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TCM Quarterly Meeting 5-22-07

TCM Quarterly Meeting 5-22-07. CBHNP. Presenters . Wendy Carnes- Outpatient Authorization Coordinator Rita Ricci- Clinical Supervisor and Project Coordinator Kelly Lauer- Provider Relations Representative Keven Cable - Provider Relations DJ Dunlap-Quality Management Clinician. Agenda.

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TCM Quarterly Meeting 5-22-07

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  1. TCMQuarterly Meeting5-22-07 CBHNP 5-9-07

  2. Presenters • Wendy Carnes- Outpatient Authorization Coordinator • Rita Ricci- Clinical Supervisor and Project Coordinator • Kelly Lauer- Provider Relations Representative • Keven Cable - Provider Relations • DJ Dunlap-Quality Management Clinician 5-9-07

  3. Agenda • Welcome and Introductions • Recovery Information (handout) • Provider Connect- Update • Outreach Letters (handout) • Enhanced Care Management Update • Reinvestment Services • NPI • Claims and Billing • New forms and instructions (handouts) • Co Occurring Disorders/Dual Diagnosis • Provider Performance • Treatment Record Reviews • Audit and DAST-10 (handout) • Critical Incident Reporting • CSS Surveys • Drexel Training Stipends • Next meeting 5-9-07

  4. Recovery Model The 10 Fundamental Components of Recovery (handout) • Self-Direction • Individualized and Person-Centered • Empowerment • Holistic • Non-Linear 5-9-07

  5. Recovery Model • Strengths-Based • Peer Support • Respect • Responsibility • Hope 5-9-07

  6. ProviderConnect • Provider Web Access ProviderConnect allows authorized providers in network to: • Check status of all authorizations • Request TCM authorizations • Update clinical information with TCM auth request • Submit or check status of claims • Review Provider profile and address information 5-9-07

  7. ProviderConnect ProviderConnect is designed to: • Reduce duplicate data entry • Limit unnecessary phone communication between affiliate providers and CBHNP • E-business functionality allows information to flow 24 hours a day 7 days a week, between CBHNP and contracted affiliate providers • Real time data - no lag in information currency created by data entry 5-9-07

  8. Outreach Letters • Revised Crisis Outreach Letter • Missed Aftercare Appointment Letter 5-9-07

  9. Enhanced Care Management (High Risk) • Utilize Reinvestment Services • Link Member with TCM • Develop & implement diversionary plans • Increase & improve natural and community supports • SA County Contact Person 5-9-07

  10. Reinvestment/ Supplemental Services • Mobile Psychiatric Services (Behavioral HealthCare Corporation) • (717)399-8288 • Peer Support Services (Philhaven/The Dauphin Clubhouse) • (717)221-9610 • Respite Services (PA Mentor) • (717)657-2073 5-9-07

  11. NPI – National Provider Index • Replaces all legacy numbers for all health payer systems • CBHNP is requiring all enrolled providers to get an NPI (Medicare is also requiring this.) • May 23, 2007 – All electronic files must contain and only contain the NPI number to identify the provider • CBHNP will also require the NPI on all paper claims 5-9-07

  12. NPI – National Provider Index • 10 digit number that the provider must request from CMS • Individual providers may only have one NPI • Organizations may need multiple NPIs • It is entirely up to the provider to understand how to identify its subparts • Must get an NPI for each of its subparts if the subpart would meet the tests for being a covered health care provider themselves if they were separate legal entities • May qualify for additional NPIs for subparts that do not meet these tests based on such factors as the subpart having a location and licensure separate from the parent organization • Group practice only needs an NPI if it conducts transactions 5-9-07

  13. NPI – National Provider Index • It is entirely up to the provider to get the number before May 23, 2007 • Provider must declare at least one and up to 15 taxonomy codes for each NPI • Can apply online at https://nppes.cms.hhs.gov/NPPES/Welcome.do • Website for more information: http://www.cms.hhs.gov/NationalProvIdentStand/ 5-9-07

  14. NPI – National Provider Index • Providers must communicate their NPI to CBHNP • Include Taxonomy codes when reporting NPI • Send by faxing to Provider Relations at 717-671-6522 5-9-07

  15. Claims and Billing • 60 day claims submission • Grievances and billing • Group authorization billing - separate out June and July as units are changing • Submission of electronic claims • edi@cbhnp.og 5-9-07

  16. Review of TCM Changes • Revised forms-Review • Revised Instructions-Review • Website 5-9-07

  17. TCM Requests Please: • Check eligibility • Use provider name/address as contracted with CBHNP • Note the Member’s living situation and if marking “Other”, advise what Other means • If you make a master form please make changes as needed for other requests • Check Member Info for accuracy • Send your request in within 30 calendar days of the first billable date of service for initial and within 10 calendar days for reauthorizations • Use the Correction Form for existing auths only 5-9-07

  18. TCM Requests for Corrections • 30 days to submit the correction form • only to correct information on auth. letters • CBHNP or Provider error • After 30 days use Administrative Appeal process 5-9-07

  19. Provider Performance • Provider Performance • New indicators in provider performance 5-9-07

  20. Treatment Records reviews • Treatment Record Reviews • Audit and DAST-10 screens 5-9-07

  21. Critical Incident Reports • Must be submitted within 24 hours • Fax to the attention of QI • Reference the level of care 5-9-07

  22. CSS Survey Information and Training • Consumer and Family Satisfaction Surveys • CSS (Consumer Satisfaction Services, INC.) Survey Process • Other points 5-9-07

  23. Reminders • Drexel Training Stipend • TCM instructions and forms are on the web • Provider Manual is on the web • Authorization will no longer print the member’s social security number • Complaints and Grievance’s brochures should be placed in main waiting areas • Next Meeting: September 2007 5-9-07

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