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Brief History

Brief History. Became operational November 1, 1979 Chartered in West Virginia and domiciled in Ohio as a 501-C-4 Non-Profit Corporation Licensed to do business in Ohio & West Virginia Expanded into North Central WV in 1994 Expanded Statewide 2010 / 2011. HANCOCK.

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Brief History

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  1. Brief History • Became operational November 1, 1979 • Chartered in West Virginia and domiciled in Ohio as a 501-C-4 Non-Profit Corporation • Licensed to do business in Ohio & West Virginia • Expanded into North Central WV in 1994 • Expanded Statewide 2010 / 2011

  2. HANCOCK HEALTH PLAN EXPANSION 2010 / 2011 BROOKE OHIO PENNSYLVANIA MARSHALL MARYLAND MONONGALIA WETZEL MORGAN OHIO MARION BERKELEY TYLER PRESTON MINERAL HARRISON HAMPSHIRE PLEASANTS TAYLOR JEFFERSON DODDRIDGE WOOD RITCHIE BARBOUR GRANT TUCKER HARDY WIRT LEWIS GILMER UPSHUR CALHOUN JACKSON MASON RANDOLPH ROANE BRAXTON PENDLETON PUTNAM WEBSTER VIRGINIA CLAY CABELL KANAWHA NICHOLAS POCAHONTAS WAYNE LINCOLN Service Area Prior to Expansion FAYETTE BOONE GREENBRIER COA Received LOGAN MINGO RALEIGH Expansion 2012 SUMMERS MONROE WYOMING KENTUCKY MERCER MCDOWELL

  3. Expansion Details • 24 additional West Virginia Counties • Over 2100 New Providers • 27 New Hospitals Tertiary Facilities Include: • Ohio State • WVU • Cleveland Clinic • UPMC Childrens • Allegheny / West Penn • Nationwide Childrens • CAMC

  4. Additional Information • All contracting and service items (new providers, claims inquiries, questions, etc.) serviced by Health Plan directly • No Programs or Services Carved Out • Health Plan requires credentialing of all providers including extenders • Contact Provider Relations (800) 624-6961 Ext. 7633 for contracting information

  5. Membership Breakdown

  6. Coverage of Autism Spectrum Disorder • WV Legislative mandate for coverage effective January 2012 • Large employer groups required to cover: in preceding year averaged over 25 eligible employees • Coverage effective upon reenrollment of large groups throughout the year • Diagnosis of ASD prior to age 8 • Coverage applies to children age 18 months to 18 years.

  7. Establishing the Diagnosis of Autism Spectrum Disorder • Primary Care Physician (PCP) completes ASD screenings as per AAP and AAN guidelines as part of the preventive health visits • Multidisciplinary approach to establishing diagnosis • Referrals to specialists, ancillary support, and testing are directed by the PCP • Diagnosis of ASD based on DSM-IV-TR

  8. Establishing the Diagnosis of Autism Spectrum Disorder • Once diagnosis is confirmed, coverage for autism treatment is initiated as per the member’s insurance benefit plan. • To assure payment of treatment and therapy under the benefit, services related to ASD require preauthorization

  9. Covered services: • Applied Behavior Analysis provided and/or supervised by a Board Certified Behavior Analyst (BCBA) • Information found at www.healthplan.org > provider services > additional BHU resources > Initial Authorization for ABA and Concurrent Authorization for ABA • Medically necessary treatments, such as OT, ST, PT

  10. Coverage of ABA • Initial authorization: • Results of screening and scaling • Functional Behavioral Assessment • Goals • Risk Assessment • Targeted interventions aimed at specific behaviors • Parental training

  11. Continuation of ABA • Behaviors and interventions identified on initial authorization form • Improvements and achievements • Supporting documentation

  12. Billing for ABA • Evaluation and Management Codes from Current Procedural Terminology have been assigned to various levels of treatment • Billing details will be in your contract

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