Long Island Regional Behavioral Health Organization (BHO) Inpatient Mental Health/Substance Abuse Services Kick-Off 1
Objectives Welcome and Introductions. Philosophy of BHM. Overview of BHM. Clinical Requirements. ProviderConnect Demo. Questions and Answers. 2
3 Program Overview
Long Island Behavioral Health Management (BHM) Mission To improve the outcomes of those receiving mental health and substance abuse services within the region by: encouraging and facilitating region-wide multi-stakeholder collaboration/communication supporting the emergence of Health Homes in the region strengthening provider efforts toward more effective discharge planning reducing preventable readmissions encouraging the application of evidence based practices and quality improvement efforts collecting and reporting on data to inform and enhance local and state government regional planning efforts advancing the principles of recovery and resiliency preparing the region s public behavioral health care system, and relevant health and human services partners for the advent of responsively integrated managed health care reform in 2013-14 4
Long Island Behavioral Health Management (BHM) Vision BHM is committed to supporting and advancing the development of an integrated, efficient, reliable and recovery-focused regional service delivery system that is flexible and innovative, assuring timely and appropriate access to the right service at the right time in order to responsively address the person-centered mental health and chemical dependency needs of those receiving services within the region. 5
Long Island Behavioral Health Management (BHM) Overview A partnership between ValueOptions and the North Shore LIJ Health System. Care management leadership to the Long Island Region for the treatment services and support required by Medicaid-eligible adults with serious mental illnesses and substance use disorders whose behavioral health needs are not covered by NYS Medicaid Health Plans, as well as children and youth diagnosed with a serious emotional disturbance. 6
Long Island Behavioral Health Management (BHM) Overview BHO initiative will include: Monitoring and improving the efficiency of inpatient services. Support and assistance to reduce avoidable readmissions and improve rapid linkage with required outpatient services postdischarge. Reduce regional service fragmentation through active outreach and communication with all components of the inpatient and outpatient behavioral health service delivery system. Systems advocacy efforts to focus on peer wellness and navigation services, particularly for high risk individuals who have fallen out of care and are at risk for emergency hospitalization or incarceration. Suicide prevention protocols into all aspects of clinical care management operations. 7
8 Clinical Requirements
Utilization Management Inpatient requests are completed either through the web or telephonically by calling the dedicated toll free number 877.468.8530. BHM Staff are available from Monday -Friday from 8:30 AM to 5:00 PM. 9
Program Requirements Inpatient Providers Notification: Providers are required to notify BHM of all Inpatient admissions within 24 hours of admission, except for admissions which occur on a weekend or holiday. Then notification would be required by 5 P.M. of the next business day following such weekend or holiday. Initial Review: Providers are required to provide initial review information for all members within 72 hours after admission. Concurrent Review: Providers are required to provide concurrent review at regular intervals. Discharge Review: Provider to complete and submit a discharge review no later than 24 hours post discharge. 10
Admission Notification Form 11
Initial Inpatient Review Initial Review Providers can notify BHM by telephone (877.468.8530), fax (855.263.5072), or by submitting information through the BHM website. ProviderConnect, accessible through the BHM website, is the preferred method for notification. The BHM website can be accessed through (www.libhm.org). 12
Initial Inpatient Review (page 1 of 4) 13
Initial Inpatient Review (page 2 of 4) 14
Initial Inpatient Review (page 3 of 4) 15
Initial Inpatient Review (page 4 of 4) 16
Concurrent Inpatient Review Concurrent Review A Concurrent Inpatient Review can be submitted as an attachment in ProviderConnect, accessible through the BHM website, or can be faxed to BHM at 855.263.5072. The BHM website can be accessed through (www.libhm.org). 17
Concurrent Review (page 1 of 4) 18
Concurrent Review (page 2 of 4) 19
Concurrent Review (page 3 of 4) 20
Concurrent Review (page 4 of 4) 21
Discharge Review Discharge Review The Discharge Review can be submitted as an attachment in ProviderConnect, accessible through the BHM website, or can be faxed to BHM at 855.263.5072. The BHM website can be accessed through (www.libhm.org). 22
Discharge Review (page 1 of 4) 23
Discharge Review (page 2 of 4) 24
Discharge Review (page 3 of 4) 25
Discharge Review (page 4 of 4) 26
27 Demonstration of ProviderConnect
ProviderConnect (Provider Online Services) What is ProviderConnect? An online tool where providers can: Access ProviderConnect message center. Access and print forms. Enter notification and clinical information. Submit customer service inquiries. Submit updates to provider demographic information. Increased convenience, decreased administrative processes. 28
ProviderConnect Benefits What are the benefits of ProviderConnect? Free and secure online application. Access routine information 24 hours a day, 7 days a week. Complete multiple transactions in single sitting. View and print information. Reduce calls for routine information. 29
Accessing ProviderConnect? Go to www.libhm.org, choose Providers. All in-network providers can self register for ProviderConnect using their provider ID number. Self-registration is only available for the first registrant for each facility ID number. If additional ProviderConnect log ons for that same provider ID number are desired, please do the following: Fill out the Online Provider Services Account Request Form and fax the completed form to 866.698.6032. Additional log on turnaround time is 2 business days. ProviderConnect registration questions or questions about the form referenced above please contact the ValueOptions EDI Helpdesk at 888.247.9311 (Monday to Friday, 8:00 a.m. - 6:00 p.m. ET) 30
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ProviderConnect Registration 33
ProviderConnect Registration 34
ProviderConnect Login Screen 35
User Agreement Page 36
ProviderConnect Home Page 37
Attaching a Document to an Inquiry 38
39 Questions & Answers
40 Thank You