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Report to the Operations Sub-Committee July 7, 2006

This report provides an update on operations, including hiring progress, authorization and concurrent review updates, new processes for home-based services, outpatient services, and IVR/Web technology implementation.

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Report to the Operations Sub-Committee July 7, 2006

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  1. Report to the Operations Sub-Committee July 7, 2006

  2. Operations Update • Hiring • 95% of Key Positions • UM Director position currently open • 98% Overall • 3 Peer Specialists • 1 ICM clinician

  3. Authorization and Concurrent Review Update *duplicates cleaned in June

  4. Operations Update, con’d • Inpatient Auth to Claims: 7/1/2006 • Care Coordination and Crisis Stabilization new auth process pended – need to finalize level of care criteria • Home based Services: 8/2006 • MST, IICAPs, MDFT, FFT for dates of service 8/1/06 and after will be auth’ed via clinician. Winfax process will capture members currently in care • FST will register via web registration in August and back date start date to capture individuals in care from August 1, 2006 and forward as a registered service vs auth’ed service

  5. Operations Update, con’d • Outpatient Services via web registration: • 9/2006 for services provided for dates of service 9/1/06 and forward • IVR/Web technology: 8/2006-9/2006 • Provider Trainings to be held in July and August • Web technology available August 2006, mandated to ensure payment effective September 1, 2006 • Providers will begin registering care in the system in August, will provide an additional 30 day window through September • Interim plan (possibly winfax) as alternative to web registration • Modified IVR/winfax technology October 2006

  6. Operations Update, con’d • Pre-Certification Call Duration • Reviewed Avaya phone system to test capability • More focused reporting has been programmed • Average call length: 16:53 min:sec • Maximum call length: 21:33 min:sec • ICM Activity • 186 total cases • 58 referred in June, 55 accepted • 19% of total referrals from inpatient psychiatric units • 34% of total referrals from internal source • Other referral sources include: MCO’s, DCF, self referral, Residential and EDs • Referrals from EDs decreased by approximately 65% since March

  7. Operations Update, con’d • ED Interface • Decrease in call volume from EDs. Instituting daily outreach calls effective July 1, 2006 • Delay in Discharge (Inpt., PRTF, Resi) • 6% of all clients in 24 hour LOC have discharge delays • 20% of the 6% represent delays from inpatient care • 20% of the 6% represent delays from PRTF • 60% of the 6% represent delays from residential • Majority indicate the family is requesting additional treatment

  8. Stuck ED Volume June 2006

  9. Call Management/Customer Service

  10. CT BHP Call ManagementJune, 2006*Please note: MCO and 211 totals are calculated in “member” total monthly calculation.

  11. Types of InquiriesJune, 2006 38% - Provider Referrals for Members 18% - Member Eligibility Verification 39% - Provider Related/Authorization/Enrollment/Billing 5% - General Information43% = Member Inquiries 0.01% = Inquiries initiated due to provider status change from IN to OON Type and percentage of calls remains relatively the same as May, 2006

  12. CT BHP CALL MANAGEMENTIncoming Calls Totals: June 2006 Total 4892 Increase of 215 calls over May, 2006

  13. Network Operations

  14. Network Operations/Status • Provider Handbook • Posted to the website June 14 2006 • Feedback appreciated • CMAP Network as of June 26, 2006 • 1,435 Total Providers • 519 Facilities • Individual Providers • MD and MD Groups: 381 • LCSW: 308 • LMFT: 122 • LPC: 82 • Add/Change report: 0-5 adds per week, 5-10 changes • DCF Network • 122 RTC and Group Home providers (Increase of 36 providers since 11/2005)

  15. Cycle date 051906 we have identified the following issues: 16 inpatient providers put data in auth line 7 IOP/PHP providers submitted claims without prior authorization Outreach calls were provided to the high level denial providers Cycle date 060906 we have identified the following issues: 343 Claims were submitted without authorization; 51 Claims were submitted outside the effective authorization dates; 43 Claims were submitted with the incorrect authorization number; 31 Claims were submitted with an invalid provider number; 17 Claims were submitted by Out-of-State providers without receiving prior authorization; 14 Claims were submitted after the effective authorization dates; Rapid Response Team Findings

  16. Rapid Response Team Process • The Rapid Response Team is composed of representatives from CTBHP, DSS and EDS: • The RRT meets bi-weekly to review any denial issues; • CTBHP produces a detailed report of provider claims that directly correlate with the reports forwarded by EDS; • CTBHP works in concert with EDS to resolve claims issues. • Providers are contacted and the denial(s) are reviewed for resolution; • CTBHP’s outreach contributes to building the relationship with the Network and providing cohesion across the departments;

  17. Rapid Response Team Process Cont’d • Reviewed claims issues for 26 providers, follow up included: • 16 Outreach Calls to providers; • Claim information was faxed and issues were resolved for 4 providers; • 3 Providers pending response from EDS Provider Assistance Center follow-up; • 1 Provider presently remains in review with RRT;

  18. Quality Management

  19. Quality Initiatives, con’d • Satisfaction Surveys • Member, Member with Complex Needs and Provider Surveys • Data collection will begin in June and July for the provider survey and conclude in late summer, early Fall – completed via phone interviews • Provider report complete Fall of 2006 • Member Survey presented to Quality Sub-Committee, feedback to be incorporated • Member Survey roll-out Fall of 2006

  20. Complaints and GrievancesJanuary – June 2006 • Complaints: 30 from January to June 23rd. 5 member complaints in June: 2 Quality of Service, 2 Quality of Care, 1 concerning member wanting to use an Out of Network provider • Grievances: 3 from January to June 23rd. None in June. All Complaints and Grievances were resolved within standard timeframes

  21. Community Outreach

  22. Community Outreach • June, 2006 • Systems Managers 91 DCF, Provider, Collaborative and MSS meetings in June 551 Meetings year to date • Peer/Family Meetings 49 Family forums, informational meetings, DCF and Collaborative meetings, 2 Staff attended NAMI conference in Washington DC • Peer/Family Outreach/Coordination: 41 Open family/peer consultations in June (68% increase from May) 19 Family/peer consults completed in June

  23. Local Area Development Plans • Preliminary plans submitted to the Departments on June 30, 2006 • Departments will review over the next 30 days • Final submission due September, 2006 • Statewide themes and regional variation • Sample of general issues: • Recognized commitment for continued change/reform • Determination to expand community-based services, while strengthening local service system development • System gridlock, lack of coordinated system infrastructure and accountability, lack of integration of resources, knowledge and strategies across advisory groups

  24. Questions?

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