IHCP Workshop: Combined Behavioral Health Presentation Quarter 2, 2017
Introduction Agenda Policy Updates Hoosier Care Connect transition MCE s contact information Roundtable discussion
Introduction
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 90899 Rev Code 905 Psychiatric and 906 Chemical Dependence Professional Services CMS 1500 use: CPT Code S9480 Psychiatric and H0015 Chemical Dependency Rev Code - None
Policy Updates PA Reminder For majority of outpatient services, PA is not required for contracted participating providers Applied Behavior Analysis (ABA) therapy - Codes 96150-96155, (with modifiers U1, U2, U3) require PA.
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 (99408-99409) https://www.caresource.com/providers/policies/ Urine Drug Screens Medical benefit and do not Specific policies: require PA https://www.caresource.com/documents/2016- MHS mm-0054/ PA required https://www.caresource.com/documents/2017apy-0020/ therapy, Inpatient, Detox, ABA services, ECT, in-home PA required: neurological/developmental/psychological testing, Inpatient, ABA services, PHP, IOP PHP, IOP
Where to find PA lists Go to the appropriate MCE PA guide to verify which services need PA Anthem https://mediproviders.anthem.com/in/pages/prior-authorization.aspx CareSource For HIP: https://www.caresource.com/members/indiana/hip-hhw/healthyindiana-plan/ For HHW: https://www.caresource.com/members/indiana/hip-hhw/hoosierhealthwise/ MDwise http://www.mdwise.org/for-providers/forms/prior-authorization/ MHS http://www.cenpatico.com/providers/indiana/in-providertools/?state=indiana#forms?state=indiana
Behavioral Health vs Medical Anthem BH follows same Appeals/Disputes as Medical Anthem: Indiana Provider Disputes/Appeals PO Box 61599 Virginia Beach, VA 23466 PA forms found at: https://mediproviders.anthem.com/in/pages/forms.aspx CareSource Use the Universal PA Form Claims submitted same as Medical P.O. Box 3607, Dayton, OH 45401-3607 for HIP and HHW Appeals: https://www.caresource.com/providers/indiana/medicaid/authorization-claimsappeals/grievances-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: www.cenpatico.com Claims Address: Cenpatico PO Box 6800, Farmington, MO 63640-3817 Appeals Address: Cenpatico PO Box 6000, Farmington, MO 63640-3809 Medical Necessity Appeals: Cenpatico, Appeals Coordinator, 12515-8 Research Blvd, Suite 400, Austin TX 78707 OR fax to 1-866-714-7991 Claims Support: 1-866-324-3632 Payor Id: 68068 Cenpatico s Secure Web Portal: https://provider.cenpatico.com/sso/login Credentialing https://www.mhsindiana.com/providers/become-aprovider.html?state=indiana
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, 2017. Please refer to IHCP Bulletin BT201713 for more details.
MCE Behavioral Health Contacts
Donnica Hinkle, LMHC Statewide Behavior Health Network Education Rep. Sr. Donnica.Hinkle@anthem.com (317) 617-7097 Additional contact information Anthembehavioral@anthem.com www.anthem.com/inmedicaiddoc
Denise Edick Manager Health Partnerships: denise.edick@caresource.com (317) 361-5872
Nichole Young, RN Statewide Behavioral Health Provider Relations Representative nyoung@mdwise.org (317) 822-7509 Holli Mahoney, LMHC Behavioral Health Manager hmahoney@mdwise.org (317) 983-7768 http://www.mdwise.org/for-providers/behavioral-health/ bhticket@mdwise.org for Behavioral Health questions
Kelvin Orr Director, Network Operations 1-877-647-4848 x. 20049 Kelvin.Orr@EnvolveHealth.co m Richard Elliott Manager, Network Development 1-877-647-4848 x. 20143 Relliott@mhsindiana.com Provider representative by territory Mary Schermer - West Provider Relations Specialist 1-877-647-4848 x. 20268 Mschermer@mhsindiana.co m LaKisha Browder - East Provider Relations Specialist 1-877-647-4848 x. 20224 lbrowder@mhsindiana.com
Roundtable Discussion Questions?