February 3, 2016 The Managed Care Technical Assistance Center of New York
Managed Care Rest of State Refresher Housekeeping WebEx Chat Functionality for Q&A Slides are posted at MCTAC.org and a recording will be available soon (usually less than one week) Questions not addressed today will be re-visited during subsequent presentations Reminder: Information and timelines are current as of the date of the presentation
MCTAC Overview Contracting/Credentialing and Billing Timeline Contracting and Credentialing Billing Claim Testing Utilization Management -- Authorizations Adult BH HCBS RPCs Upcoming Events Tools Readiness Assessment Q/A
MCTAC is a training, consultation, and educational resource center that offers resources to all mental health and substance use disorder providers in New York State. MCTAC s Goal Provide training and intensive support on quality improvement strategies, including business, organizational and clinical practices to achieve the overall goal of preparing and assisting providers with the transition to Medicaid Managed Care.
Who is MCTAC?
MCTAC Partners
The Managed Care Technical Assistance Center of New York
Contracting and Credentialing Claims Testing February March April April May June Billing July August September On-Going
Providers must complete both contracting and credentialing process to be considered an in-network provider New Contracts vs. Established Contracts Providers with existing Managed Care Contracts might only need to execute/sign contract amendment If you don t currently have a contract with a plan you will have to complete the full contracting and credentialing process State Protections Contracting requirements: (e.g. must contract where there are 5 or more enrollees; and, OTP are essential community BH providers so plans must offer all contracts) Payment requirements: Plan must pay at the government rate for first 24 months (including APG rates) Technical Assistance Contracting Webinars Contracting Fairs
Claims Testing Providers and Managed Care Organizations are strongly encouraged to test claims Testing must be done with test claims and should go through a same process as live claim in test environment Providers should reach out to their EHR/Billing Vendors and when applicable to Clearinghouses to make sure that their systems are set up correctly Billing Manual Billing Guideline Technical Assistance UM/Billing In-Person Presentations 10
New Clients As of July 1 st, 2016 some services will require authorizations. Please refer to State Guidance Existing Clients Refer to state guidance on existing clients definition Will have 90 day grace period for authorization Technical Assistance In person presentation 11
Timelines Assessments start in July 1, 2016 Adult BH HCBS Services Go-Live: October 1, 2016
MCTAC will conduct technical assistance covering the following areas: EPACES H Codes Documentation Billing Service Overview Training Workflow Plan of Care Training will a combination of both in person and web-based
The Managed Care Technical Assistance Center of New York
Concept of the NYS Conference of Local Mental Hygiene Directors Info www.clmhd.org Hot Topics for full description & map of RPC regions CLMHD & LGUs beginning start-up and staffing now RPCs-multi-stakeholder groups comprised of: Consumers Families/Youth LGU s MCOs & HARPS Adult and child services Housing providers Hospitals & primary care providers PPSs PHIPs State Agencies LDSS LDH Based on the premise: Transforming the BH system and how the implementation impacts the system & the people & the families served Requires a collaborative community focus and continuous, vigilant attention This is the role and function of the RPCs
The Managed Care Technical Assistance Center of New York
Contracting Webinar: Overview: 2/10 Timelines & State Protections: 2/17 In Person Contracting Fairs: Buffalo: Monday, 2/29 Syracuse: Tuesday, 3/1 Albany: Wednesday, 3/2 Long Island: Friday, 3/18 Lake Placid/North Country-- COMING SOON: April 2016 Hudson Valley- COMING SOON: March 2016 UM/Billing In Person Events Buffalo: Monday, 4/11 Syracuse: Tuesday, 4/12 Finger Lakes: Thursday, 4/14 North Country: Coming Soon, April 2016 Albany: COMING SOON, May 2016 Hudson Valley: COMING SOON, May 2016
The Managed Care Technical Assistance Center of New York
Tools MCO Matrix: interactive online tool that provides critical information necessary for providers to successfully engage with the plans. Billing/Claims: tool that contains critical information for clean claim submission with field by field detail for the UB-04/837i form, plan by plan Glossary of Terms/Top Acronyms/Managed Care Language Guide Utilization Management: tool that provides guidance around prior authorization and concurrent review practices for each plan for state ambulatory services. Credentialing: An integrated tool that provides information on required credentialing processes & documentation Chargemaster: tool to assist providers in cross walking information from services provided to the necessary billing codes.
The Managed Care Technical Assistance Center of New York
Beginning in September, 2014, MCTAC offered a tool targeting behavioral health providers to help them assess their own readiness for Managed Care and benchmark them with their fellow agencies around the state. 546 Readiness Assessments have been collected in total and the population has included to date: OASAS OMH OCFS Major Findings: There are no statistically significant differences by Region There are statistically significant differences by Reimbursement There are statistically significant differences by Funding Mechanism
Domain Name Label in Graphs 1 Understanding MCO Priorities & Present Managed Care Involvement MCO Priorities 2 MCO Contracting Contracting 3 Communication /Reporting (Services authorization, etc.) Communication 4 IT System Requirements IT Level of Care (LOC) Criteria / Utilization Management 5 Practices Level of Care 23 6 Member Services/Grievance Procedures Member Services 7 8 Interface with Physical Health, Social Support and Health Homes Quality Management/Quality Studies/Incentive Opportunities Interface Quality 9 Finance and Billing Finance 10 Access Requirements Access 11 Demonstrating Impact/Value (Data Management & Evaluation Capacity) Evaluation Aggregate Total Score Total Score
@CTACNY mctac.info@nyu.edu