eval, no Medic, Doctorate Psychiatric Eval, w/ Medical MD/DO Psychotherapy, 30 min Psychotherapy, 45 min Psychotherapy, 60 min Family Psychotherapy Group Psychotherapy Office/OP Visit New Pt: L Office/OP Visit New Pt: L Office/OP Visit New Pt: L Office/OP Visit New Pt: L Office/OP Visit New Pt: L Office/OP Visit Established: L Office/OP Visit Established: L Office/OP Visit Established: L Office/OP Visit Established: L Office/OP Visit Established: L5 G9012 Other specified case management H0006 SUD Case Management H0007 SUD Crisis Intervention H0010 Alcohol and/or drug services H0011 Alcohol and/or drug services; sub- acute detox (residential addiction program IP) H0014 Alcohol and/or drug services; ambulatory detoxification H0015 H0020 H0035 H0038 H2034 Intensive Outpatient (IOP) Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) Partial Hospitalization Self- help/peer services, per 15 minutes Alcohol/drug abuse halfway house services, per diem H2036 Q3014 S9445 S9446 T1012 Alcohol and/or other drug treatment program, per diem SUD TeleHealth Patient education, not otherwise classified, non- physician provider, individual, per session Patient education, not otherwise classified, non- physician provider, group, per session Alcohol and/or substance abuse services, skills development Long Term Services & Supports Providers Proc/Rev Code Description S5102 Adult Day Health Care T1999 T1000 T1031 T1030 Assistive Technology Only Congregate Nursing/RN or LPN Congregate Respite Nursing/LPN Congregate Respite Nursing/RN Environmental Modification, Maintenance Costs Only S5165 Environmental Modifications Only S5160 PERS Installation S5185 S5161 H2021 T1019 T1005 S9125 S5109 H2000 S5116 T1028 PERS Medication Monitoring PERS Monitoring PERS Nursing Services/LPN or RN Personal Care Respite Care Respite Care LPN Service Facilitation Consumer Training Visit Service Facilitation Initial Comprehensive Visit Svc Facilitation Mgmt Training Hours Svc Facilitation Reassessment Visit Service Facilitation Routine Visit T1003 T1002 H2015 Skilled Nursing Services/LPN Skilled Nursing Services/RN Transition Coordination Non-Traditional Mental Health Services Proc/Rev Code Description H0023 Mental Health Case Management H0035 HA Therapeutic Day Treatment (TDT) for Children H0035 HB Day Treatment/ Partial Hospitalization for Adults H0036 Crisis Intervention H0039 H0046 H2012 H2017 H2019 H2020 H2022 T1016 H2033 H0038 T1012 S9445 S9446 Intensive Community Treatment Mental Health Skill- building Services (MHSS) Intensive In- Home Psychosocial Rehab Crisis Stabilization Level B Group Home Level A Group Home Treatment Foster Care Case Management Multi- systemic Therapy (ABA) Self- help/peer services, per 15 min Alcohol and/or substance abuse services, skills development Patient education, not otherwise classified, non- physician provider, individual, per session Patient education, not otherwise classified, non- physician provider, group, per session Page 3 of 3
Medicare Behavioral Health Authorization List Effective 5/26/18
100 All inclusive room and board 101 All inclusive room and board 104 Anesthesia, ECT 114 Room and Board- private psychiatric 116 Room and Board- private room detoxification 118 Room and Board- private
More informationGuide to Provider Forms
Guide to Provider Forms ACTION Add a Provider to the group YOU WILL NEED TO COMPLETE THE SECTIONS IDENTIFIED BELOW ON THE PROVIDER INFORMATION UPDATE FORM (PIF) AND ANY ADDITIONAL DOCUMENTS LISTED. ALL
More informationAmeriHealth Caritas North Carolina Provider Data Intake Form
AmeriHealth Caritas North Carolina Provider Data Intake Form Section 1 instructions: Please complete all fields below for the provider. Entity name (as written on W9): IPA name (if applicable): Category:
More informationTBH Medicaid Participating Provider ARQ Page 1
TBH Medicaid Participating Provider ARQ Page 1 Room & Board Inpatient 90785 Interactive complexity code 90791 90792 90832 Room & Board Inpatient Psych Per Diem Psychiatric diagnostic evaluation Psychiatric
More informationMAGELLAN UNIVERSAL SERVICES LIST - Includes Preferred HIPAA Compliant Codes. UB-04 Revenue Codes
Service Name & Detailed Magellan Description (see column heading explanations at end of this document) MAGELLAN UNIVERSAL SERVICES LIST - Includes Preferred HIPAA Compliant Codes Codes Used to Determine
More informationPROVIDER INFORMATION UPDATE FORM CURRENT CONTRACT INFORMATION - ALL FIELDS IN THIS SECTION ARE REQUIRED
PROVIDER INFORMATION UPDATE FORM CURRENT CONTRACT INFORMATION - ALL FIELDS IN THIS SECTION ARE REQUIRED 1. Type of Group: Ancillary Specialist PCP Hospital Urgent Care FQHC/RHC QFPP/ X Contracted Entity/Name:
More informationOptum/OptumHealth Behavioral Solutions of California Facility Network Request Form / Credentialing Application
Optum/OptumHealth Behavioral Solutions of California Is the facility currently in the Optum network? Yes No Acceptance into the Optum/OptumHealth Behavioral Solutions of California (Optum) provider network
More informationBehavioral Health Services in Ohio Hospitals Ohio Hospital Association. Ohio Department of Medicaid January 23, 2018
Behavioral Health Services in Ohio Hospitals Ohio Hospital Association Ohio Department of Medicaid January 23, 2018 1 Outpatient Hospital Behavioral Health Services 2 OPHBH Services in Hospitals Outpatient
More informationFacility-Based Behavioral Health Program Professional Fees Reimbursement Policy Annual Approval Date. Approved By
Policy Number 2016RP505A Facility-Based Behavioral Health Program Professional Fees Reimbursement Policy Annual Approval Date 09/30/2016 Approved By Optum Behavioral Reimbursement Committee IMPORTANT NOTE
More informationRehabilitative Behavioral Health Providers Frequently Asked Questions
Rehabilitative Behavioral Health Providers Frequently Asked Questions Q. What has changed regarding rehabilitative behavioral health services? A. Effective July 1, 2016, South Carolina Department of Health
More informationApplication Checklist for Facilities
Application Checklist for Facilities Please use the following checklist to complete the credentialing process. Current copies of all items listed below are required for each facility to participate with
More informationVolume 26 No. 05 July Providers of Behavioral Health Services For Action Health Maintenance Organizations For Information Only
Newsletter Published by the N.J. Dept. of Human, Div. of Medical Assistance & Health & the Division of and Volume 26 No. 05 July 2016 TO: SUBJECT: Providers of Behavioral Health For Action Health Maintenance
More informationFacility Data Intake Form
Section 1 instructions: Please complete all fields below for the facility and check the appropriate facility type. Facility name: Type: Ancillary Behavioral health Hospital MLTSS Name doing business as
More informationFacility/Agency Change Form
Facility/Agency Change Form Submit a Facility/Agency Change Form (FCF) per TIN. Do not submit changes for multiple TINs on FCF. The preferred method for completing the FCF is electronically. Hand written
More informationState of New Jersey Department of Human Services Division of Medical Assistance & Health Services (DMAHS)
State of New Jersey Department of Human Services Division of Medical Assistance & Health Services (DMAHS) Outpatient Facility Behavioral Health Integration Billing Frequently Asked Questions (FAQs) 1.
More informationAges Ages 3 through 64.
Medicaid: Follow-Up After Discharge from Community Hospitals, State Psychiatric Hospitals, and Facility Based Crisis Services for Mental Health Treatment The percentage of discharges for individuals ages
More informationBehavioral Health Providers: Frequently Asked Questions (FAQs)
Behavioral Health Providers: Frequently Asked Questions (FAQs) Q. What has changed as far as behavioral health services? A1. Effective April 1, 2012, the professional and outpatient facility charges for
More informationBehavioral Health Covered Benefits
https://providers.amerigroup.com Behavioral Health Covered Benefits The matrix below lists the available behavioral health benefits for members enrolled in the Iowa Health and Wellness Plan. Outpatient
More informationVA DMAS CMHRS, Residential, EPSDT Behavioral Therapy (ABA), and TFC Case Management Service Request Process
VA DMAS CMHRS, Residential, EPSDT Behavioral Therapy (ABA), and TFC Case Management Service Request Process Presented by: Katie Richardson, Lead IT Analyst Rick Kamins, Ph.D., Chief Clinical Officer, Magellan
More informationCMHRS APPLICATION PACKET
OPTIMA BEHAVIORAL HEALTH CMHRS APPLICATION PACKET Thank you for your interest in becoming a participating provider with Sentara Health Plans, dba Optima Behavioral Health (OBH). We are currently accepting
More informationBehavioral Health Covered Benefits
https://providers.amerigroup.com Behavioral Health Covered Benefits The matrix below lists the available behavioral health benefits for members enrolled in Medicaid programs. Iowa Health and Wellness enrollees
More informationSPECIALIZED BEHAVIORAL HEALTH SERVICES - CPT Codes (V2 Effective ) HA=Child. Modifier >
SPECIALIZED BEHAVIORAL HEALTH SERVICES - CPT Codes (V2 Effective 1.1.18) Code Description Age Psychiatrist APRN/CNS/PA Medical Psychologist Psychologist LCSW LPC LMFT LAC HA=Child Modifier > HB=Adult AF
More informationPeach State Health Plan Covered Services & Authorization Guidelines Programs for Behavioral Health
Peach State Health Plan Covered s & Guidelines Programs for Health n-participating providers (those that are not contracted and credentialed with Peach State Health Plan) require prior authorization for
More informationApplication Checklist for Facilities
Application Checklist for Facilities Please use the following checklist to complete the credentialing process. Current copies of all items listed below are required for the facility to participate with
More informationSection V: To be completed by the PIHP contract manager as applicable. Section VI: To be completed by the PIHP Credentialing Committee as applicable.
Sections I-IV: To be completed by the organizational provider at the time of initial network application for enrollment and credentialing; or at the time of the biennial re-credentialing. Section I. Agency
More informationCovered Behavioral Health Services
Behavioral Health Services Covered Behavioral Health Services Cenpatico, Buckeye s behavioral health affiliate, has been delegated the provision of covered mental health and substance use disorder services
More informationCardinal Innovations Healthcare 2017 Needs and Gaps Analysis
2017 Community Mental Health, Substance Use and Developmental Disabilities Services Needs and Gaps Analysis for the Triad Region (Formerly known as CenterPoint Human Services) This study assesses the community
More informationOrganizational Provider Credentialing Application
Organizational Provider Credentialing Application New Mexico Organizational provider identification Legal business name (as reported to the IRS): Medicaid number: Doing Business As (DBA) name (if applicable):
More informationCOMMONWEALTH COORDINATED CARE PLUS. A Managed Long Term Services and Supports Program
COMMONWEALTH COORDINATED CARE PLUS A Managed Long Term Services and Supports Program Agenda Background and Key Facts Populations Services Regional Launch CCC Plus Enrollment 2 Overview of Commonwealth
More informationService Array: Mental Health Medicaid Specialty Supports and Services Descriptions Note:
Service Array: Mental Health Medicaid Specialty Supports and Services Descriptions Note: If you are a Medicaid beneficiary and have a serious mental illness, or serious emotional disturbance, or developmental
More informationPaula Stone Deputy Director, DMS, DHS
Paula Stone Deputy Director, DMS, DHS 1 Outpatient mental health services available to AR Medicaid beneficiaries include: Individual, family and group counseling services provided in an outpatient agency
More informationAdult Behavioral Health Home and Community Based Services Quality and Infrastructure Program: Improving Lives
Adult Behavioral Health Home and Community Based Services Quality and Infrastructure Program: Improving Lives April 30, 2018 2 Agenda for the Day Vision and Overview: HARP and BH HCBS Recovery Coordination
More informationAcute Crisis Units. Shelly Rhodes, Provider Relations Manager
Acute Crisis Units Shelly Rhodes, Provider Relations Manager Shelly.Rhodes@beaconhealthoptions.com Training Agenda Agenda: Transition and Certification Coverage of Services Service Code Definition Documentation
More informationVSHP/ Behavioral Health
VSHP/ Behavioral Health Deb Dukes & Dr Kelly Askins The contact numbers in the presentation apply to WEST Member Services ONLY. New numbers for EAST Member Services will be published and distributed by
More informationFacility and Ancillary Credentialing Application INSTRUCTIONS
Facility and Ancillary Credentialing Application INSTRUCTIONS Please complete the application thoroughly in its entirety. The checklist below may not be exhaustive of all materials, but is provided as
More informationBehavioral Health Concurrent Review
Today s date: Contact information Level of care: psych Anthem Blue Cross and Blue Shield Healthcare Solutions Please fax to 1-877-434-7578 on the last authorized day. detox chemical dependency Psychiatric
More informationNot Covered HCPCS Codes Reimbursement Policy. Approved By
Policy Number 2017RP506A Annual Approval Date Not Covered HCPCS Codes Reimbursement Policy 6/27/2017 Approved By Optum Behavioral Reimbursement Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY
More informationInnovative Ways to Finance Mental Health Services in a Primary Care Setting
Innovative Ways to Finance Mental Health Services in a Primary Care Setting Prepared by: Kathleen Reynolds, MSW, ACSW Executive Director And Virginia Koster, MSW, ACSW Integrated Initiatives Coordinator
More informationWeekly Provider Q&A Session 3 rd Quarter 2017
Weekly Provider Q&A Session 3 rd Quarter 2017 Type Issue/Agenda Item Response/Outcome/Updates Are providers allowed to bill for the MHSS service while a member is in hospital/acute care? It is important
More informationProspective Provider Information Form Organizational / Group Behavioral Health and Substance Use Providers
Prospective Provider Information Form Organizational / Group Behavioral Health and Substance Use Providers Please review our current provider network needs outlined on the Health Share of Oregon website
More informationBehavioral Health Provider Training: BHSO updates
Behavioral Health Provider Training: BHSO updates Agenda Diagnosis Code 799 Laboratory Work CPT Code Q3014- Telehealth BHSO Claims submission Process Targeted Case Management Diagnosis Codes Diagnosis
More informationCODES: H0045-U4 = Individual Respite H0045-HQ-U4 = Group Respite T1005-TD-U4 = Nursing Respite-RN T1005-TE-U4 = Nursing Respite-LPN
CODES: H0045-U4 = Individual Respite H0045-HQ-U4 = Group Respite T1005-TD-U4 = Nursing Respite-RN T1005-TE-U4 = Nursing Respite-LPN (b)(3) Respite Children MH/ID/DD/SUD and Adults with Developmental Disabilities
More informationJoining Passport Health Plan. Welcome IMPACT Plus Providers
Joining Passport Health Plan Welcome IMPACT Plus Providers Agenda Passport Behavioral Health Services Overview Steps to Joining Passport Health Plan s Network Getting a Medicaid Number Enrolling in the
More informationWeekly Friday Provider Call Agenda (09/22/2017) Program updates/announcements from today s meeting:
#1-IACCT Inquires for Youth Residing in DJJ *Note this was an email blast sent to providers on 09/15/2017 in summary: Effective October 1, 2017, we will be no longer accepting IACCT inquires for youth
More informationMedicaid Transformation
JOINT LEGISLATIVE COMMITTEE ON MEDICAID AND NC HEALTH CHOICE Medicaid Transformation Dr. Mandy Cohen, Dave Richard, Jay Ludlam Department of Health and Human Services Nov. 14, 2017 Recap: Where We Are
More informationPlease feel free to send thoughts to: We hope you enjoy this. Karl Steinkraus
Maryland enewsletter May 2016 Welcome to the new Beacon Maryland Newsletter Beacon Health Options has designed this new quarterly publication to assist providers in getting the news out to the Maryland
More informationPlace of Service Code Description Conversion
Place of Conversion CMS Place of Code Place of Name The place of service field indicates where the services were performed Possible values include: Code Description Inpatient Outpatient Office Home 5 Independent
More informationDrug Medi-Cal Organized Delivery System
Drug Medi-Cal Organized Delivery System Presented by Elizabeth Stanley-Salazar, MPH CMS Approval of DMC-ODS Waiver under ACA August 13, 2015 Pathway to Parity 2010 President Obama Signs the Affordable
More informationNETWORK ADEQUACY OF SPECIALIZED BEHAVIORAL HEALTH PROVIDERS OFFICE OF BEHAVIORAL HEALTH LOUISIANA DEPARTMENT OF HEALTH
NETWORK ADEQUACY OF SPECIALIZED BEHAVIORAL HEALTH PROVIDERS OFFICE OF BEHAVIORAL HEALTH LOUISIANA DEPARTMENT OF HEALTH PERFORMANCE AUDIT SERVICES ISSUED OCTOBER 18, 2017 LOUISIANA LEGISLATIVE AUDITOR 1600
More informationNorth Carolina s Transformation to Managed Care
North Carolina s Transformation to Managed Care Jay Ludlam, Assistant Secretary Department of Health and Human Services December 2017 My background Only 10+ years of experience in Medicaid Assistant Attorney
More informationCBHS100 MENTAL HEALTH SERVICES (MHS) & DRUG AND ALCOHOL SERVICES (DAS) PROVIDER DATA FORM
CBHS100 MENTAL HEALTH SERVICES (MHS) & DRUG AND ALCOHOL SERVICES (DAS) PROVIDER DATA FORM The purpose of this Provider Data Form (CBHS100) is to facilitate and track the set up of a new Mental Health (MHS)
More informationTips for Completing the CMS-1500 Version 02/12 Claim Form
Tips for Completing the CMS-1500 Version 02/12 Claim Form NOTE: FAILURE TO PROVIDE VALID INFORMATION MATCHING THE INSURED S ID CARD COULD RESULT IN A REJECTION OF YOUR CLAIM. Enter in the white, open carrier
More informationLOUISIANA MEDICAID PROGRAM ISSUED: 06/09/17 REPLACED: CHAPTER 2: BEHAVIORAL HEALTH SERVICES SECTION 2.2: OUTPATIENT SERVICES PAGE(S) 8
Licensed Practitioner Outpatient Therapy includes: Individual; Family; Group; Outpatient psychotherapy; Mental health assessment; Evaluation; Testing; Medication management; Psychiatric evaluation; Medication
More informationBehavioral Health Provider Training: Program Overview & Helpful Information
Behavioral Health Provider Training: Program Overview & Helpful Information 1 Overview The Passport Behavioral Health Program provides members with access to a full continuum of recovery and resiliency
More informationPrimary Care Mental Health for Veterans: Integrating Care. October 25, 2017
Primary Care Mental Health for Veterans: Integrating Care October 25, 2017 Integrated Care Mental Health Specialty Care Location On site, embedded in the primary care clinic A different floor,
More informationLCSW, RN Ther, LCPC. PHD Psych CRNP - PMH APRN - PMH
non-facili facili On- Off- OTHER PROFESSIONAL SERVICES FOR IOP, PHP & CRS 90791 iatric diagnostic evaluation 157.80 110.29 128.49 112.50 180.74 90791 C&A iatric diagnostic evaluation 157.80 110.29 128.49
More informationLegend. SAR = Service Authorization Request
= Comprehensive Clinical Assessment Sandhills Center Care/Utilization Management Legend = Service Authorization Request = Individual Support PA=Prior Approval = Person-Centered LOC = Level of Care Form
More informationSandhills Center Care/Utilization Management Service Certification Request Reviews. Legend
= Comprehensive Clinical Assessment Sandhills Center Care/Utilization Management Legend = Service Authorization Request = Individual Support PA=Prior Approval = Person-Centered LOC = Level of Care Form
More informationAccess to Adult BH HCBS for Non-Health Home Enrollees: The State Designated Entity. February 22, 2018
Access to Adult BH HCBS for Non-Health Home Enrollees: The State Designated Entity February 22, 2018 February 22, 2018 Agenda Overview of HARP and Adult BH HCBS What is a State Designated Entity? Becoming
More informationChildren Come First Covered Services Fee Schedule
Children Come First Covered Services Fee Schedule Covered Service: Assessment Inpatient Billing Unit Rate: [per hour] 99221 99222 99223 Neurological, psychiatric, developmental, functional behavioral,
More informationJMOC Update: Behavioral Health Redesign. December 15 th, 2016
JMOC Update: Behavioral Health Redesign December 15 th, 2016 2 Implementation Schedule BH Redesign 7/1/2017: Medicaid requires rendering (NPI) practitioner*, ORP, and/or supervisor on claims Go Live for
More informationJOB OPENINGS PIEDMONT COMMUNITY SERVICES
JOB OPENINGS PIEDMONT COMMUNITY SERVICES Our Excellent full time benefits package offers: Virginia Retirement with Employer match Paid Life Insurance = 2X Your Salary Partially Paid Medical Insurance +
More informationWORK PROCESS DOCUMENT NAME: Medical Necessity Review for Behavioral Health and Substance Use Disorder REPLACES DOCUMENT: RETIRED:
PAGE: 1 of 7 SCOPE: Coordinated Care Departments for Behavioral Health and Substance Use Disorder (SUD) Reviews for members enrolled in Integrated Managed Care and Behavioral Health Services Only PURPOSE:
More informationSANTA BARBARA COUNTY DEPARTMENT OF Behavioral Wellness A System of Care and Recovery. o--,-.m-a----,laa~-d-c~~~~~~~~~~-
Page 11 of 8 SANTA BARBARA COUNTY DEPARTMENT OF Behavioral Wellness A System of Care and Recovery Departmental Policy and Procedure Section Sub-section Alcohol and Drug Program (ADP) Policy Drug Medi-Cal
More informationMedicaid Managed Care Readiness For Agency Staff --
Medicaid Managed Care Readiness 101 -- For Agency Staff -- To Understand: Learning Objectives Basic principles of Managed Care as a payment vehicle for health care services The structure of the current
More informationState of Connecticut REGULATION of. Department of Social Services. Payment of Behavioral Health Clinic Services
R-39 Rev. 03/2012 (Title page) Page 1 of 17 IMPORTANT: Read instructions on back of last page (Certification Page) before completing this form. Failure to comply with instructions may cause disapproval
More informationProvider Handbook Supplement for Virginia Behavioral Health Service Administrator (BHSA)
Magellan Healthcare of Virginia * Provider Handbook Supplement for Virginia Behavioral Health Service Administrator (BHSA) *In Virginia, Magellan contracts as Magellan Healthcare, Inc., f/k/a Magellan
More informationFidelis Care New York Provider Manual 22C-1
Fidelis (MAP) is for individuals who have Medicare and Medicaid coverage and who have a chronic illness or disability. Member Eligibility Fidelis provides managed long-term care services to members who:
More informationMolina Healthcare of Ohio Behavioral and Mental Health Molina Dual Options MyCare Ohio 2014
Molina Healthcare of Ohio Behavioral and Mental Health Molina Dual Options MyCare Ohio 2014 1 Headline Goes Here Mental Health/Behavioral Health Services Cont. Mental and emotional well-being is essential
More informationArkansas Department of Human Services
Arkansas Department of Human Services Stakeholder Webinar May 31, 2018 Agenda OBH Certification Update Billing Update ConnectCare Services Transition Plan Tier 2 and Tier 3 New Services Q&A OBH CERTIFICATION
More informationIV. Clinical Policies and Procedures
A. Introduction The role of ValueOptions NorthSTAR is to coordinate the delivery of clinical services. There are three parties to this care coordination process: the Enrollee, the Provider(s), and the
More informationIntensive In-Home Services Training
Intensive In-Home Services Training Intensive In Home Services Definition Intensive In Home Services is an intensive, time-limited mental health service for youth and their families, provided in the home,
More informationThe Money Follows the Person Demonstration in Massachusetts
The Money Follows the Person Demonstration in Massachusetts Use of Concurrent 1915(b)(c) Waivers to Serve Elders and Adults with Disabilities Transitioning from Long-Stay Facilities HCBS Conference Arlington,
More informationAll Waiver Providers, Extended Care ICF/MRs, and Rehabilitation Facilities. Traumatic Brain Injury Waiver Program
P R O V I D E R B U L L E T I N B T 2 0 0 0 1 2 M A R C H 1 0, 2 0 0 0 To: Subject: All Waiver Providers, Extended Care ICF/MRs, and Rehabilitation Facilities Overview Beginning January 1, 2000, the Health
More informationMental Health Updates. Presented by EDS Provider Field Consultants
Mental Health Updates Presented by EDS Provider Field Consultants October 2007 Agenda Session Objectives Outpatient Mental Health Medicaid Rehabilitation Option (MRO) Somatic Treatment Assertive Community
More informationBH Redesign Billing Examples. NextGen Users Group. April 11, 2017
BH Redesign Billing Examples NextGen Users Group April 11, 2017 Billing Example: Mental Health Day Treatment Hourly July 2 nd, 2017: 1 hour of MH Day treatment is provided by a bachelor s level social
More informationAD Ordering, Referring, and Prescribing Providers
Provider Notice To: From: All PerformCare Network Providers Scott Daubert, PhD, VP Operations Date: Revised December 1, 2017 (originally September 30, 2017) Subject: AD 17 104 Ordering, Referring, and
More informationBEHAVIORAL HEALTH SERVICES PROVIDER MANUAL Chapter Two of the Medicaid Services Manual
BEHAVIORAL HEALTH SERVICES PROVIDER MANUAL Chapter Two of the Medicaid Services Manual Issued March 14, 2017 State of Louisiana Bureau of Health Services Financing SECTION: TABLE OF CONTENTS PAGE(S) 1
More informationMEDICAID MANAGED LONG-TERM SERVICES AND SUPPORTS OPPORTUNITIES FOR INNOVATIVE PROGRAM DESIGN
Louisiana Behavioral Health Partnership MEDICAID MANAGED LONG-TERM SERVICES AND SUPPORTS OPPORTUNITIES FOR INNOVATIVE PROGRAM DESIGN Rosanne Mahaney - Delaware Lou Ann Owen - Louisiana Brenda Jackson,
More informationADDING A PRACTITIONER FORM
This form is applicable for Medicaid AND Passport Advantage provider networks. YOU ONLY NEED TO SUBMIT THIS FORM ONE (1) TIME. ADVANTAGE (HMO SNP) ADDING A PRACTITIONER FORM Must complete entire form for
More informationBehavioral Health Provider Training: Program Overview & Helpful Information
Behavioral Health Provider Training: Program Overview & Helpful Information Agenda Passport Behavioral Health Services Overview Steps to Joining Passport Health Plan s Network Getting a Medicaid Number
More informationChapter 1 Section 5.1. Requirements For Documentation Of Treatment In Medical Records
Administration Chapter 1 Section 5.1 Requirements For Documentation Of Treatment In Medical Records Issue Date: June 1, 1999 Authority: 32 CFR 199.2; 32 CFR 199.6(b); 32 CFR 199.7(b), and (b)(1) 1.0 ISSUE
More informationBehavioral Health Facility and Ancillary Credentialing Application
Behavioral Health Facility and Ancillary Credentialing Application Please complete the application thoroughly in its entirety. The checklist below may not be exhaustive of all materials, but is provided
More informationCovered Service Codes and Definitions
Covered Service Codes and Definitions [01] Assessment Assessment services include the systematic collection and integrated review of individualspecific data, such as examinations and evaluations. This
More informationState-Funded Enhanced Mental Health and Substance Abuse Services
and and Contents 1.0 Description of the Service... 3 2.0 Individuals Eligible for State-Funded Services... 3 3.0 When State-Funded Services Are Covered... 3 3.1 General Criteria... 3 3.2 Specific Criteria...
More informationIf you are credentialed and a contract is required for your network participation; the contract will be
We would like to thank you for your interest in enrolling as a Licensed Independent Practitioner ( LIP ) in the Cardinal Innovations Healthcare ( Cardinal Innovations ) provider network. Enrollment requires
More informationHigher Level of Care Registration/Concurrent Review Template All fields with * are required.
Higher Level of Care Registration/Concurrent Review Template All fields with * are required. *Requested Start Date for this Request: *Admit Date: *Has the member already been admitted to the facility?
More informationTHE ADDICTION AND RECOVERY TREATMENT SERVICES PROGRAM (ARTS) PROVIDER MANUAL
THE ADDICTION AND RECOVERY TREATMENT SERVICES PROGRAM (ARTS) PROVIDER MANUAL SUPPLEMENTAL INFORMATION This Supplement to the Optima Health Provider Manual is available for Providers who provide services
More informationLOUISIANA MEDICAID PROGRAM ISSUED: 08/24/17 REPLACED: 07/06/17 CHAPTER 2: BEHAVIORAL HEALTH SERVICES APPENDIX B GLOSSARY/ACRONYMS PAGE(S) 5 GLOSSARY
GLOSSARY The following is a list of abbreviations, acronyms and definitions used in the Behavioral Health Services manual chapter. Ambulatory Withdrawal Management with Extended On-Site Monitoring (ASAM
More informationMental Health Outpatient Treatment Report form
Mental Health Outpatient Treatment Report form https://providers.amerigroup.com Please submit via website at https://providers.amerigroup.com/ia or fax to 1-866-877-5229. Fill out completely to avoid delays.
More informationOPTIMA HEALTH COMMUNITY CARE PROVIDER MANUAL
OPTIMA HEALTH COMMUNITY CARE PROVIDER MANUAL SUPPLEMENTAL INFORMATION This supplement is provided for Providers that participate with Optima Health Community Care (OHCC). Information contained in this
More informationIHCP Annual Workshop October 2016
IHCP Annual Workshop October 2016 MDwise Home Health and Hospice Exclusively serving Indiana families since 1994. Agenda Who is MDwise? IHCP Overview & MDwise Delivery System Model What is Home Health
More informationMental Health Services
Mental Health Services Fee-for-Service Indiana Health Coverage Programs DXC Technology October 2017 1 Agenda Reference Materials Provider Healthcare Portal Outpatient Mental Health Inpatient Mental Health
More informationCredentialing Application
Credentialing Application 1. NAME Last First MI Degree Gender 2. BIRTH, SOCIAL SECURITY & E-MAIL ADDRESS Date of Birth Social Security # E-Mail Address 3. PRACTICE, OFFICE & SPECIALTY INFORMATION 3.1 Please
More informationOptima Behavioral Health New Provider Application Packet
Optima Behavioral Health New Provider Application Packet Thank you for your interest in becoming a participating provider in the Optima Behavioral Health (OBH) Network. We are currently accepting applications
More informationAffiliate Provider Application Instructions and Check Sheet
WellSpan EAP P.O. Box 1827 York, PA 17405 1827 Phone: 866 227 6527 Fax: (717) 851 4493 Affiliate Provider Application Instructions and Check Sheet Enclosed is an Affiliate Provider Application for your
More informationNew provider orientation. IAPEC December 2015
New provider orientation IAPEC-0109-15 December 2015 Welcome 2 Agenda Introduction to Amerigroup Provider resources Preservice processes Member benefits and services Claims and billing Provider responsibilities
More informationMedicaid Funded Services Plan
Clinical Communication Bulletin 007 To: From: All Enrollees, Stakeholders, and Providers Cham Trowell, UM Director Date: May 10, 2016 Subject: Medicaid Funded Services Plan benefit changes, State Funded
More informationDraft Children s Managed Care Transition MCO Requirements
Draft Children s Managed Care Transition MCO Requirements OVERVIEW On February 1 st, New York State released for stakeholder feedback a draft version of the Medicaid Managed Care Organization (MCO) Children
More informationTransforming Behavioral Health Care in Louisiana Magellan in Louisiana/ Dr. Craig Coenson/Year 1 Report to the Community
Transforming Behavioral Health Care in Louisiana Magellan in Louisiana/ Dr. Craig Coenson/Year 1 Report to the Community Today s Discussion Welcome and Introductions Year 1: A change for good Meeting our
More information