Vermont Collaborative Care, LLC. Release date: May 15, 2013 Updates to original March 2013 Overview highlighted in yellow

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1 Vermont Collaborative Care, LLC Release date: May 15, 2013 Updates to original March 2013 view highlighted in yellow Vermont Collaborative Care, LLC (VCC) will begin operations on July 1, VCC was created from a partnership between Blue Cross and Blue Shield of Vermont (BCBSVT) and Brattleboro Retreat s managed service organization, PrimariLink. VCC initiatives and priorities include providing integrated care management services for BCBSVT and The Vermont Health Plan, LLC (TVHP) members that will integrate physical and mental health care planning. Please refer to our December 2012 mailing for full details. Below is an overview of the program and specific impacts. Alpha Prefix All BCBSVT and TVHP members with managed mental health and substance abuse benefits, regardless of alpha prefix, will use VCC as their mental health and substance abuse care manager. Non- managed members with inpatient precertification requirements will need approval through VCC. Appeals The details are still being finalized; more details to come. Magellan will handle the appeals for claims with dates of service prior to July 1, 2013 using their existing process. BCBSVT provider website at Provider Landing Page (non-secure) We have placed information related to this transition on the public area of our provider website titled Mental Health and Substance Abuse Integrated Care (VCC). We encourage you to review the information as it may address questions you have. Provider Web Portal (secure) You will be able to use all functionality; you can review eligibility, accumulator information, claim status and remit processing. Benefits Member benefits will not be changing as a result of this transition. At this time, we will keep most of the Magellan structure in place, such as the 10 pass- through visits for specific outpatient CPT codes, per rendering provider NPI.

2 Page 2 Blueprint practices/medical homes There is no change or impact. Care/Case Management For patients who are in care/case management, both outpatient and inpatient, will be transitioned from Magellan to VCC. The details are not yet finalized, but we will post more details once information is available. The Medical Management phone number is (800) Clinicians providing care to members enrolled through Case Management will have a direct number to their case manager as they do today. Current members under Case Management will begin to be transitioned from Magellan to VCC beginning May 1, 2013 to assure a smooth transition. See also, Ten Pass Through below. Claims Claims will continue to be submitted to BCBSVT. There continues to be a one hundred and eighty (180) day filing period. We will process according to all of the existing BCBSVT logic (such as ClaimCheck). Claims that span into the transition to VCC do not have to be split out into separate bills (both CMS 1500 and UB04). Claim Status Claim status can be verified through our secure provider website at or contact our customer service department at (800) regardless of date of service. Contracts A separate contract is not required; we amended your existing indemnity contract to now include managed mental health and substance abuse. Customer Service The BCBSVT customer service department will address inquiries related to services, benefits, claim status or claim questions at (800)

3 Page 3 VCC will respond to all questions on care management or prior approval. If you happen to call BCBSVT customer service with those types of questions, we have established a method to transfer your call directly to VCC. Providers will call directly into Medical Management for: o Outpatient psychotherapy prior approval for patients requiring more than 10 sessions (provide link to list) o Inpatient Preadmission/Prior Approval Review VCC phone number (800) Members enrolled in Case Management will have a direct number to their case manager. Eligibility Verify the eligibility of members through our secure provider website at or contact our customer service department at (800) Enrollment of Mental Health and Substance Abuse Clinicians If you are already enrolled with BCBSVT and/or Magellan, no action is required of you at this time. Current BCBSVT and Magellan network clinicians will not have to be recredentialed until their usual recredential date. New clinicians (clinicians who are not known to BCBSVT) need to apply for credentialing and enrollment directly with BCBSVT beginning May 1, The effective date of new clinicians will not be before July 1, 2013, even if credentialing is completed prior to this date. This applies to new clinicians only. In addition to the submission of the Provider enrollment and change form, mental health and substance abuse clinicians who are new and just applying will also need to complete an Area of Expertise form. This form is located on the provider website under Forms, Enrollment and Credentialing. The form is used for clinicians to identify the area of expertise in which they would like to be marketed. Federal Employee Members (FEP) FEP members, easily identified with a prefix of R, are excluded from the VCC transition. As of July 1, 2013, FEP members will have non- managed care mental health and substance abuse benefits. For full details, contact FEP customer service at (800)

4 Page 4 Identification Card We will issue new identification cards to managed mental health members that will include the new managed mental health phone number(s). We have posted a sample of the revised identification cards to our provider website. Inpatient Stays Inpatient stays that will span the July 1, 2013 VCC transition will remain in the care management of Magellan until the patient is discharged. At that time, Magellan and VCC will coordinate the care of the member for a smooth transition. For billing purposes, the claim does not have to be split. Medical Policies The details are still being finalized. We will post this information once it is available Payment(s) If you receive paper checks, we will report and pay through your remit as part of the normal process. If you receive Electronic Fund Transfers (EFT), payments will be included in the EFT transactions; no additional action is required on your part. Prior Approval Requirements Magellan will forward to BCBSVT/VCC all prior approvals that remain valid for services on or after July 1, There is no need to resubmit these requests for consideration. Prior approvals need to be secured prior to the services being rendered. Retrospective reviews are not permitted, except for urgent or emergent situations. Providers are held liable for services where a prior approval was not secured. We are still finalizing the details of when prior approval requests will transition to VCC, but will be no later than July 1, We will post this information once it is available. Provider Manual We recommend reviewing the provider manual located on our website at as it contains important information and requirements of which you should be aware. As VCC develops, so will the material contained in the manual.

5 Page 5 Reimbursement Managed Care members will remain at the existing reimbursement level provided by Magellan. Non- managed care members will remain at the existing BCBSVT community rate. Providers are responsible for writing off balances between the allowed amount and charge amount. Members will only be liable for applicable co-pay, coinsurance or deductible. Remittance Advice Paper remits, electronic PDF formats (from Emdeon or BCBSVT secure website) will report to the applicable product type as part of the normal process. There will not be a separate remit or line of business. HIPAA compliant 835 will be part of the standard transaction and will be included in the full file. Ten Pass Through Currently, select outpatient services do not require prior approval for the first ten visits per clinician. For now, VCC will continue to follow this guideline. The count of the ten pass through will continue once the transition to VCC is complete; it will not be reset. So, for example, if a clinician has seen a member for four qualifying sessions, after the transition to VCC, the member will be on his or her fifth of the ten pass through; they will not restart at 10. If you have any questions or concerns, please feel free to contact your provider relations consultant. You can reach us by phone at (888) You may also reach us via at providerrelations@bcbsvt.com. Our business hours are Monday through Friday, 8 a.m. 4:30 p.m.