Treatment for Substance Use Disorders

Size: px
Start display at page:

Download "Treatment for Substance Use Disorders"

Transcription

1 Treatment for Substance Use Disorders CHRISTUS Health Plan and CompCare HHSC: Posted CHRISTUS/Marketing/SFY 2013/ December 14, 2012 CHRISTUS and CompCare CHRISTUS Health Plan CHRISTUS Health Plan (CHP) contracts with the Texas Health and Human Services Commission (HHSC) to administer the Medicaid Managed Care and CHIP programs in the Nueces service area Nueces Service Area Aransas, Bee, Brooks, Calhoun, Goliad, Jim Wells, Karnes, Kennedy, Kleberg, Live Oak, Nueces, Refugio, San Patricio and Victoria STAR offers a wide range of free health care services to low income individuals including pregnant women and children No premiums or co-payments for doctor visits, eye glasses or prescriptions CHIP offers health care services for children 18 or under with little to no cost to their family CHRISTUS Subcontracts with CompCare for management of Behavioral Health Services 2

2 CHRISTUS and CompCare (Cont.) Comprehensive Behavioral Care, Inc. (CompCare) NCQA accredited Managed Behavioral Healthcare Organization (MBHO) Serving managed behavioral health needs of Texas STAR and CHIP members for more than 15 years CompCare provides full compliment of MBHO services to CHRISTUS members Access and Referral Utilization Management Credentialing and Contracting Claims Quality Reporting 3 Medicaid Enrollment Requirements for Facilities Enrollment Prerequisites: Typically, Medicaid provider enrollment requires enrollment as a Medicare provider as well. Medicare enrollment is not a requirement for Medicaid enrollment for any Facility or a Chemical Dependency Treatment Facilities (CDTFs). Treatment facilities must have a National Provider Identifier (NPI), as required in the Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standards. Facilities must be actively licensed by DSHS as a Chemical Dependency Treatment Facility (CDTF). Facilities cannot be enrolled in Texas Medicaid if their licenses are due to expire within 30 days. 4

3 Medicaid Enrollment Requirements for Facilities (cont.) A Credentialing Application is required for the following: Facilities, CHMCs, CDTFs Individual Practitioners NOTE: CompCare considers delegating credentialing to organizations Other requirement include (see credentialing packet for additional information based on licensure type): Copies of all applicable Active Licenses Malpractice Insurance Site Visits, etc. Providers (practitioners or facilities) must possess both of the following to be considered for inclusion into the network. Active Texas Provider Identification number (TPI) National Practitioners ID number (NPI) 5 Medicaid Enrollment Requirements for Other (Non-Facility) Providers Enrollment Prerequisites: Providers (e.g., physicians such as psychiatrists) who are not affiliated with the following facilities must also be enrolled in Medicare in order to enroll as a Texas Medicaid provider: Substance Abuse Treatment Facilities, or Are affiliated with a facility but do not plan to bill through that facility Enrollment requirements as a provider of Texas Medicaid Providers dispensing opioid drugs for treatment of opioid addiction must be certified by the Substance Abuse and Mental Health Services Administration and must comply with the federal regulations of 42 C.F.R 8. Providers who want to prescribe Buprenorphine (a medication used in medication assisted therapy), must apply for a waiver that allows providers to dispense this drug for opioid addiction treatment. To apply for the waiver, contact the Center for Substance Abuse Treatment (CSAT) at BUP-CSAT( ). 6

4 Medicaid Enrollment Requirements for Other (Non-Facility) Providers (cont.) Enrollment Prerequisites (cont.): Eligible Providers for Reimbursement Physician/MD provider types A Licensed Professional Counselor (LPC) Can enroll as an individual provider May perform other counseling services Bill under BH codes Licensed Chemical Dependency Counselors (LCDCs) Not currently a recognized provider type Cannot enroll as independent Medicaid providers 7 Additional Information for Providers Who Plan to Serve STAR Medicaid Managed Care Clients Information on STAR Credentialing and Contracting: In addition to Medicaid enrollment, providers must be credentialed and contracted with the CompCare to receive reimbursement for treatment of CHRISTUS members Generally, credentialing involves verifications of qualifications and practice history, including an examination of appropriate licensure, a look at sanctions, limits on licensure, registration, and malpractice history. The credentialing process must be completed before the start date of a contract between the health plan and an individual provider. Contracts are negotiated between each provider and the health plans. 8

5 Additional Information for Providers Who Plan to Serve STAR Medicaid Managed Care Clients (Cont.) Information on STAR Credentialing and Contracting: STP status does not allow SUD providers to set different conditions than other providers. STPs must accept the terms and conditions for contracting with the health plan. Providers who have been credentialed by CompCare (CHRISTUS Health Plan) and have an existing contract with a health plan to serve children in Medicaid managed care may need to update their contracts or provider agreements, if they desire to serve adults. The credentialing and contracting process can take up to three months if all required information is not received upon initial submission. 9 How to become Contracted and Credentialed with CompCare to see CHRISTUS Members A contract and credentialing application can be obtained following the presentation Credentialing Timeframe days Less time if all information is received upon initial submission To obtain an application and contract: Contact Michelle Brochu, VP of Project Management Office: Provide an or office address A packet will be sent 10

6 Substance Abuse Services for STAR (Medicaid) Reiterate the Statement of Benefits: Treatment for Substance Use Disorders (SUD) is a benefit of Texas Medicaid. SUD treatment services are age appropriate, medical, and psychotherapeutic services designed to treat an individual s substance disorder and restore function. Services and provider requirements associated with this benefit are found in Texas Department of Insurance (TDI) regulations (28 Texas Administrative Code (TAC), part 1chapter 3 subchapter HH) and TAC 448. Medical necessity for substance abuse services will be determined based on the TDI regulations and nationally recognized standards such as those from the American Society of Addiction Medicine (ASAM) or the Center for Substance Abuse Treatment (CSAT). 11 Overview of Substance Abuse Services for STAR (Medicaid) (cont.) SUD Covered Services for STAR Enrollees: An Assessment/Evaluation 1 per Episode of Care Ambulatory SUD treatment services Group Counseling provided by a CDTF Individual Counseling Medication Assisted Therapy Outpatient setting Detoxification Treatment Services Acute Care Hospital setting Residential or Ambulatory Services in a CDTF Setting Residential SUD treatment services SUD services provided by a CDTF are limited to those provided by facilities licensed and regulated by the Department of State Health Services (DSHS) to provide SUD services within the scope of that facility s DSHS license 12

7 Overview of Substance Abuse Services for STAR (Medicaid) (cont.) These SUD Services Require Prior Authorization Ambulatory SUD treatment services Benefit Limit per calendar year 135 hours (max.) of Group Counseling provided by a CDTF 26 hours of Individual Counseling Medication Assisted Therapy in an outpatient setting Detoxification Treatment services in Acute Care Hospital, Residential or Ambulatory CDTF Setting Benefit Limit Up to 21 days Residential SUD treatment services Benefit Limit Up to 21 days An Assessment is covered without prior authorization Benefit Limit 1 assessment per episode of care 13 Substance Abuse Services for STAR (Medicaid) (cont.) Assessment Assessment by a chemical dependency treatment facility (CDTF) for admission into a SUD treatment program. Assessment does not require prior authorization CDTF assessment must be performed by a qualified credentialed counselor (OCC) to determine the severity of an individual s SUD and identify their treatment needs. Assessments are limited to one per episode of care Use the following procedure code for assessment: H0001 (with HF Modifier) Alcohol and/or Drug Assessment 14

8 Substance Abuse Services for STAR (Medicaid) (cont.) Detoxification Ambulatory (outpatient) Detoxification Medical needs do not require close monitoring It is not a stand alone service and must be provided in conjunction with ambulatory substance abuse treatment services. Use H0014 (with HF Modifier) Alcohol and/or drug services to bill for ambulatory (outpatient) detox Codes are bundled in the H0014 per diem rate and negotiated with the provider. Include, but not limited to: H0050 (with HF Modifier) Alcohol and/or drug services; brief intervention, per 15 minutes S9445 (with HF Modifier) Patient Education, not otherwise classified, individual per session Residential Detoxification Medical needs do not warrant acute inpatient hospital admission Severity of the anticipated withdrawal requires close monitoring. Use H0047 (with HF Modifier) Alcohol and/or drug services procedure code Per diem rate for Residential Detoxification (acute detox residential addiction inpatient) Use H0031 (with HF Modifier) Mental Health Assessment by a Non- Physician Prior Authorization is Required by contacting CompCare 15 Substance Abuse Services for STAR (Medicaid) (cont.) Detoxification Continued Inpatient Detoxification (medically supervised hospital) is appropriate when one of the following criterion is met: Client has complex medical needs or complicated co-morbid conditions that necessitates hospitalization for stabilization. Services are provided to a client incidental to other medical services that are provided as a component of an acute care hospital stay Use the appropriate Revenue Codes for inpatient detoxification that are negotiated in the contract NOTE: Crisis stabilization is not a component of detoxification. Crisis stabilization for a mental health condition may be provided as needed when the service is medically necessary and the clinical criteria for psychiatric care are met. 16

9 Substance Abuse Services for STAR (Medicaid) (cont.) Residential Treatment Residential SUD services require prior authorization and are limited up to 21 days. The services include counseling, education and life skills. Use the following procedure codes for the residential treatment services H2036 (with HF Modifier) Alcohol and/or drug abuse treatment program, per diem 17 Substance Abuse Services for STAR (Medicaid) (cont.) Treatment Continued Ambulatory (outpatient) treatment services require prior authorization and are limited to 135 hours per year of group services and 26 hours of individual services per year when provided by a QCC. Use the following procedure codes for ambulatory (outpatient) treatment services: H0004 (with HF Modifier) Behavioral health counseling and therapy (per 15 minutes) H0005 (with HF Modifier) Alcohol and/or drug services, group counseling by a clinician (1 hour increments) NOTE: These codes are limited to the following diagnosis: , 291.9, 292.0, , 292.9, , , , , , , , , , , , , , , , ,

10 Substance Abuse Services for STAR (Medicaid) (cont.) Treatment Continued Medication Assisted Therapy (MAT) may be a benefit when using a drug or biological recognized in the treatment of SUD and provided as a component of a comprehensive treatment program as per TAC 448, or as a conjunctive treatment regimen for individuals addicted to abusable substances who meet the current DSM criteria for a SUD. MAT is limited to clients in ambulatory (outpatient) treatment. MAT is considered part of detoxification (residential and ambulatory (outpatient)) and residential treatment. Documentation requirements supporting the medical necessity for MAT must be maintained in the client s medical record as per 42 C.F.R. 8. No client under 18 years of age (age of majority) may be admitted to narcotic maintenance unless a parent or legal guardian, or responsible adult designated by the relevant State authority consents in writing to such treatment. To be eligible for narcotic maintenance treatment, clients 18 years of age or younger must have had 2 documented attempts at short-term detoxification or drug-free treatment. A waiting period of no less than 7 days is required between the first and the second short-term detoxification treatment. 19 Substance Abuse Services for STAR (Medicaid) (cont.) Treatment Continued Medication Assisted Therapy (MAT) for the treatment of opioid addiction must comply with the requirements in Federal Regulation 42 C.F.R. 8. Use the following procedure code for MAT for opioid addiction when using methadone: H0020 Alcohol and/or drug services, methadone administration and/or service provisions of the drug by a licensed program. H0020 UA Methadone given in person H0020 U1 Methadone take-home doses H2010 Comprehensive medication services, per 15 minutes H2010 HG, UA Nonmethadone given in person (opioid) H2010 HG, U1 Nonmethadone take-home doses (opioid) H2010 HF, UA Nonmethadone (non-opioid) 20

11 Substance Abuse Services for STAR (Medicaid) (cont.) Service that are not a covered benefit (exclusions): Aftercare Occupational therapy as part of a residential detoxification or treatment program. Services for which the client fails to meet the treatment eligibility or authorization criterion; or which are not clinically appropriate in the setting requested based on the client s medical condition. Services for tobacco and caffeine addiction. Detoxification services for hashish or marijuana addiction. Detoxification with an opioid when the client has had two or more unsuccessful opioid detoxification episodes (has left the program AMA) within a twelve month period (see 42 C.F.R Section 8). Substance abuse counseling or related services provided by electronic means such as telemedicine, , or telephone. 21 Substance Abuse Services for STAR (Medicaid) (cont.) Provider Type(s): 08 Chemical Dependency Treatment Facility (TCADA approved) 19 Physician (D.O.) 20 Physician (M.D.) 21 Physician Group (D.O.S only) 22 Physician Group (M.D.S only and multi specialty) Place(s) of Service 1 Office 3 Inpatient Hospital 5 Outpatient Hospital 9 Other Locations 22

12 Initial Outpatient Referral/Authorization The member does not need a PCP referral The member may self refer for treatment CompCare has a toll-free number available for members to use A member may call CompCare for assistance in locating an innetwork provider CompCare contracts and credentials with behavioral healthcare group practices, independent practitioners, agencies and facilities in the member s area Authorization is generated for follow up visits once a provider has been chosen The assessment does not require prior authorization A certification letter or auth mailer is sent to the provider and/or member The Authorization Number is also communicated over the phone to allow for immediate access 23 Concurrent Outpatient Authorization Network providers requiring additional outpatient services have the option of submitting an Outpatient Treatment Review (OTR) Form Fax Mail Portal on our Website Authorizations for concurrent outpatient services are reviewed and decisions rendered within 2 business days 24

13 Urgent Access/Referral/Authorization Urgent Access includes, but not limited to Situations of crisis, but not actively suicidal/homicidal Possible relapse that is causing significant distress Care Advocate transfers the call to a licensed Care Manager Our Care Management staff are master s prepared, licensed clinicians with at least 5 years post-graduate experience Urgent appointments are scheduled within 48 hours CompCare staff will set up a psychiatric consult with a network behavioral health care practitioner for the PCP at a medical or nursing home facility 25 Emergent Access/Referral/Authorization If the member is experiencing a very serious situation, perhaps wanting to hurt themselves or someone else, - do not hesitate to call or send (as appropriate) to the nearest emergency room or mental health center 26

14 Inpatient/Detox Authorization Members need inpatient behavioral health services Pre-certification services available 24 hours a day, 7 days a week Facility UR Staff contact CompCare s Central Triage Unit Licensed Care Managers obtain clinical information Review the clinical against the Level of Care Guidelines Authorize for services as appropriate Begin Coordinating a Discharge Plan The Care Management Department Care Managers Monitor the cases concurrently Further solidifies the follow up to discharge activity CompCare Physician Advisors Make denial and appeal decisions Conduct Peer to Peer conversations with the Attending MD Care Managers staff cases CompCare Discharge Planners Follow up with members upon discharge Ensure a follow up appointment is made and kept within 7 days and 30 days 27 Coordination of Care Primary Care Physician (PCP) Communication ~ Providers are required to attempt to obtain a signed consent form from members so that information about important aspects of care can be forwarded to the PCP Should the member refuse consent, documentation regarding the refusal should be placed in the member s chart PCP communication is monitored and targeted education is completed during outpatient concurrent review 28

15 Complaint Process All complaints should be directed to the Customer Service Department at CompCare Acknowledgement Letters are sent within 5 business days of receipt of complaint 30 Day Complaint Resolution and Notification Provider complaints are handled by CompCare Member complaints are registered by CompCare and then forwarded to the Health Plan for resolution CompCare is not delegated member complaints CompCare acts as a data gatherer Member also has the opportunity to complain HHSC 29 Complaint Appeal Process Complaint Appeals are handled through CHRISTUS s Complaint Appeal Panel The Complaint Appeal Panel has 30 Days Complaint Appeal Resolution Member Notification of Decision Member also has the opportunity to appeal the complaint decision to HHSC 30

16 Appeals Process Member Appeals are not delegated to CompCare Member has 30 days from date of the Notice of Action to appeal Member Advocates will document verbal appeal requests and send it to the member for review. The member needs to return the form to the Member Advocate. A written request can be sent to: CHRISTUS Health Plan Attention: Member Advocate PO Box Dallas, TX Acknowledgement letters sent within 5 business days 30 Day Appeal Resolution and Notification of Decision A State Fair Hearing request can occur any time during or after the appeal process Provider Appeals are sent to: CompCare Attn.: Appeals Dept W. Dr. Martin Luther King Jr. Blvd., Ste. 101 Tampa, FL The CompCare website provides helpful resources to include, but not limited to: Provider Resource Manual Level of Care Guidelines Clinical Practice Guidelines Preferred Practice Guidelines Current & Archive Provider Newsletters Faxblasts Informative materials and brochures Satisfaction survey results Executive summaries of the QI/UM Program Description, Work Plan, and Evaluation Providers who does not have internet access can request a copy of the documents to be mailed to them. Fax Blasts are used for all communications such as provider newsletters and are also posted on the CompCare website 32

17 Claims Submission Electronic Claims WebMD/Emdeon as the Clearinghouse Emdeon Payer ID: Paper Claims Submission Comprehensive Behavioral Care, Inc. Attention: Claims 3405 W. Dr. Martin Luther King Jr. Blvd.; Suite 101 Tampa, FL Clean Claims must be submitted within 95 days of the date of services to be considered for payment. Submit H-codes on CMS-1500 or UB 04 forms Revenue Codes are billed on UB 04 forms only CPT codes are billed on CMS 1500 forms 33 Contact Information for CHRISTUS Health Plan Provider Hotline Medicaid: CHIP:

18 CompCare Management Contacts Michelle Brochu Vice President of Project Management Lisa Smithers-Cambridge Vice President of Claims/Customer Service Bridgitt Scott-McCaughey, MSW, LLMSW Vice President of Quality and Compliance CompCare Quick Reference Contact CHRISTUS STAR Behavioral Health Prior Authorization Customer Service Referrals Claims Complaints Appeals CHRISTUS CHIP Behavioral Health All related items mentioned above 36

Substance Use Disorder Services to be a Benefit of Texas Medicaid

Substance Use Disorder Services to be a Benefit of Texas Medicaid Substance Use Disorder Services to be a Benefit of Texas Medicaid Information Posted on August 13, 2010 Effective for dates of service on or after September 1, 2010, the following substance use disorder

More information

Department of Mental Health and Addiction Services 17a-453a-1 2

Department of Mental Health and Addiction Services 17a-453a-1 2 17a-453a-1 2 DEPARTMENT OF MENTAL HEALTH AND ADDICTION SERVICES General Assistance Behavioral Health Program The Regulations of Connecticut State Agencies are amended by adding sections 17a-453a-1 to 17a-453a-19,

More information

NEW HAMPSHIRE CODE OF ADMINISTRATIVE RULES. PART He-W 513 SUBSTANCE USE DISORDER (SUD) TREATMENT AND RECOVERY SUPPORT SERVICES

NEW HAMPSHIRE CODE OF ADMINISTRATIVE RULES. PART He-W 513 SUBSTANCE USE DISORDER (SUD) TREATMENT AND RECOVERY SUPPORT SERVICES CHAPTER He-W 500 MEDICAL ASSISTANCE PART He-W 513 SUBSTANCE USE DISORDER (SUD) TREATMENT AND RECOVERY SUPPORT SERVICES He-W 513.01 Purpose. The purpose of this part is to establish the procedures and requirements

More information

Magellan Behavioral Health Providers of Texas, Inc. Provider Handbook Supplement for Texas Medicaid (STAR) and CHIP Programs.

Magellan Behavioral Health Providers of Texas, Inc. Provider Handbook Supplement for Texas Medicaid (STAR) and CHIP Programs. Magellan Behavioral Health Providers of Texas, Inc. Provider Handbook Supplement for Texas Medicaid (STAR) and CHIP Programs Table of Contents Section 1. Section 2. Section 3. Section 4. Section 5. Introduction

More information

MAD-MR: 12-13 SPECIALTY SERVICES EFF: 9-1-12 MEDICATION ASSISTED TREATMENT FOR OPIOID ADDICTION INDEX

MAD-MR: 12-13 SPECIALTY SERVICES EFF: 9-1-12 MEDICATION ASSISTED TREATMENT FOR OPIOID ADDICTION INDEX INDEX 8.325.11 8.325.11.1 ISSUING AGENCY...1 8.325.11.2 SCOPE...1 8.325.11.3 STATUTORY AUTHORITY...1 8.325.11.4 DURATION...1 8.325.11.5 EFFECTIVE DATE...1 8.325.11.6 OBJECTIVE...1 8.325.11.7 DEFINITIONS...1

More information

Medicaid Substance Abuse Treatment Self-Referral Protocols Substance Abuse Improvement Initiative (SAII) January 1, 2010

Medicaid Substance Abuse Treatment Self-Referral Protocols Substance Abuse Improvement Initiative (SAII) January 1, 2010 Medicaid Substance Abuse Treatment Self-Referral Protocols Substance Abuse Improvement Initiative (SAII) January 1, 2010 The Substance Abuse Improvement Initiative (SAII) allows Medicaid enrollees to select

More information

TREATMENT MODALITIES. May, 2013

TREATMENT MODALITIES. May, 2013 TREATMENT MODALITIES May, 2013 Treatment Modalities New York State Office of Alcoholism and Substance Abuse Services (NYS OASAS) regulates the addiction treatment modalities offered in New York State.

More information

ST. CLAIR COUNTY COMMUNITY MENTAL HEALTH Date Issued: 07/09 Date Revised: 09/11;03/13;06/14;07/15

ST. CLAIR COUNTY COMMUNITY MENTAL HEALTH Date Issued: 07/09 Date Revised: 09/11;03/13;06/14;07/15 ST. CLAIR COUNTY COMMUNITY MENTAL HEALTH Date Issued: 07/09 Date Revised: 09/11;/13;06/14;07/15 WRITTEN BY Jim Johnson Page 1 REVISED BY AUTHORIZED BY Jessica Moeller Debra Johnson I. APPLICATION: THUMB

More information

NJ FamilyCare Expansion and Provider Enrollment FAQs

NJ FamilyCare Expansion and Provider Enrollment FAQs NJ FamilyCare Expansion and Provider Enrollment FAQs Roxanne Kennedy MSW, LCSW Project Officer, Managed Behavioral Health Division of Medical Assistance and Health Service January 17, 2014 1 Expansion

More information

OUTPATIENT SUBSTANCE USE DISORDER SERVICES FEE-FOR-SERVICE

OUTPATIENT SUBSTANCE USE DISORDER SERVICES FEE-FOR-SERVICE OUTPATIENT SUBSTANCE USE DISORDER SERVICES FEE-FOR-SERVICE Brief Coverage Statement Outpatient Substance Use Disorder (SUD) Fee-For-Service (FFS) Treatment Services are available for the treatment of substance

More information

Frequently Asked Questions (FAQs) from December 2013 Behavioral Health Utilization Management Webinars

Frequently Asked Questions (FAQs) from December 2013 Behavioral Health Utilization Management Webinars Frequently Asked Questions (FAQs) from December 2013 Behavioral Health Utilization Management Webinars 1. In the past we did precertifications for Residential Treatment Centers (RTC). Will this change

More information

OUTPATIENT SUBSTANCE USE DISORDER SERVICES FEE-FOR-SERVICE

OUTPATIENT SUBSTANCE USE DISORDER SERVICES FEE-FOR-SERVICE OUTPATIENT SUBSTANCE USE DISORDER SERVICES FEE-FOR-SERVICE BRIEF COVERAGE STATEMENT This benefit coverage standard describes outpatient Substance Use Disorder services (known as SUD Fee-For-Service (FFS)

More information

ACUTE TREATMENT SERVICES (ATS) FOR SUBSTANCE USE DISORDERS LEVEL III.7

ACUTE TREATMENT SERVICES (ATS) FOR SUBSTANCE USE DISORDERS LEVEL III.7 ACUTE TREATMENT SERVICES (ATS) FOR SUBSTANCE USE DISORDERS LEVEL III.7 Providers contracted for this level of care or service are expected to comply with all requirements of these service-specific performance

More information

Well Sense Health Plan. How We Do Business with Providers

Well Sense Health Plan. How We Do Business with Providers Well Sense Health Plan How We Do Business with Providers New Hampshire Health Protection Program August 2014 Agenda Working with Well Sense and our members Our partners Provider responsibilities Resources

More information

Clinical Criteria 4.201 Inpatient Medical Withdrawal Management 4.201 Substance Use Inpatient Withdrawal Management (Adults and Adolescents)

Clinical Criteria 4.201 Inpatient Medical Withdrawal Management 4.201 Substance Use Inpatient Withdrawal Management (Adults and Adolescents) 4.201 Inpatient Medical Withdrawal Management 4.201 Substance Use Inpatient Withdrawal Management (Adults and Adolescents) Description of Services: Inpatient withdrawal management is comprised of services

More information

Behavioral Health Provider Training: Program Overview & Helpful Information

Behavioral Health Provider Training: Program Overview & Helpful Information Behavioral Health Provider Training: Program Overview & Helpful Information Overview The Passport Behavioral Health Program provides members with access to a full continuum of recovery and resiliency focused

More information

Section 8 Behavioral Health Services

Section 8 Behavioral Health Services Section 8 Behavioral Health Services Superior subcontracts with Cenpatico Behavioral Health Services, Inc. to manage behavioral health services (mental health and substance abuse) for Superior Members.

More information

Behavioral Health Provider Training: Substance Abuse Treatment Updates

Behavioral Health Provider Training: Substance Abuse Treatment Updates Behavioral Health Provider Training: Substance Abuse Treatment Updates Agenda Laboratory Services Behavioral Health Claims Submission Process Targeted Case Management Utilization Management eservices Claims

More information

SUBSTANCE ABUSE FACILITY GENERAL INFORMATION

SUBSTANCE ABUSE FACILITY GENERAL INFORMATION SUBSTANCE ABUSE FACILITY GENERAL INFORMATION I. BCBSM s Substance Abuse Facility Programs Traditional The Traditional BCBSM Substance Abuse Program provides benefits for the treatment of substancerelated

More information

AHCCCS Billing Manual for IHS/Tribal Providers April, 2004 Behavioral Health Services Chapter: 12 Page: 12-1

AHCCCS Billing Manual for IHS/Tribal Providers April, 2004 Behavioral Health Services Chapter: 12 Page: 12-1 Chapter: 12 Page: 12-1 GENERAL INFORMATION NOTE: Coverage and reimbursement for both Title XIX (Medicaid-AHCCCS) and Title XXI (KidsCare) services are explained in this chapter. The covered services, limitations,

More information

MENTAL HEALTH PARITY AND ADDICTION EQUITY ACT RESOURCE GUIDE

MENTAL HEALTH PARITY AND ADDICTION EQUITY ACT RESOURCE GUIDE MENTAL HEALTH PARITY AND ADDICTION EQUITY ACT RESOURCE GUIDE May 2014 THE UNIVERSITY OF MARYLAND CAREY SCHOOL OF LAW DRUG POLICY AND PUBLIC HEALTH STRATEGIES CLINIC 2 PARITY ACT RESOURCE GUIDE TABLE OF

More information

ATTENTION: ALTERNATIVE BILLING CONCEPTS (ABC) CODES FOR BEHAVIORAL HEALTH SERVICES TO END AS OF 12/31/2009

ATTENTION: ALTERNATIVE BILLING CONCEPTS (ABC) CODES FOR BEHAVIORAL HEALTH SERVICES TO END AS OF 12/31/2009 ATTENTION: ALTERNATIVE BILLING CONCEPTS (ABC) CODES FOR BEHAVIORAL HEALTH SERVICES TO END AS OF 12/31/2009 Alaska Medical Assistance will transition from use of Alternative Billing Concepts (ABC) procedure

More information

STANDARD OPERATING PROCEDURES MANUAL FOR VERMONT MEDICAID INPATIENT PSYCHIATRIC AND DETOXIFICATION AUTHORIZATIONS

STANDARD OPERATING PROCEDURES MANUAL FOR VERMONT MEDICAID INPATIENT PSYCHIATRIC AND DETOXIFICATION AUTHORIZATIONS Agency of Human Services STANDARD OPERATING PROCEDURES MANUAL FOR VERMONT MEDICAID INPATIENT PSYCHIATRIC AND DETOXIFICATION AUTHORIZATIONS Department of Vermont Health Access Department of Mental Health

More information

Professional Treatment Services in Facility-Based Crisis Program Children and Adolescents

Professional Treatment Services in Facility-Based Crisis Program Children and Adolescents Professional Treatment Services in Facility-Based Crisis Program Children and Adolescents Medicaid and North Carolina Health Choice (NCHC) Billable Service WORKING DRAFT Revision Date: September 11, 2014

More information

Case Management and Care Coordination:

Case Management and Care Coordination: HEALTH MANAGEMENT CUP recognizes the importance of promoting effective health management and preventive care for conditions that are relevant to our populations, thereby improving health care outcomes.

More information

Behavioral Health Management of Substance Use Disorder Services

Behavioral Health Management of Substance Use Disorder Services Behavioral Health Management of Substance Use Disorder Services Arlene González-Sánchez, Commissioner Robert Kent, General Counsel SAMSHA: New York State should remain consistent with SAMSHA policy philosophy

More information

Medical and Rx Claims Procedures

Medical and Rx Claims Procedures This section of the Stryker Benefits Summary describes the procedures for filing a claim for medical and prescription drug benefits and how to appeal denied claims. Medical and Rx Benefits In-Network Providers

More information

Section 6. Medical Management Program

Section 6. Medical Management Program Section 6. Medical Management Program Introduction Molina Healthcare maintains a medical management program to ensure patient safety as well as detect and prevent fraud, waste and abuse in its programs.

More information

UTAH DIVISION OF SUBSTANCE ABUSE AND MENTAL HEALTH SUBSTANCE USE DISORDER SERVICES MONITORING CHECKLIST (FY 2014) GENERAL PROGRAM REQUIREMENTS

UTAH DIVISION OF SUBSTANCE ABUSE AND MENTAL HEALTH SUBSTANCE USE DISORDER SERVICES MONITORING CHECKLIST (FY 2014) GENERAL PROGRAM REQUIREMENTS UTAH DIVISION OF SUBSTANCE ABUSE AND MENTAL HEALTH SUBSTANCE USE DISORDER SERVICES MONITORING CHECKLIST (FY 2014) Program Name Reviewer Name Date(s) of Review GENERAL PROGRAM REQUIREMENTS 2014 Division

More information

Supplemental Manual for Substance Abuse Treatment Services(SATS) RULES OF PRACTICE AND PROCEDURE

Supplemental Manual for Substance Abuse Treatment Services(SATS) RULES OF PRACTICE AND PROCEDURE ARKANSAS DEPARTMENT OF HUMAN SERVICES DIVISION OF BEHAVIORAL HEALTH SERVICES OFFICE OF ALCOHOL AND DRUG ABUSE PREVENTION Supplemental Manual for Substance Abuse Treatment Services(SATS) RULES OF PRACTICE

More information

Provider Handbooks. Telecommunication Services Handbook

Provider Handbooks. Telecommunication Services Handbook Provider Handbooks January 2016 Telecommunication Services Handbook The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid under contract with the Texas Health

More information

Medicaid Services for Substance Abuse

Medicaid Services for Substance Abuse Medicaid Services for Substance Abuse Community Behavioral Health Services Coverage and Limitations Handbook 2007 FADAA Annual Conference-Orlando Making Medicaid Work for Substance Abuse Agenda Overview

More information

Mental Health Rehabilitative Services and Mental Health Targeted Case Management TXPEC-0870-14

Mental Health Rehabilitative Services and Mental Health Targeted Case Management TXPEC-0870-14 Mental Health Rehabilitative Services and Mental Health Targeted Case Management TXPEC-0870-14 1 Agenda Key contacts Eligibility Mental Health Rehabilitative services (MHR) and Mental Health Targeted (TCM)

More information

Division of Behavioral Health. Requirements for Program Staff

Division of Behavioral Health. Requirements for Program Staff Division of Behavioral Health Requirements for Program Staff Integrated BH Regulations Training 1 Program Staff Program Staff are professionals who render behavioral health services directly to a recipient.

More information

The Collaborative Models of Mental Health Care for Older Iowans. Model Administration. Collaborative Models of Mental Health Care for Older Iowans 97

The Collaborative Models of Mental Health Care for Older Iowans. Model Administration. Collaborative Models of Mental Health Care for Older Iowans 97 6 The Collaborative Models of Mental Health Care for Older Iowans Model Administration Collaborative Models of Mental Health Care for Older Iowans 97 Collaborative Models of Mental Health Care for Older

More information

2014 FLORIDA SUBSTANCE ABUSE LEVEL OF CARE CLINICAL CRITERIA

2014 FLORIDA SUBSTANCE ABUSE LEVEL OF CARE CLINICAL CRITERIA 2014 FLORIDA SUBSTANCE ABUSE LEVEL OF CARE CLINICAL CRITERIA SUBSTANCE ABUSE LEVEL OF CARE CLINICAL CRITERIA Overview Psychcare strives to provide quality care in the least restrictive environment. An

More information

FAQ#1 * Updated for November 2014 Behavioral Health Administrative Services Organization Transition

FAQ#1 * Updated for November 2014 Behavioral Health Administrative Services Organization Transition FAQ#1 * Updated for November 2014 Behavioral Health Administrative Services Organization Transition Provider Enrollment and Registration How will providers register with the Administrative Services Organization

More information

Consumer Toolkit for Navigating Behavioral Health and Substance Abuse Care Through Your Health Insurance Plan

Consumer Toolkit for Navigating Behavioral Health and Substance Abuse Care Through Your Health Insurance Plan CONNECTICUT INSURANCE DEPARTMENT Consumer Toolkit for Navigating Behavioral Health and Substance Abuse Care Through Your Health Insurance Plan What consumers need to know about seeking approval for behavioral

More information

STANDARD OPERATING PROCEDURES MANUAL FOR VERMONT MEDICAID INPATIENT PSYCHIATRIC AND DETOXIFICATION AUTHORIZATIONS

STANDARD OPERATING PROCEDURES MANUAL FOR VERMONT MEDICAID INPATIENT PSYCHIATRIC AND DETOXIFICATION AUTHORIZATIONS Agency of Human Services STANDARD OPERATING PROCEDURES MANUAL FOR VERMONT MEDICAID INPATIENT PSYCHIATRIC AND DETOXIFICATION AUTHORIZATIONS Department of Vermont Health Access Department of Mental Health

More information

Affordable Care Act: Health Coverage for Criminal Justice Populations. Colorado Center on Law and Policy Colorado Criminal Justice Reform Coalition

Affordable Care Act: Health Coverage for Criminal Justice Populations. Colorado Center on Law and Policy Colorado Criminal Justice Reform Coalition Affordable Care Act: Health Coverage for Criminal Justice Populations Colorado Center on Law and Policy Colorado Criminal Justice Reform Coalition Who we are CCJRC and CCLP have partnered to help Colorado

More information

OUTPATIENT SERVICES. Components of Service

OUTPATIENT SERVICES. Components of Service OUTPATIENT SERVICES Providers contracted for this level of care or service are expected to comply with all requirements of these service-specific performance specifications. Additionally, providers contracted

More information

Performance Standards

Performance Standards Performance Standards Outpatient Performance Standards are intended to provide a foundation and serve as a tool to promote continuous quality improvement and progression toward best practice performances,

More information

Provider enews TREATING PRESCRIPTION DRUG ADDICTION

Provider enews TREATING PRESCRIPTION DRUG ADDICTION Provider enews TREATING PRESCRIPTION DRUG ADDICTION Treating addiction to prescription opioids July 2012 Several options are available for effectively treating prescription opioid addiction. These options

More information

AMOUNT, DURATION, AND SCOPE OF MEDICAL AND REMEDIAL CARE AND SERVICES PROVIDED TO THE CATEGORlCALL Y NEEDY

AMOUNT, DURATION, AND SCOPE OF MEDICAL AND REMEDIAL CARE AND SERVICES PROVIDED TO THE CATEGORlCALL Y NEEDY Transmittal# 13-02 Page 6-d.l 0 CARE AND SERVICES PROVIDED TO THE CATEGORlCALL Y NEEDY Rehabilitative: Substance Use Disorder Services: Substance Use Disorder (SUD)treatment services include; screening,

More information

Maryland Medicaid HealthChoice Substance Use Disorder Form Instructions

Maryland Medicaid HealthChoice Substance Use Disorder Form Instructions Maryland Medicaid HealthChoice Substance Use Disorder Form Instructions Form Instructions for the following Community-Based Substance Use Disorder Services: Individual Outpatient Therapy, Group Outpatient

More information

PROVIDER QUICK REFERENCE GUIDE

PROVIDER QUICK REFERENCE GUIDE PROVIDER QUICK REFERENCE GUIDE Superior Quality of Care Superior Clinical Outcomes 9606 North Mopac Suite 600 Austin, TX 78759 P.O. Box 209010, Austin, TX 78720-9010 512.347.7900 Fax 724.741.4552 Dear

More information

Blue Choice PPO SM Behavioral Health Services (Mental Health & Chemical Dependency)

Blue Choice PPO SM Behavioral Health Services (Mental Health & Chemical Dependency) SM (Mental Health & Chemical Dependency) In this Section The following topics are covered in this section: Topic Page Integrated Program I 2 Program Components I 2 Focused Outpatient Management Program

More information

504 Lavaca Street Suite 850 Austin, Texas 78701 PROVIDER NEWSLETTER

504 Lavaca Street Suite 850 Austin, Texas 78701 PROVIDER NEWSLETTER 504 Lavaca Street Suite 850 Austin, Texas 78701 PROVIDER NEWSLETTER PROVIDER REPORT www.cenpatico.com Welcome to the first Cenpatico provider report for 2013. We re excited to share with you details on

More information

Appendix D. Behavioral Health Partnership. Adolescent/Adult Substance Abuse Guidelines

Appendix D. Behavioral Health Partnership. Adolescent/Adult Substance Abuse Guidelines Appendix D Behavioral Health Partnership Adolescent/Adult Substance Abuse Guidelines Handbook for Providers 92 ASAM CRITERIA The CT BHP utilizes the ASAM PPC-2R criteria for rendering decisions regarding

More information

KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. Non-PIHP Alcohol and Substance Abuse Community Based Services

KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. Non-PIHP Alcohol and Substance Abuse Community Based Services KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL Non-PIHP Alcohol and Substance Abuse Community Based Services Introduction Section 7000 7010 8100 8200 8300 8400 Appendix Forms PART II BILLING INSTRUCTIONS

More information

CHAPTER 5 SERVICE DESCRIPTIONS. Inpatient Hospital Psychiatric Services. Service Coverage

CHAPTER 5 SERVICE DESCRIPTIONS. Inpatient Hospital Psychiatric Services. Service Coverage CHAPTER 5 SERVICE DESCRIPTIONS Inpatient Hospital Psychiatric Services Service Coverage Inpatient psychiatric care involves skilled psychiatric services in a hospital setting. The care delivered includes

More information

Performance Standards

Performance Standards Performance Standards Co-Occurring Disorder Competency Performance Standards are intended to provide a foundation and serve as a tool to promote continuous quality improvement and progression toward best

More information

Consumer Toolkit for Navigating Behavioral Health and Substance Abuse Care Through Your Health Insurance Plan

Consumer Toolkit for Navigating Behavioral Health and Substance Abuse Care Through Your Health Insurance Plan ConneCtiCut insurance DePARtMent Consumer Toolkit for Navigating Behavioral Health and Substance Abuse Care Through Your Health Insurance Plan What consumers need to know about seeking approval for behavioral

More information

PERFORMANCE STANDARDS DRUG AND ALCOHOL PARTIAL HOSPITALIZATION PROGRAM. Final Updated 04/17/03

PERFORMANCE STANDARDS DRUG AND ALCOHOL PARTIAL HOSPITALIZATION PROGRAM. Final Updated 04/17/03 PERFORMANCE STANDARDS DRUG AND ALCOHOL PARTIAL HOSPITALIZATION PROGRAM Final Updated 04/17/03 Community Care is committed to developing performance standards for specific levels of care in an effort to

More information

Mental Health/Substance Abuse Provider Orientation

Mental Health/Substance Abuse Provider Orientation Mental Health/Substance Abuse Provider Orientation Blue Cross Blue Shield of Vermont (BCBSVT) Welcome to Blue Cross Blue Shield of Vermont Our Vision A transformed health system in which every Vermonter

More information

STRUCTURED OUTPATIENT ADDICTION PROGRAM (SOAP)

STRUCTURED OUTPATIENT ADDICTION PROGRAM (SOAP) STRUCTURED OUTPATIENT ADDICTION PROGRAM (SOAP) Providers contracted for this level of care or service are expected to comply with all requirements of these service-specific performance specifications.

More information

Maryland Data as of July 2003. Mental Health and Substance Abuse Services in Medicaid and SCHIP in Maryland

Maryland Data as of July 2003. Mental Health and Substance Abuse Services in Medicaid and SCHIP in Maryland Mental Health and Substance Abuse Services in Medicaid and SCHIP in Maryland As of July 2003, 638,662 people were covered under Maryland's Medicaid/SCHIP programs. There were 525,080 enrolled in the Medicaid

More information

KANSAS MEDICAL ASSISTANCE PROGRAM. Provider Manual. Psychiatric Residential Treatment Facility

KANSAS MEDICAL ASSISTANCE PROGRAM. Provider Manual. Psychiatric Residential Treatment Facility Provider Manual Psychiatric Residential Treatment Facility Updated 11/2011 PART II Introduction Section 7000 7010 7020 8100 8300 8400 BILLING INSTRUCTIONS Introduction to the CMS-1500 Claim Form......

More information

Quality Management. Substance Abuse Outpatient Care Services Service Delivery Model. Broward County/Fort Lauderdale Eligible Metropolitan Area (EMA)

Quality Management. Substance Abuse Outpatient Care Services Service Delivery Model. Broward County/Fort Lauderdale Eligible Metropolitan Area (EMA) Quality Management Substance Abuse Outpatient Care Services Broward County/Fort Lauderdale Eligible Metropolitan Area (EMA) The creation of this public document is fully funded by a federal Ryan White

More information

Superior HealthPlan Hospital Training. SHP_2013158 Hospital Orientation Presentation

Superior HealthPlan Hospital Training. SHP_2013158 Hospital Orientation Presentation Superior HealthPlan Hospital Training SHP_2013158 Hospital Orientation Presentation Introductions & Agenda Presenter Introductions About Superior HealthPlan Eligibility Medical Management CHIP Perinate

More information

Florida Data as of July 2003. Mental Health and Substance Abuse Services in Medicaid and SCHIP in Florida

Florida Data as of July 2003. Mental Health and Substance Abuse Services in Medicaid and SCHIP in Florida Mental Health and Substance Abuse Services in Medicaid and SCHIP in Florida As of July 2003 2,441,266 people were covered under Florida's Medicaid and SCHIP programs. There were 2,113,820 enrolled in the

More information

Magellan Behavioral Care of Iowa, Inc. Provider Handbook Supplement for Iowa Autism Support Program (ASP)

Magellan Behavioral Care of Iowa, Inc. Provider Handbook Supplement for Iowa Autism Support Program (ASP) Magellan Behavioral Care of Iowa, Inc. Provider Handbook Supplement for Iowa Autism Support Program (ASP) 2014 Magellan Health Services Table of Contents SECTION 1: INTRODUCTION... 3 Welcome... 3 Covered

More information

INSTRUCTIONS AND PROTOCOLS FOR THE IMPLEMENTATION OF MEDICATION-ASSISTED TREATMENT FOR OPIOID/OPIATE DEPENDENCE

INSTRUCTIONS AND PROTOCOLS FOR THE IMPLEMENTATION OF MEDICATION-ASSISTED TREATMENT FOR OPIOID/OPIATE DEPENDENCE 201 Mulholland Bay City, MI 48708 P 989-497-1344 F 989-497-1348 www.riverhaven-ca.org Title: MAT Protocol Original Date: March 30, 2009 Latest Revision Date: December 16, 2013 Approval/Release Date: January

More information

CHAPTER 7: UTILIZATION MANAGEMENT

CHAPTER 7: UTILIZATION MANAGEMENT OVERVIEW The Plan s Utilization Management (UM) program is collaboration with providers to promote and document the appropriate use of health care resources. The program reflects the most current utilization

More information

Residential Sub-Acute Detoxification Guidelines

Residential Sub-Acute Detoxification Guidelines I. Background Information A. Definition of Detoxification Residential Sub-Acute Detoxification Guidelines SAMSA s TIP #45, Detoxification and Substance Abuse Treatment: Treatment Improvement Protocols

More information

TIMEFRAME STANDARDS FOR UTILIZATION MANAGEMENT (UM) INITIAL DECISIONS

TIMEFRAME STANDARDS FOR UTILIZATION MANAGEMENT (UM) INITIAL DECISIONS ADMINISTRATIVE POLICY TIMEFRAME STANDARDS FOR UTILIZATION MANAGEMENT (UM) INITIAL DECISIONS Policy Number: ADMINISTRATIVE 088.15 T0 Effective Date: November 1, 2015 Table of Contents APPLICABLE LINES OF

More information

Maryland Medicaid HealthChoice Use Form Instructions

Maryland Medicaid HealthChoice Use Form Instructions Maryland Medicaid HealthChoice Use Form Instructions Form Instructions for the following Community-Based Substance Use Disorder Services: Individual Outpatient Therapy, Group Outpatient Therapy, Intensive

More information

Oregon Health Plan - Fee-For-Service Outpatient & Opioid Replacement

Oregon Health Plan - Fee-For-Service Outpatient & Opioid Replacement Oregon Health Plan - Fee-For-Service Outpatient & Opioid Replacement H0001 H0002T Alcohol and/or Drug Assessment $139.70 One assessment equals one unit of service. Service frequency limitation is based

More information

Targeted Case Management and Mental Health Rehabilitative Service through UnitedHealthcare Community Plan. Doc#201481.24

Targeted Case Management and Mental Health Rehabilitative Service through UnitedHealthcare Community Plan. Doc#201481.24 Targeted Case Management and Mental Health Rehabilitative Service through UnitedHealthcare Community Plan Doc#201481.24 Eligible Population Mental health rehabilitative services and mental health targeted

More information

MEDICAL POLICY Treatment of Opioid Dependence

MEDICAL POLICY Treatment of Opioid Dependence POLICY........ PG-0313 EFFECTIVE......11/11/14 LAST REVIEW... 07/14/15 MEDICAL POLICY Treatment of Opioid Dependence GUIDELINES This policy does not certify benefits or authorization of benefits, which

More information

Certain exceptions apply to Hospital Inpatient Confinement for childbirth as described below.

Certain exceptions apply to Hospital Inpatient Confinement for childbirth as described below. Tennessee Applicable Policies PRECERTIFICATION Benefits payable for Hospital Inpatient Confinement Charges and confinement charges for services provided in an inpatient confinement facility will be reduced

More information

Appendices to Interim Report on the Baltimore Buprenorphine Initiative. Managed Care Organization Information Pages

Appendices to Interim Report on the Baltimore Buprenorphine Initiative. Managed Care Organization Information Pages Appendices to Interim Report on the Baltimore Buprenorphine Initiative Appendix A Managed Care Organization Information Pages Appendix B Buprenorphine Online Physician Training Information Packet Appendix

More information

Both Outpatient Counseling and Residential Substance Abuse Treatment programs shall comply with the following requirements:

Both Outpatient Counseling and Residential Substance Abuse Treatment programs shall comply with the following requirements: SUBSTANCE ABUSE COUNSELING - OUTPATIENT COUNSELING AND RESIDENTIAL TREATMENT (General HIV/AIDS Population & MAI for Residential Treatment) (YEAR 25 Service Priorities #8 for outpatient; and #10 for Part

More information

To precertify inpatient admissions or transitional care services, call 1-866-688-3400 and select option #1.

To precertify inpatient admissions or transitional care services, call 1-866-688-3400 and select option #1. Security Health Plan provides coverage of various mental health/aoda (alcohol and other drug abuse) benefits to individual and employer group members. These benefits are managed by Security Health Plan.

More information

Provider Additions and Maintenance

Provider Additions and Maintenance Working with Anthem Subject Specific Webinar Series Provider Additions and Maintenance Access to Audio Portion of Conference: Dial-In Number: 877-497-8913 Conference Code: 1322819809# Please Mute Your

More information

New Haven/Fairfield Counties Ryan White Part A Program Substance Abuse Service Standard SUBSTANCE ABUSE

New Haven/Fairfield Counties Ryan White Part A Program Substance Abuse Service Standard SUBSTANCE ABUSE I. DEFINITION OF SERVICE New Haven/Fairfield Counties Ryan White Part A Program Substance Abuse Service Standard SUBSTANCE ABUSE CORE MEDICAL SERVICE Support for Substance Abuse Treatment Services-Outpatient,

More information

MEDICAL POLICY No. 91608-R1 MENTAL HEALTH RESIDENTIAL TREATMENT: ADULT

MEDICAL POLICY No. 91608-R1 MENTAL HEALTH RESIDENTIAL TREATMENT: ADULT MENTAL HEALTH RESIDENTIAL TREATMENT: ADULT Effective Date: June 4, 2015 Review Dates: 5/14, 5/15 Date Of Origin: May 12, 2014 Status: Current Summary of Changes Clarifications: Pg 4, Description, updated

More information

CLAIMS AND BILLING INSTRUCTIONAL MANUAL

CLAIMS AND BILLING INSTRUCTIONAL MANUAL CLAIMS AND BILLING INSTRUCTIONAL MANUAL 2007 TABLE OF ONTENTS Paper Claims and Block Grant Submission Requirements... 3 State Requirements for Claims Turnaround Time... 12 Claims Appeal Process... 13 Third

More information

Financing integrated Healthcare in Washington

Financing integrated Healthcare in Washington Financing integrated Healthcare in Washington as of: April 23. 2012 E & M Codes CPT Code 99201-99205 99211-99215 Est. Pt Diagnostic Code May be used only with physical Federally Qualified Health Centers

More information

Keep Your Mind and Body Healthy: Understanding Mental Health Providers, Care and Coverage

Keep Your Mind and Body Healthy: Understanding Mental Health Providers, Care and Coverage Keep Your Mind and Body Healthy: Understanding Mental Health Providers, Care and Coverage Our mental health is a vital part of our overall well-being. It affects how we think, how we feel, and how we act.

More information

Ambulatory Patient Groups (APG) Policy and Medicaid Billing Guidance OASAS Certified Outpatient Chemical Dependence Programs

Ambulatory Patient Groups (APG) Policy and Medicaid Billing Guidance OASAS Certified Outpatient Chemical Dependence Programs Ambulatory Patient Groups (APG) Policy and Medicaid Billing Guidance OASAS Certified Outpatient Chemical Dependence Programs www.oasas.ny.gov TABLE OF CONTENTS SECTION: PAGE 1. Background and Introduction

More information

Outpatient and Intensive Outpatient Narrative

Outpatient and Intensive Outpatient Narrative Los Angeles County Department of Public Health Substance Abuse Prevention and Control (SAPC) will implement an initial benefit package of Substance Use Disorder (SUD) services within the initial twelve

More information

A GUIDE TO BEHAVIORAL HEALTH

A GUIDE TO BEHAVIORAL HEALTH A GUIDE TO BEHAVIORAL HEALTH Important information about your behavioral healthcare options in Central Texas At Seton Behavioral Health Care, we offer support and programs to lead you through life s challenges.

More information

Frequently Asked Questions and Answers: Managed Care Organizations and HCS/TxHmL Program Providers

Frequently Asked Questions and Answers: Managed Care Organizations and HCS/TxHmL Program Providers Frequently Asked Questions and Answers: Managed Care Organizations and HCS/TxHmL Program Providers Pharmacy/Medication Related Questions: 1) Question: After the initial transition pre-authorization period,

More information

907 KAR 9:005. Level I and II psychiatric residential treatment facility service and coverage policies.

907 KAR 9:005. Level I and II psychiatric residential treatment facility service and coverage policies. 907 KAR 9:005. Level I and II psychiatric residential treatment facility service and coverage policies. RELATES TO: KRS 205.520, 216B.450, 216B.455, 216B.459 STATUTORY AUTHORITY: KRS 194A.030(2), 194A.050(1),

More information

North Carolina Medicaid Special Bulletin

North Carolina Medicaid Special Bulletin North Carolina Medicaid Special Bulletin An Information Service of the Division of Medical Assistance Please visit our Web site at www.ncdhhs.gov/dma JULY 2006 Attention: All Mental Health/Substance Abuse

More information

OSCAR Health Insurance Frequently Asked Questions/General Information

OSCAR Health Insurance Frequently Asked Questions/General Information Q: What is the relationship between Oscar and ValueOptions? A. ValueOptions administers the mental health and substance abuse benefits for Oscar Health Insurance. They have contracted with ValueOptions,

More information

Services Available to Members Complaints & Appeals

Services Available to Members Complaints & Appeals Services Available to Members Complaints & Appeals Blue Cross and Blue Shield of Texas (BCBSTX) resolves complaints and appeals related to any aspect of service provided by itself or any subcontractor

More information

STAR/Medicaid Member Complaint and Appeals Process

STAR/Medicaid Member Complaint and Appeals Process STAR/Medicaid Member Complaint and Appeals Process What should I do if I have a complaint? We want to help. If you have a complaint, please call us toll-free at 1-855-526-7388 to tell us about your problem.

More information

GENERAL INSTRUCTIONS

GENERAL INSTRUCTIONS This section provides definitions and general instructions for the Montana Substance Abuse Management System (SAMS). Subject areas include system overview, program requirements, system components and general

More information

NEWS. TCHP offers health education classes in provider offices. May 2012. A publication of Texas Children s Health Plan

NEWS. TCHP offers health education classes in provider offices. May 2012. A publication of Texas Children s Health Plan Provider A publication of Texas Children s Health Plan NEWS May 2012 TCHP offers health education classes in provider offices Did you know that Texas Children s Health Plan (TCHP) case managers can host

More information

Subacute Inpatient MH - Adult

Subacute Inpatient MH - Adult Subacute Inpatient MH - Adult Definition Subacute Inpatient hospital psychiatric services are medically necessary short-term psychiatric services provided to a client with a primary psychiatric diagnosis

More information

Psychiatric Rehabilitation Clinical Coverage Policy No: 8D-1 Treatment Facilities Revised Date: August 1, 2012. Table of Contents

Psychiatric Rehabilitation Clinical Coverage Policy No: 8D-1 Treatment Facilities Revised Date: August 1, 2012. Table of Contents Table of Contents 1.0 Description of the Procedure, Product, or Service... 1 2.0 Eligible Recipients... 1 2.1 Provisions... 1 2.2 EPSDT Special Provision: Exception to Policy Limitations for Recipients

More information

Telemedicine services. Crisis intervcntion response services, except

Telemedicine services. Crisis intervcntion response services, except Approved: MAY 2 4 2010 ATTACHMENT 3.1 -A Page 54j 4. Consultation with relatives, guardians, friends, employers, treatment providers, and other significant people, in order to change situations and allow

More information

2014 Behavioral Health. Utilization Management. Program Description

2014 Behavioral Health. Utilization Management. Program Description APS Healthcare 2014 Behavioral Health Utilization Management Program Description 2014 APS BH UM Program Description APS Healthcare 2014 Behavioral Health Utilization Management Program Description I. PURPOSE

More information

Substance Abuse Treatment Certification Rule Chapter 8 Alcohol and Drug Abuse Subchapter 4

Substance Abuse Treatment Certification Rule Chapter 8 Alcohol and Drug Abuse Subchapter 4 1.0 Authority Substance Abuse Treatment Certification Rule Chapter 8 Alcohol and Drug Abuse Subchapter 4 1.1 This rule is adopted pursuant to 8 V.S.A 4089b and 18 V.S.A 4806. 2.0 Purpose 2.1 This rule

More information

Mental Health and Substance Abuse Services Under BadgerCare Plus

Mental Health and Substance Abuse Services Under BadgerCare Plus Update January 2008 No. 2008-05 BadgerCare Plus Information for Providers To: Advanced Practice Nurse Prescribers with Psychiatric Specialty, AODA Counselors, Community Support Programs, Comprehensive

More information

SUBSTANCE ABUSE ENCOUNTER REPORTING: HCPCS and Revenue Codes Overview of Updates for Fiscal Year 2008

SUBSTANCE ABUSE ENCOUNTER REPORTING: HCPCS and Revenue Codes Overview of Updates for Fiscal Year 2008 SUBSTANCE ABUSE ENCOUNTER REPORTING: HCPCS and Overview of Updates for Fiscal Year 2008 This encounter code and modifier chart, effective 10/1/2007, describes how submitted encounter codes and modifiers

More information

ANCILLARY STABILIZATION AND WITHDRAWAL. The Why And How Of Stabilizing The Patient In A Comprehensive Treatment Setting

ANCILLARY STABILIZATION AND WITHDRAWAL. The Why And How Of Stabilizing The Patient In A Comprehensive Treatment Setting ANCILLARY STABILIZATION AND WITHDRAWAL The Why And How Of Stabilizing The Patient In A Comprehensive Treatment Setting About CASAColumbia A science-based, multidisciplinary organization Focused on transforming

More information