Indiana Health Coverage Program Behavioral Health Presented by CompCare October 22-24, 2007

Transcription

1 Indiana Health Coverage Program Behavioral Health Presented by CompCare October 22-24, 2007

2 Topic Behavioral Health About MDwise About CompCare CompCare Provider Contracting Process CompCare Quick Contact Sheet CompCare Provider Services Overview CompCare Prior Authorization Process CompCare Claims processing requirements Claims Forms and Fast Blast ( inside folders) Questions and Answers

3 About MDwise Not for profit organization serving the Hoosier Healthwise members since 1994 Provider sponsored Policy direction comes from community board and participating providers Created to focus on Medicaid managed care only Mission to serve low-income families Currently serving over 280,000 Medicaid lives statewide

4 MDwise Quick Contact Sheet Click to get up to date information on where to mail claims, medical management, etc.

5 About CompCare Selected as the MBHO for MDwise effective January 1, 2007 To provide Behavioral Health and Mental Health services to ALL MDwise members statewide

6 Provider Contracting

7 Provider Contracting Process How often will I be recredentialed? At least every three (3) years beginning at the date of the initial credentialing decision. NOTE: Site visit is conducted at the time of recredentialing. What if I have changes to my billing or service information? Notify CompCare in writing of any changes. CompCare must be notified in writing of any changes in Tax Identification Number. (NOTE: You may not assign your contract without written permission from CompCare).

8 CompCare Provider Services Who do I contact if I have a concern or a complaint? Claims and Billing problems should be directed to the CompCare Customer Service Department at Concerns about clinical issues should be directed to the CompCare Care Manager or the CompCare Director of Clinical Services. Problems / Questions concerning administrative procedures and contract obligations and other provider related issues should be directed to the CompCare Provider Services Department.

9 CompCare Quick Contact Sheet Click for CompCare Quick Contact Sheet.

10 Provider Services All CompCare provider complaints should be directed to the Provider Relations at the following numbers: See quick contact sheet

11 Prior Authorization and Referrals

12 CompCare Referral/Prior Authorization Process Members may self-refer for initial services. This initial visit will automatically be reimbursed without authorization as long as the provider of service possesses an IHCP number, which is required for payment. NOTE: members are only allowed (1) for a Medical Doctor (1) for a therapist in a 12-month time frame. Additional services require prior authorization by CompCare with the exception of out-of-network psychiatrist (see notes on benefit grid). Network providers requiring additional services will have the option of submitting an OTR Form to CompCare via fax, mail or a portal located at Authorizations for concurrent outpatient services are reviewed and decisions rendered within 2 days.

13 CompCare Referral/Prior Authoization Process Referral/Initial Authorization Routine Calls Should a member contact CompCare for a referral, a choice of providers are given to the member. Authorization is generated for an evaluation and follow up visits once a provider has been chosen. A certification letter is sent to the provider Additional sessions may be authorized after CompCare receives and reviews a completed outpatient treatment request (OTR) form from the provider.

14 CompCare Claims Submission Providers serving Hoosier Healthwise members will be paid within twenty-one (21) days of receipt of a clean electronic claim. Providers serving Hoosier Healthwise members will be paid within thirty (30) days of receipt of a clean paper claim. Clean claims paid outside of the timeframes are subject to interest payments.

15 Claims Filing Limit CompCare In-network Providers 60 or 180 days. This information is outlined in your provider contract. Make sure you know your claims filing limit

16 CompCare Claims Processing Requirements Charges for outpatient services should be submitted on a CMS 1500/08-05 claim form. Charges for inpatient services and facility charges should be submitted on a UB04 claim form. Both forms should be submitted with the correct coding system, i.e. CPT codes, HCPCS codes, Revenue Codes, etc. ICD-9 codes for diagnosis codes and CPT, HCPCS, Medicaid Codes, and Revenue Codes for claims payment purposes are used.

17 Clean Claim Defined CompCare is subject to the definitions as set forth by Indiana Code. Claims that are not submitted with all data elements will be denied and returned to the provider with missing fields identified. For specific details on field specifications, please consult our Provider Manual via

18 Clean Claims Claims that are not submitted with all data elements will be denied and returned to the provider with missing fields identified. For specific details on field specifications, please consult our Provider Manual via CompCare is subject to the definitions as set forth by Indiana Code.

19 Claims Dispute Process For a contracted provider, a claims dispute must be submitted within the timeframes specified in the provider s contract from the date of the explanation of benefit or the manual denial letter, unless otherwise mandated contractually. The claims dispute must include a copy of the claim, a copy of the EOB, a cover letter including the reason for the appeal, and any other supporting documentation Disputed claims and denials are handled through a formal Claims Disputes Team chaired by the Director of Claims. All appeals are addressed within the time guidelines specified by the state or within thirty (30) calendar days of the receipt of the claims dispute.

20 Where Do I Send Claims? Electronic Claims: WebMD/Emdeon as the Clearinghouse Paper claims can be submitted to: Comprehensive Behavioral Care, Inc. Attention: Claims 3405 W. Dr. Martin Luther King Jr. Blvd Suite 101 Tampa, FL 33607

21 CompCare Website The CompCare website provides a helpful resource page including the Provider Manual, several clinical guides informative materials, and satisfaction survey results. If you do not have internet access and would like additional copies of the Provider Guide, please contact Provider Services at:

22 Question/Answers

23 Thank You! From the staff of MDwise and CompCare