Division of Behavioral Health. Provider Agency Requirements Information Resources for Providers
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1 Division of Behavioral Health Provider Agency Requirements Information Resources for Providers 1
2 Community Behavioral Health Services (CBHS) Grantee Provider Agency Requirements Must meet requirements for CBHS provider outlined in 7 AAC Be a city, borough or nonprofit Must receive money from the Department which must be used for costs of service provision not capital expenditures Have formal agreement with physician if providing clinic services Collect and report statistical and service data as requested by the Department Participate in Department service delivery planning Maintain Medicaid standard requirement for clinical records Have Policies & Procedures to apply fees based on individual personal financial circumstances Provide services to eligible consumers regardless of ability to pay NOT replace local funding with grant funds Be a dual diagnosis capable or dual diagnosis enhanced program -7 AAC (19)(20) Meet additional requirements for Alcohol and Drug Detoxification Services OR Residential Substance Use Treatment Services Possess Department Approval for the applicable services, service area, and business locations Accreditation from approved agency (7 AAC ) Working toward accreditation while meeting Interim Standards for Operation (7 AAC ) 2
3 Provider Information Resources - Documents/Publications REGULATIONS Internet Access STATE OF ALASKA REFERENCE MATERIALS Internet Access - STATE OF ALASKA, DHSS/DBH Program Policies & Claims Billing Procedures Manuals Training Materials Frequently Asked Questions/Answers Links Internet Access FISCAL AGENT ACS, Inc. Program Policies & Claims Billing Procedures Manuals Forms 3
4 How to find Regulations on the Internet START at the Alaska State home page ( select Find State Statutes & Regulations" located under the heading Services midway down page scroll down and find the heading labeled Alaska Law Resources" and then select "Alaska Administrative Code select "Title 7 - Health and Social Services" Select Part 5 entitled Services for Behavioral Health Recipients, Seniors, and Persons with a Disability (7 AAC 70 7 AAC 75) Chapter 70 Behavioral Health Services Applicability & Scope; BH Services Provider Qualifications; BH Services Interim Standards for Operation; General Provisions Select Part 8 entitled Medicaid Coverage and Payment (7 AAC AAC 165) Chapter 105 Medicaid Provider & Recipient Participation applicable to all services Provider Enrollment, Responsibilities, Record-keeping, Payments & Overpayment Recovery, Appeals, Sanctions/Restrictions Chapter 110 Medicaid Coverage; Professional Services applicable to all services Physician (7 AAC ), ANP (7 AAC ), Psychologist (7 AAC ) Chapter 135 Medicaid Coverage; Behavioral Health Services Scope; Recipient Eligibility; Provider Enrollment; Service Authorization; BH Services; Residential BRS, Definitions Chapter 145 Medicaid Payment; Conditions and Methods applicable to all services Timely Filing, Reassignment Prohibition, Payment Methodologies, Cost Sharing by Recipients, Out-of-State Coverage/Payment; Chapter 160 Medicaid Program; General Provisions Program Integrity & Quality Assurance (includes Audits); Third-Party Liability & Estate Recovery Adoption by Reference (7 AAC ) Definitions (7 AAC ) applicable to all services (in addition to separate definitions included in specific chapters) 4
5 How to Find State of Alaska Department of Health & Social Services/Division of Behavioral Health (DHSS/DBH) Website START at the Alaska State home page ( Select the Health" tab located under the heading Services midway down page Select More Dept. of Health & Social Services Select Behavioral Health under the heading Organization on the right side midway down page Double-Click on the words Use this link for New Integrated Behavioral Health Regulations Implementation located to the right of the DBH Director s picture New Integrated Regulations Provider Communications Provider Training Resources Medicaid Billing Related Technical Assistance Frequently Asked Questions (FAQs) Regulation Clarification Process Select from the following to obtain other information Programs Alaska Psychiatric Institute, Policy & Planning, Prevention & Early Intervention, Program Integrity, Treatment & Recovery Resources Documents & Publications, Forms, Policies & Procedures, Training & Conferences, etc 5
6 Fiscal Agent - Contracted with the Department of Health and Social Services Xerox 1835 South Bragaw Street, Suite 200 Anchorage, Alaska Anchorage: (907) Outside Anchorage: (800) (In State Toll Free) 6
7 Fiscal Agent Functions Processes all Medical Assistance claims, including technical support to accommodate electronic submission of claims and other transactions Provides customer service for providers and recipients Enrolls providers in Medical Assistance Provides Medical Assistance billing training to the provider community Publishes and distributes provider billing manuals Maintains website of information for providers Prior authorizes some services Performs First Level Provider Appeals Performs Intake for Recipient Fair Hearing Requests Generates and issues claim payments and tax information Perform Surveillance and Utilization Review (program integrity) 7
8 How to find Alaska Medical Assistance Information using the Fiscal Agent s Website 1. Start at the fiscal agent s Alaska Medical Assistance page ( 2. Select Providers" located in the horizontal list at the top of the page Select Billing Manuals" then click on the boxed word Accept at bottom of page Program Policies & Claims Billing Procedures Manuals Community Behavioral Health Services Providers Mental Health Physician Clinic Services Providers Inpatient Psychiatric (includes residential psychiatric treatment centers) Other Service Providers (Physician, Advanced Nurse Practitioner, Federally Qualified Health Center, Tribal Services, School Based Services, etc.) Claim Form Instructions CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services select Forms" Provider Enrollment Application forms Information Submission Agreements Service Authorization Request Forms Claim Form Instructions (see above) select Updates Manual replacement pages and other updates select HIPAA" Companion Guides for all Electronic Transactions Tool kit, testing procedures, and other information for becoming an electronic submitter/receiver select Training" Schedule, Registration, Materials, etc. select Contact Us Contact information for designated work units, staff, mailing addresses, etc. 8
9 Provider Resources Training & Staff Support State of Alaska DHSS/DBH: Area Trainings, Change Agent Conferences, Topic Specific Webinars, Stakeholder Meetings Regulations Clarification Process Staff in Program Integrity, Treatment & Recovery, and AKAIMS Fiscal Agent Xerox Area Trainings (focus on billing and payment) Enhanced Provider Support Staff Chandra Lewis 9
10 Regulations Clarification Process 1. Procedure for providers to inquire about meaning or applicability of Behavioral Health Services Regulations 2. Mechanism for DHSS/DBH to explain (FAQ) or interpret (Clarification) Behavioral Health Services Regulations 3. Method for compiling information leading to updates in provider manual and potential revisions of Behavioral Health Services Regulations 10
11 Regulations Clarification Process Procedure: 1. Provider completes and submits Clarification Request Form (Appendix I-F in provider manual) 2. DHSS/DBH staff researches question & develops recommended response 3. DHSS/DBH Executive Team reviews, edits and approves response 4. DHSS/DBH staff posts response as FAQ on website, and informs provider who submitted request; OR 5. Publishes response as a regulation clarification in provider manual 11
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