Aetna Behavioral Health Insights TM

Transcription

1 Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Spring 2015 Volume 10, Issue 1 Aetna Behavioral Health Insights TM Behavioral Health newsletter Inside this issue Update your office s data online 1 Value-based contracting 2 Check out our education site CMS requirements 3 Ready for ICD-10? 3 Autism directory changes 4 OfficeLink newsletter 4 Aetna Student Health precert 4 GET CONNECTED! Electronic claims submission 5 EAP CORNER Mobile app resources 6 Veterans Employment Toolkit 6 Join our educator network 6 PROVIDER QUALITY COUNTS What is HEDIS? 7 ADHD quality of care 8 Clinical Practice Guidelines 9 Member Rights online 9 Manual includes patient rights 9 Update your office s demographic data online If you need to change or update your office s demographic information new addresses, or a new mailing address, phone or fax numbers you should do it through our secure provider website. Having your correct address on file is very important to us. It s our preferred way of communicating important information to you. Online security is more important than ever in today s high-tech world. Our secure site lets you validate the information you submit. It also ensures that unauthorized individuals aren t submitting incorrect information about your office or facility. Your Security Officer can make demographic changes, or they may give access to others. You ll need to register for our secure website To use the secure website you must first register. Registration is easy. Once registered, you ll also be able to submit claims transactions, check member eligibility and benefits and even verify referrals. You may see a letter from us about your data We may send you a letter asking you to validate your demographic information. The letter will show the current information we have on file for you. We ask that you respond to the letter with any updates as soon as you can. CONTACT US I (4/15)

2 We ve started value-based contracting in some markets We know that evidence-based and outcome-focused behavioral health care leads to improved management of the member s condition. In fact, we believe that partnering with and changing how we pay providers can improve both the cost and quality of care for our members. To that end, we ve started using a value-based contracting approach with select high-quality behavioral health care providers. We launched the program initially in southeastern PA and Dallas/Fort Worth, TX. In 2015, we re expanding to more areas in Texas and Pennsylvania, as well as Florida and New Jersey. We re also looking for opportunities to align more closely with current medical accountable care organizations (ACOs). The goal of this value-based contracting initiative is to identify and compensate high quality providers. Participating providers can earn additional recognition, increased volume and compensation in exchange for performance. Some measures include: Timely access Use of evidence-based tools and practices Use of electronic medical records Collaboration with medical providers Outreach to lapsed patients Patient satisfaction We ll continue to add new providers to this program. Look for updates in future issues of Insights as we expand. Check out learning opportunities on our education site is our education site for health care professionals. It s the no-cost single source of learning opportunities for health care providers, including behavioral health care professionals. The site offers: User-friendly navigation and search Small digestible pieces of content Free continuing medical education/continuing education courses (CME/CE) for participating providers A variety of office staff courses to help ease administration Effortless share with a colleague functionality Online, live webinars and recorded events Valuable reference tools to make your job easier, and much more Coming to in 2015 Look for behavioral health continuing education programs available at later this year. You ll find details in our next issue of Insights. 2 Aetna Behavioral Health Insights

3 2015 Centers for Medicare & Medicaid Services (CMS) compliance requirements Through your Aetna and/or Coventry provider contract, you must meet CMS compliance requirements for First Tier, Downstream or Related Entities (FDRs) on an annual basis. These program compliance requirements include: General compliance and fraud, waste and abuse (FWA)* training Code of conduct/compliance policies dissemination Exclusion list screenings Reporting mechanisms for potential FWA and compliance issues Offshore protected health information operation reporting Downstream entity oversight Complete your 2015 Medicare compliance Attestation** To avoid changes in participation status, an authorized representative of your organization must complete and submit your 2015 Medicare Attestation. You can submit your attestation within the Aetna Provider Education Portal by following these steps: 1. Log in or register at 2. Type attestation in the search field and click go 3. Select the 2015 Aetna Medicare Attestation (log in required) Questions? For more details on the FDR program compliance requirements, visit Then search attestation. Or, you can call our Provider Service Center at *Failure to meet the FDR compliance requirements annually may impact your participation status. * *You only need to complete one attestation to meet both Aetna and Coventry compliance obligations. Are you ready for ICD-10? As you know, the federal Health Insurance Portability and Accountability Act (HIPAA) requires that ICD-10 code sets replace ICD-9 code sets. Along with you, we re required to make this change on October 1, What you told us through our survey We d like to share some early results from the readiness survey we sent out in April. If you haven t already taken the survey, it s not too late. Please complete it by June 3, Steps you can take Keep working with your billing or software vendors and clearinghouses for conversion information and testing plans Determine the impact of the ICD-10 conversion on clinical, financial, billing and coding processes Read Q&A and ICD-10 testing results webinars So far, we received over 5,000 responses from both medical and behavioral health providers. 65 percent have tested with their clearinghouses or plan to do so before October 1, percent said they had some degree of confidence that they ll be ready for ICD-10. How confident are you? Have you tested with your clearinghouses? SPRING

4 Autism directory changes We re automating our autism directory. As a result, starting later this year we ll publish autism provider addresses in our directory. If you re an autism provider and you do not want to be listed in our online directory, send an to us at AetnaBH-AppliedBehaviorAnalyst@AETNA.com to opt out. Don t forget to read OfficeLink Aetna OfficeLink Updates our quarterly newsletter for medical providers and other health care professionals may also offer articles useful to behavioral health practitioners. Get this publication on our website. You can also find archived issues of both OfficeLink and BH Insights quickly and easily. Aetna Student Health: Behavioral Health Precertification Policy Reminder Please make sure you consult the Behavioral Health Precertification List and Aetna s precertification policy before providing services for Aetna Student Health members. As a reminder, your contract with us requires you to follow the Behavioral Health Precertification List and comply with Aetna s precertification policy. What this means for you If you submit claims to Aetna after July 1, 2015 for services that require precertification and have not been precertified, we may pay these claims at a reduced rate or not at all. Questions? Call us at Aetna Behavioral Health Insights

5 GET CONNECTED Get paid faster by submitting all of your claims electronically Submitting all of your Aetna claims electronically means you ll receive faster payments. Don t have billing software? Register for our free secure provider website on NaviNet and start submitting your professional claims for free! Benefits of electronic submission We ve improved our systems to allow for receipt and processing of claims you used to send on paper: Corrected and/or voided claims: All you need to do is submit a Claim Frequency Code to tell us whether the claim should be voided or corrected, and provide the Aetna claim number assigned to the previously submitted claim. Contact your vendor to learn how easy it is to transmit the information to us electronically. --To mark a claim as corrected or voided, use the Claim Frequency Code field (the equivalent to Box 22 on a CMS-1500 paper claim form). For corrected claims, enter a 7. For voided claims, enter an 8. Coordination of benefits (COB) claims: We can accept and process electronic COB claims. Visit our dedicated COB web page to learn how to send them. To help you navigate COB for your patients, we participate in COB Smart, a CAQH Solution. That means when you submit an electronic eligibility request, we ll tell you whether your patient has additional insurance coverage and which plan is primary, making it even easier for you to get it right the first time. You can help your patients report additional insurance coverage by having them complete the COB form on our website. Clearing up misconceptions Let s talk about some common reasons you may not be submitting all your claims electronically: Claims attachments: Keep copies of referrals, precertifications, progress reports, chart notes and more in your files. If we need them, we ll let you know. Participation status: While we d like you to participate with Aetna, if you don t, you can still send us your claims electronically. Patients benefits plans: It doesn t matter what type of Aetna benefits plans your patients are enrolled in, whether they get their coverage from their employer or the health care marketplace. Submit claims for them electronically. Questions? Send us any questions by clicking on Feedback then on Aetna Website. SPRING

6 EAP CORNER Mobile app offers free resources The Aetna Resources For Living SM mobile app offers resources for both members and the general public. These include tips for balancing work and life and coping with stress and anxiety. A mood rater also gives a custom message to uplift users on bad days and reinforce good feelings on better ones. Monthly, the What s New section features new content from our employee assistance program (EAP) member and manager newsletters. Members can also fill out a short form to request service, link to mystrength s unique wellness portal and check out special discount programs. Give it a try, then spread the word to your Aetna clients You and your clients can download the app for free. Simply search for Aetna Resources For Living in your device s app store. Check out the Veterans Employment Toolkit online We wanted to remind you about your access to the online Veterans Employment Toolkit. We offer this free toolkit to you as part of our collaboration with the Department of Veterans Affairs. The toolkit includes an online course that provides CEU credit. Look for the EAP-Providers Supporting Veterans in the Workplace course inside the toolkit. How the toolkit can help you work with veterans The Department of Veterans Affairs created the Veterans Employment Toolkit to increase veterans employment retention and facilitate their success in the workplace. The toolkit gives practical information and guidance for employers, managers and supervisors, human resource professionals, and employee assistance program (EAP) providers to support employees who are also veterans or members of the Reserve and National Guard. The online toolkit features information about the value veterans bring to the workplace, describes military experience and culture and discusses common readjustment challenges veterans and members of the Reserve and National Guard may experience. It also includes resources to help veterans obtain employment, make important career decisions and succeed in the workplace. Help us support our veterans Visit the Department of Veterans Affairs public website to check out the free toolkit. We encourage you to share with your colleagues and patients. Consider becoming an Aetna Resources for Living seminar presenter 6 Aetna Resources For Living, our EAP, offers a broad range of seminars to our customers. Categories include EAP service orientation, daily living, health and well-being and professional development. These seminars are delivered both face to face and virtually at our customers locations nationwide. Our training network includes behavioral health and training professionals with varied expertise and backgrounds. Aetna Behavioral Health Insights We invite qualified professionals to join our educator network We re looking to expand our educator network. Qualifications for trainers include: A minimum of two years of training experience Ability to adapt to a wide range of demographics A minimum of two years working with an EAP If you re interested in becoming a part of this educator network us at eapseminarrequest@rfl.com. One of our staff members will reach out to set up an interview.

7 PROVIDER QUALITY COUNTS What is HEDIS? The Healthcare Effectiveness Data and Information Set (HEDIS)1 represents the leading set of standardized health care performance measures. Designed and maintained by the National Committee for Quality Assurance (NCQA), HEDIS allows comparisons among managed care plans. HEDIS reports on major public health issues such as cancer, heart disease, smoking, depression and diabetes. HEDIS includes eight measures related to behavioral health services: Antidepressant medication management Follow-up after hospitalization for mental illness Follow-up care for children prescribed Attention-Deficit/ Hyperactivity Disorder (ADHD) medication Initiation and engagement of alcohol and other drug dependence treatment Diabetes screening for people with schizophrenia or bipolar disorder who are using antipsychotic medications Diabetes monitoring for people with diabetes and schizophrenia Cardiovascular monitoring for people with cardiovascular disease and schizophrenia Adherence to antipsychotic medications for individuals with schizophrenia The measures correspond with best clinical practices and are based on scientific evidence. By standardizing these measures, NCQA has established a uniform method on which managed behavioral health organizations, and their clinician networks, can be evaluated. With your help, the quality of care delivered to health plan enrollees will improve. NCQA publishes the results for the HEDIS measures in its State of Health Care Quality (SOHCQ) report each year. In the 2014 SOHCQ report, NCQA noted that many behavioral health measures show significant decline and the ADHD rates are below 50 percent meaning most children do not get the follow-up ADHD care they should, regardless of the kind of insurance they have. We actively work to improve the HEDIS rates of our customer health plans. We encourage you to read the articles in upcoming issues focused on HEDIS behavioral health measures with tips on how to help. You may get s, mailings or faxes from us with recommendations on how to comply with the HEDIS measures. We may also contact you to find out if a patient has kept an appointment with you. We appreciate your cooperation with these activities, and invite feedback about what we can do to help you meet these measures. You can contact our Quality Improvement department at QualityImprovement2@aetna.com. 1 NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA s HEDIS is the most widely used performance measurement tool in health care. SPRING

8 New study shows opportunity to improve quality of ADHD care According to results from a new study in the journal Pediatrics, community-based care for children with ADHD varies considerably and is not consistent with evidence-based practice.1 In the study, pediatricians across diverse practices in Ohio used Diagnostic and Statistical Manual of Mental Health Disorders, Fourth Edition (DSM-IV) criteria in only about two-thirds of patients during an ADHD assessment. They used parent and teacher rating scales for only about half of the patients, despite the American Academy of Pediatrics (AAP) consensus guidelines recommending both. AAP clinical practice guideline The AAP clinical practice guideline for the treatment of school-aged children with ADHD advocates the use of explicit DSM-IV criteria to diagnose the disorder. The guideline also stresses the importance of gathering information about the child s symptoms in more than one setting, notably in schools. Regarding treatment, most patients with ADHD included in the analysis received medication, but few received psychosocial treatment. Combined treatment is the most effective treatment strategy for children with ADHD.2 Also, less than half of children prescribed medication had contact with their pediatrician within the first month of the prescription. Rates of evidenced-based care were determined by chart reviews of a random sample of 1,594 patient charts across 188 pediatricians at 50 different practices. Aetna s adoption of AAP clinical practice guideline In February 2014, we adopted the AAP clinical practice guideline for the diagnosis, evaluation and treatment of ADHD in children and adolescents. You re encouraged to use the guideline to ensure effective, appropriate, quality care for our members. We annually monitor provider adherence to these guidelines through the HEDIS measure, Follow-up care for children prescribed ADHD medication. Monitoring your patient s adherence NCQA has established two measures to monitor patients adherence to follow-up visits after receiving ADHD medications for the first time. It s important to monitor the percentage of your patients who attend a follow-up visit within 30 days of prescribing ADHD medication. Also, your patient should remain on the ADHD medication and attend at least two additional follow-up visits within nine months of the first follow-up visit (one of which can be over the phone). 1 Epstein JN et al. Variability in ADHD Care in Community-based Pediatrics. Pediatrics 2014 Nov 3 ( used performance measurement tool in health care. 2 The MTA Cooperative Group. A 14-Month Randomized Clinical Trial of Treatment Strategies for Attention-Deficit/Hyperactivity Disorder. Arch Gen Psychiatry. 1999;56(12): doi: /archpsyc article.aspx?articleid= Aetna Behavioral Health Insights

9 Consult our behavioral health CPGs when caring for patients NCQA requires health plans to regularly inform practitioners about the availability of clinical practice guidelines (CPGs). The following behavioral health CPGs are based on nationally recognized recommendations and peer-reviewed medical literature. They re posted on our secure provider website. Go to Plan Central/Aetna Health Plan/Support Center/Clinical Resources/ Clinical Practice Guidelines or click the links below to access the guidelines. Helping patients who drink too much Adopted 2/14 Treating patients with major depressive disorder Adopted 2/14 ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of Attention-Deficit/ Hyperactivity Disorder in children and adolescents Adopted 2/14 For a hard copy of a specific CPG, call our Provider Service Center at Member Rights and Responsibilities are available online Our Member Rights and Responsibilities are available online on our public website at in the Individuals & Families section under Rights & Resources on the Your Rights page. For a copy of Aetna s Member Rights and Responsibilities Statement, call Office Manual includes information about patient rights Our Office Manual for Health Care Professionals, available on our public website at includes information on member rights and responsibilities, including those about discrimination. All participating physicians and behavioral health practitioners should have a documented non-discrimination policy. Federal and state laws prohibit discrimination in the treatment of patients on the basis of race, ethnicity, national origin, religion, sex, age, mental or physical disability, medical condition, sexual orientation, claims experience, medical history, evidence of insurability (including conditions arising out of acts of domestic violence), genetic information or source of payment. Patient rights under ADA All participating physicians and all behavioral health practitioners or health care professionals may also be obligated under the federal Americans with Disabilities Act (ADA) to provide physical access to their offices. The ADA also mandates reasonable accommodations for patients and employees with disabilities. If you don t have Internet access, call our Provider Service Center for a paper copy of the Office Manual. SPRING

10 For more information or if you need to contact us Online: Access our secure provider website on NaviNet available through our public website. Once there select Health Care Professionals, then Log In/Register. Already registered? Go to To access the Aetna Behavioral Health and Employee Assistance Program page: Log in to our secure provider website Choose Aetna Support Center from the upper-left menu Select Doing Business with Aetna followed by Aetna Benefit Products By phone: Aetna Behavioral Health: For general questions about Aetna Behavioral Health For HMO-based and Medicare Advantage plans claims, benefits, eligibility or demographic changes For all other plans claims, benefits, eligibility or demographic changes MDAETNA ( ) For all HMO-based and Medicare Advantage plans precertification or case management For all other plans precertification or case management MDAETNA ( ) For questions about joining the Aetna Behavioral Health network Aetna Behavioral Health Quality: Contact us at for HMO-based and Medicare Advantage plans, or MDAETNA ( ) for all other plans if you: --Have questions about our UM criteria, or if you would like a copy --Need information on a coverage decision for one of your Aetna Behavioral Health patients --Need to speak with one of our clinical reviewers (24 hours a day, 7 days a week) If you have questions or want more information on provider quality efforts, you can also our Quality Management staff at QualityImprovement2@aetna.com. EAP Call Center: Call By mail: Aetna Behavioral Health 1425 Union Meeting Road P.O. Box 5 Blue Bell, PA Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies (Aetna). Aetna Behavioral Health refers to an internal business unit of Aetna. This material is for informational purposes only and is not medical advice. Health benefits and health insurance plans contain exclusions and limitations. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a therapist, physician or other health care professional. Information is believed to be accurate as of the production date; however, it is subject to change. Aetna Resources For Living SM is the brand name used for products and services offered through the Aetna group of subsidiary companies (Aetna). The EAP is administered by Aetna Behavioral Health, LLC, Horizon Behavioral Health Services, LLC and Resources For Living, LLC. In California for Knox-Keene plans, Aetna Health of California, Inc. and Health and Human Resources Center, Inc Aetna Inc I (4/15)