Medicaid Managed Care Integration Preparation Overview
Medicaid Managed Care providers in Ohio are gearing up for the integration of Behavioral Health services. Efforts include provider outreach, readiness activities, transitions of care guidelines, prior authorizations, and credentialing processes. The timeline, requirements, and testing opportunities are all outlined to ensure a smooth transition. Visit the provided link for comprehensive provider resources and information.
- Medicaid Managed Care
- Provider Outreach
- Behavioral Health Integration
- Ohio Medicaid
- Credentialing Process
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Presentation Transcript
Preparing for BH Integration into Medicaid Managed Care February 15, 2018
OAHP Provider Outreach and Readiness Efforts Preparations Leading to July 1 BH Collaborative standardized PA form, proactive identification of provider challenges and solutions, created BH provider resource document* Provider Communications MITS BITS, EDI meetings, Trade Association newsletters Rapid Response Team individual plan claims monitoring & outreach augmented with all MCP meetings to determine opportunities for training and outreach. Seven (7) Winter Regional Provider Forums In-person opportunity for discussion of payment issues and contracting or credentialing questions ODM Reporting Testing Activity and Results Prompt Pay/Denial Rate Reporting Contracting/Credentialing status 2 *All provider resources can be found at: http://bh.medicaid.ohio.gov/Provider/Medicaid-Managed-Care-Plans
OAHP Transitions of Care and Prior Authorizations Transitions of Care MCPs must allow the member to continue with out-of-network providers for 3 months post carve-in. To ensure continuity of care, MCPs will: Work with the service provider to add the provider to their network; Implement a single case agreement with the provider; and/or Assist the member in finding a provider currently in the MCP s network. Prior Authorization The MCP shall follow the Medicaid fee-for service (FFS) behavioral health coverage policies through June 30, 2019. The MCP may implement less restrictive policies than FFS. After one year, the MCP may conduct a medical necessity review pursuant to OAC rule 5160-26-03.1. MCPs must honor PA approved by ODM through expiration of the authorization. 3
OAHP Credentialing and Contracting Provider Panel Requirements Credentialing and Contracting The MCP contracting process can take up to 90 days. In instances when a contract is not established prior to July 1, 2018, transition of care requirements are in place for 3 months. The plan may execute a single case agreement with the provider or the plan can suggest in- network providers. ODM Provider Panel Requirements Medicaid Managed Care Plans are required to contract with a total of: 238 Provider Type (PT) 84s 216 Provider Type (PT) 95s 4
OAHP Credentialing and Contracting Data 458 391 377 319 316 242 207 183 130 83 Buckeye Health Plan Molina Paramount United Healthcare CareSource PT-84 PT-95 Total PT-84 Required Total PT-95 Required 5
Current Testing Opportunities Testing of claims begins again March 1st through June 30th at https://sites.edifecs.com/index.jsp?centene Click here for a list of trading partners Buckeye works with https://www.buckeyehealthplan.com/provi ders/resources/electronic-transactions.html Weekly Webinar opportunities on Tuesdays at 9:00AM and Thursdays at 12:00PM. RSVP at https://www.buckeyehealthplan.com/provi ders/behavioral-health.html Contracting Information Allow 90 days for the contracting/credentialing process-please start now Contact: https://www.buckeyehealthplan.com/provid ers/become-a-provider/join-our- network.html
Current Testing Opportunities Join us on Wednesdays from 3 to 4pm ET for instructions and status updates CareSource is accepting test EDI files through our trading partners Use the ODM Beta Testing Scenarios Use active CS Members Use DOS > January 1, 2018 Submit test EDI files before June 1 2018. Contracting Information Complete the New Health Partner Contract Form @ https://www.caresource.com/providers/join- our-network/ Allow 90-days for the contracting/credentialing process Be prepared with the following materials: W-9 tax form CAQH ID number Tax ID number NPI number(s) for both Provider Type 84 and/or 95 related certifications Questions/Concerns: Call CareSource s Rapid Response Team - 800.488.0134
Current Testing Opportunities Contact BHProviderServices@MolinaHealthCare.com to obtain an intake form and testing guidance We work with all participating clearinghouse to submit EDI claims Webinar opportunities to be scheduled end of February Testing is currently open Contracting Information Allow 90 days for the contracting/credentialing process-please start now Contact: Ellen Landingham at (614) 557- 3041 or Ellen.Landingham@molinahealthcare.com
Current Testing Opportunities Contact PHCBehavioralHealthTesting@ProMedica.org to engage in claims testing We work with all participating clearinghouse to submit EDI claims http://www.paramounthealthcare.com/docu ments/provider/clearinghouse-list.pdf Intensive provider consultation available upon request (prior/post testing) Testing claims are currently being accepted and will remain open through July 1, 2018 BH Redesign Implementation Contracting Information Allow 90 days for the contracting/credentialing process-please start now Contact: PHCProvider.Contracting@ProMedica.org
Current Testing Opportunities Contact Ohionetworkmanagment@optum.com to get member assignments-begins now We work with all participating clearinghouse to submit EDI claims Three (3) live webinar opportunities scheduled: 2/19; 2/21; 2/23 with one recorded/posted end of Feb. Testing Medicaid claims begins week of March 7th through June 30th Contracting Information Allow 90 days for the contracting/credentialing process-please start now Be prepared with the following materials: W-9 tax form Tax ID number NPI number(s) for both Provider Type 84 and/or 95 related certifications Contact: OhioNetworkManagment@optum.com
