Joining Passport Health Plan. Welcome IMPACT Plus Providers

Transcription

1 Joining Passport Health Plan Welcome IMPACT Plus Providers

2 Agenda Passport Behavioral Health Services Overview Steps to Joining Passport Health Plan s Network Getting a Medicaid Number Enrolling in the Passport Health Plan Network IMPACT Plus vs. Traditional OP Working with Beacon Health Strategies: Pre- Authorizations & Claims

3 Passport Health Plan s Behavioral Health Services Overview

4 Passport Health Plan Passport Health Plan (Passport) is a local nonprofit community-based health plan administering Kentucky Medicaid benefits. Since 1997, we have been working closely with local providers and community advocates to fulfill our mission. Mission: To improve the health and quality of life of our members. Vision: To be the leading model for collaboration and innovation in health care. Values: Integrity, collaboration, community, and stewardship

5 Passport Behavioral Health Benefits Passport began administering the Behavioral Health benefits in Community-based providers were allowed to join the outpatient behavioral health provider network in 2014 after Kentucky s state plan amendment.

6 Overview The Passport Behavioral Health Program provides members with access to a full continuum of recovery and resiliency focused behavioral health services through our network of contracted providers. The primary goal of the program is to provide medically necessary care in the most clinically appropriate and cost-effective therapeutic settings.

7 Overview By ensuring that all Passport members receive timely access to quality, clinically-appropriate behavioral health care services, we believe we can achieve our mission of improving the health and quality of life of our members. Passport Health Plan has contracted with Beacon Health Strategies, LLC to manage the delivery of behavioral health services for its members.

8 Behavioral Health Program Philosophy Enhance continuity and coordination with behavioral health care providers as well with physical health care providers Establish innovative preventive and screening programs to decrease the incidence, emergence or worsening of behavioral health disorders Ensure members and advocates receive timely and satisfactory service from the Passport network of providers and the Passport benefit administrator Maintain positive and collaborative working relationships with network practitioners and ensure provider satisfaction Responsibly contain health care costs

9 Steps to Joining Passport Health Plan s Network

10 Enrolling in Passport s Network Get an NPI number Get a Medicaid number Go to Passport s website and request an enrollment packet Complete and submit packet Await notification of approval process Set up eservices through Beacon s website Services provided during the approval process would require single case agreements. You can contact Taquitta Townsend with Beacon for help with this. taquitta.townsend@beaconhs.com

11 Getting a Medicaid Number

12 Who Needs a Medicaid Number? Any provider type that is approved to provide Medicaid services Any approved provider who wants to join an MCO s network Both the group and individual providers practicing in the group need Medicaid numbers. Those who practice under supervision use his or her supervisor s Medicaid number.

13 How Do I Get a Medicaid Number? Complete a Medicaid application called a MAP 811 Determine which MAP 811 form and supporting documents you need to complete by finding your Provider Type Summary. Summaries.htm MAP 811 forms can be found at

14 Submitting Your MAP 811 If you are joining an MCO s network, you will submit your MAP 811 application to the MCO. You only need to submit one Medicaid application, so if you are joining multiple MCOs, submit your MAP 811 to just one. The MCO will submit your Medicaid application to Department of Medicaid Services (DMS) on your behalf. DMS has 90 days to issue a Medicaid number. Submit your MAP 811 application and your MCO credentialing packet concurrently. If you have already submitted your MAP 811 to another MCO, write Pending on forms that request Medicaid number.

15 Enrolling in the Passport Health Plan Network

16 Joining the Passport Health Plan Network Provider Submits Online Enrollment Request Enrollment Packet ed to Provider Within a week of receiving request Provider Returns Packet to Passport Contracts & Enrollment Process Load into Passport s System Load into Beacon s System day process 2-3 weeks 2-3 weeks

17 Online Enrollment Request

18 Enrollment Packet Within a week of receiving your online request, Passport will you a contract and enrollment forms. Use the provided checklist to make sure you submit all necessary forms & documents. Your effective date is based on when Passport receives a completed packet. You can , fax, or mail your completed packet.

19 Enrollment Packet Fax: Mail: Passport Health Plan 5100 Commerce Crossings Drive Louisville, KY Attn: Contracting

20 Enrollment Packet Checklist

21 Enrollment Process When Passport receives your packet, our Contracts department logs your contract, IRS letter, and W-9. If these are not submitted, the packet stays in Contracts until the documents are received. Once Contracts logs the information, the packet is sent to our Provider Enrollment department. Provider Enrollment representatives review to make sure all necessary paperwork has been submitted. If not, Provider Enrollment representatives will contact provider for missing information. This delays the process.

22 Regions

23 Enrollment Process Credentialing verification process begins. Region 3: processed internally Statewide: processed by our business partner, Optum, who will contact you for additional needed information If approved, provider information is loaded into Passport s system. A welcome letter with Passport s provider number is sent to provider.

24 Enrollment Process Once provider is loaded into the Passport system, provider information is sent to Beacon Health Strategies to be loaded into Beacon s system. Once loaded into Beacon, the Behavioral Health Provider Relations representative will send out a letter to provider stating the process is complete and discuss scheduling an orientation. The overall process can take between days. Credentialing Hotline to check status:

25 IMPACT Plus vs. Traditional Outpatient

26 IMPACT Plus vs. Traditional OP Possible Comparable Services IMPACT Plus Individual Therapy Collateral Therapy Group Therapy Partial Hospitalization Intensive OP Behavioral Health Day Treatment Crisis Stabilization Summer Program After School Program Traditional Outpatient Individual Therapy Collateral Therapy Group Therapy Partial Hospitalization Intensive OP Behavioral Health / Substance Abuse Day Treatment / Therapeutic Rehab Program Crisis Stabilization / Mobile Crisis / Crisis Intervention Day Treatment (7 hours daily max) / Therapeutic Rehab Program (6 hours daily max) / Partial Hospitalization (per diem) Intensive OP Behavioral Health / Substance Abuse Authorization process and Maximum units available are different

27 IMPACT Plus vs. Traditional OP Possible Comparable Services IMPACT Plus Behavioral Health Evaluation Therapeutic Child Support Services Therapeutic Support Services Parent to Parent Service Therapeutic Foster Care Therapeutic Group Residential Traditional Outpatient Mental Health Assessment / Diagnostic Interview / Evaluation Peer Support / Comprehensive Community Supports Services / Skills Development & Training (BH or SA) Peer Support No comparable service at this time Crisis Stabilization Unit / Psychiatric Residential Treatment Facility / Specialized EPSDT Unit Authorization process and Maximum units available are different

28 IMPACT Plus vs. Traditional OP IMPACT Plus IMPACT Plus determines which agencies provide what services and in what regions. There are a limited number of IMPACT Plus providers in the state. Clinicians who are under supervision toward licensure can be credentialed and can bill for IMPACT Plus. Individual providers complete the disclosure form annually with documentation in the personnel file at the agency. Current record checks and current license information must be kept on file with IMPACT Plus for providers. Passport s Network for OP Services There is no limit to the number of providers who can join Passport to provide outpatient services. Clinicians under supervision regulated by a licensure board can bill under their credentialed supervisor. The rendering clinician is the credentialed supervisor s NPI and Medicaid numbers. Providers in the Passport network are re-credentialed every 36 months, but this process is seamless to the provider. Passport tracks when re-credentialing needs to be completed and will pull the provider s CAQH application. If it is up-todate, the process often happens without the provider even knowing!

29 IMPACT Plus vs. Traditional OP IMPACT Plus Clinicians under supervision must meet with their clinical supervisor of record weekly. Agencies must be able to produce records of this for IMPACT Plus when requested. In order for a child/youth to be eligible for IMPACT Plus services, they must have an existing diagnosis (before receiving their first service) and they must have first received services at a lower level of care (such as outpatient therapy) without success. Targeted Case Management is billable for IMPACT Plus, and every child with IMPACT Plus services receives TCM. All cases begin with a TCM who requests services and locates a clinician to begin therapy services. Passport s Network for OP Services Clinicians under supervision will need to comply with the regulations governing their supervisory relationships. Agencies must be able to produce records if ever requested for an audit. These are not requirements for traditional Outpatient. The child/youth must be a Passport member to receive services through Passport s network. Case management outside of a CMHC is not allowed yet. Another State Plan Amendment has been submitted from KY DMS to have case management added.

30 IMPACT Plus vs. Traditional OP IMPACT Plus Community-based therapy is part of the continuum. Referrals for community based services (or for TFC and TGR for kids who need it) are typically funneled to IMPACT Plus agencies. Other providers, hospitals, etc., know who those agencies are and refer to them. IMPACT Plus has limits on the number of units allowed per client per day and/or per week for each procedure code. Passport s Network for OP Services Community based therapy is part of outpatient therapy. Referrals will come through the typical channels such as selfreferrals, word of mouth, and targeted referrals for specialties. There is opportunity for providers to expand their referral network. Providers can bill for up to 3 hours of outpatient service in a single day.

31 IMPACT Plus vs. Traditional OP IMPACT Plus Claims must include the child s DOB, Medicaid number, diagnosis code, procedure code, number of units, service date, provider name, provider number, and PA number. Billing/claims submission is typically done electronically either via clearing house software or directly to the MCO web portals. The MCO sends the payment to IMPACT Plus and IMPACT Plus sends the provider the check. Providers typically receive payment 2-3 weeks after submitting the claim. Passport s Network for OP Services Claims need to include the same information with the addition of the member s Passport ID number. Claims can be submitted through clearinghouse or through Beacon s eservices portal Clean claims submitted electronically are required to be processed within 30 days with payments made on Fridays.

32 Working with Beacon Health Strategies: Pre-Authorizations and Claims

33 Utilization Management The Passport Behavioral Health Program uses a proprietary, Kentucky-specific medical necessity criteria that complies with regulatory mandates. We provide utilization management for inpatient, outpatient and community support services using level of care (LOC) criteria. This LOC criteria is available to Passport network providers though eservices. Please go to and choose the Provider Materials link to review this criteria.

34 Utilization Management Our application of LOC criteria and authorization procedures represent a set of formal techniques designed to monitor the use of, and/or evaluate the medical necessity, appropriateness, and efficacy of behavioral health care services. Depending on the LOC, providers may request authorizations online for convenience.

35 UM Authorization Process for Outpatient Services No authorization required for: Medication management / Injection Administration / Comprehensive Medication Services Diagnostic Interview / Evaluation Mental Health/Substance Abuse Assessments and Screenings Screening, Brief Intervention and Referral to Treatment (SBIRT) Peer Support Individual, Family and Group Therapy Collateral Services (under 21) Health & Behavioral Assessment, Group and Intervention Service Planning Crisis Services (including Therapy, Emergency Intervention, Mobile Crisis) Psychoanalysis Narcosynthesis for Psych Diagnosis Biofeedback Alcohol and/or Drug Services, brief intervention Medication Assisted Treatment For all other services: Providers may see member for 30 visits without prior authorization. Submission of electronic Outpatient Request Form (eorf) required by 30 th visit. eorf form can be downloaded at Beacon s website, under Provider Tools and can be faxed to Beacon at

36 UM Authorizations for Community Support Services Telephonic Prior Authorization is Required for the following: Partial Hospitalization Intensive Outpatient Assertive Community Treatment For Authorizations Call: Community support services eservices Authorization is required within 2 weeks of initial date of service: Day Treatment Therapeutic Rehabilitation Program Mental Health Service NOS Alcohol / Drug Service NOS Intensive Children s Services SA prevention (H0024/H0025) Targeted Case Management Adult Community Support Svcs Skills Development & Training

37 UM Appeals Providers may submit Passport appeals directly to Beacon. Appeal requests may be made by calling , or by mail to: Beacon Health Strategies Attn: Passport Health Plan Appeals 500 Unicorn Park Drive Woburn, MA Once providers have received a final determination from Beacon, they may request an external appeal or State Fair Hearing with the Commonwealth of KY.

38 eservices This is a free service for all contracted and in-network Passport providers. The goal of eservices is to make clinical, administrative, and claims transactions easy to do. By using eservices you will be able to: Submit requests for authorization Submit claims (not yet available for IMPACT Plus providers) Verify member eligibility for Passport Health Plan Confirm authorization status Check claim status View claims performance information Access to provider manuals, forms, bulletins and mailings View or print frequently asked questions (FAQs) Screen shots from the eservices website appear on the following slides.

39 eservices

40 eservices eservices is simple to log into and use. You create your own username and password.

41 eservices

42 eservices Click here Submitting an authorization is just a few key steps away! Soon, you will have to enter both the member ID and date of birth in addition to first or last name

43 eservices Click here Simply use the Member Search to find the member for which you are wanting an authorization.

44 eservices Choose the type of service from the drop down menu.

45 eservices Louisville, KY Once you have entered all of the required fields, you may submit your request.

46 eservices After you have successfully submitted your request, you will receive a reference number for your records.

47 eservices Once you have an authorization in place, you may submit a claim via eservices. Inpatient and outpatient claims can be submitted.

48 eservices Submitting a claim electronically takes less time and is more efficient than a paper claim. Once the fields are entered just hit submit!

49 eservices Now that your claim has been submitted, you will receive a transaction number. You may also print the page for your records.

50 eservices Click here Claim reconsiderations may be done online, for claims that were submitted and denied and require an in depth review.

51 eservices Always make sure to enter the original claim s RecID Once you have entered your claim info and explanation you can submit a reconsideration request.

52 eservices Claims that may have denied for an incorrect procedure code or diagnosis code may also be re-submitted electronically.

53 eservices Once the claim has been chosen, click on the resubmit link.

54 eservices After you have clicked on re-submit, the information will automatically fill-in from the previous submission. You can then make corrections and re-submit. Re-submissions must be made within the timely filing limit of 180 days.

55 Important Claim Reminders All claims must be received within Passport s timely filing limit of 180 days. All clean claim submissions (meaning no missing or incorrect numbers or information) will be processed and paid within 30 days.

56 Important Claim Reminders The top denial reasons for behavioral health claims submitted are : Timely filing (claim denied as it was not received within 180 days). Missing or incorrect NPI number. (All claims must list the rendering clinicians individual NPI number, along with the site NPI number. If either of these numbers are missing or entered incorrectly, the claim will deny.) No authorization. (If the member has no authorization to see the provider, or the authorization has expired the claim will deny. It is important to make sure the member has an authorization in place, or has initial benefit visits remaining, before seeing them.)

57 Contact Numbers Passport s Behavioral Health Hotline: (855) Main fax number: (781) Outpatient Request Forms fax: (781) TTY Number (for hearing impaired): (781) or (866) Claims Hotline: (888) eservices Helpline: (866) IVR: (888) PCP Consult Line: (866) All departments may be reached via the Passport Behavioral Health Hotline at (855) Lisa Bellafato, Ed.M. Passport Behavioral Health Provider Relations Specialist: (502) lisa.bellafato@passporthealthplan.com Liz McKune, Ed.D. Passport Director of Behavioral Health: (502) Liz.mckune@passporthealthplan.com Brigid Adams Morgan Beacon Health Strategies, Program Director for Passport: (502) brigid.adamsmorgan@beaconhs.com

58 We look forward to having you as part of our network! Questions? Thank you for helping us with our mission of improving the health and quality of life of our members.