The Louisiana Behavioral Health Partnership

1. The Louisiana Behavioral Health Partnership  Statewide Management Organization

2. Claim Submission and Tracking

3. The manual contains information on: Service definitions Provider qualifications Eligibility criteria Limitations/exclusions Provider types allowed to deliver specific services Snapshot of the Service Description Manual Magellan Health Services, Inc. | 3

4. Covered services- 8 sections Services for CSoC Children Parent/youth support & training Crisis intervention Respite Independent living/skills-building Case Conference for Adults and Children Face-to-face conferences for CSoC and 1915(i) adults Snapshot of the Service Description Manual Magellan Health Services, Inc. | 4

5. Snapshot of the Service Description Manual Behavioral Health Services Delivered by Unlicensed Individuals Psychosocial rehabilitation Community psychiatric support & treatment Crises intervention Therapeutic group home Addiction services American Society of Addiction Medicine levels of care Magellan Health Services, Inc. | 5

6. Outpatient & Inpatient Hospitals Psychiatric Residential Treatment Facility (PRTF) Children under age 21, pre-certified by an independent team employed by the SMO Outpatient Therapy by Licensed Practitioners Individual, family, group outpatient psychotherapy and mental health assessment, evaluation and testing. Medical, psychiatrist, other licensed practitioner service Snapshot of the Service Description Manual Magellan Health Services, Inc. | 6

7. Service Description Manual Addendum Section Therapeutic Foster Care and Non-Medical Group Home Treatment services provided by and billed through other licensed practitioners and qualifying services Magellan Health Services, Inc. | 7

8. Service Description Manual Addendum Section Additional Service Criteria for Evidence-Based Practices (EBPs) Assertive community treatment � adults with serious and persistent mental illnesses (SPMI) Multi-systemic therapy (MST) Homebuilders Functional family therapy (FFT) MST, Homebuilders, FFT � target youth with significant externalizing behaviors, at high-risk of out-of-home placement and may be involved with multiple child-serving agencies (OJJ, DCFS) Magellan Health Services, Inc. | 8

9. Magellan of Louisiana provider contracts are developed using the Service Manual Codes spreadsheet Magellan reimbursement schedules sent out with the contracts correlate to Service Manual Codes and rates Magellan can contract only with providers meeting requirements defined in the manual for specific services We look forward to partnership and dialogue with individual Louisiana providers Magellan and the Service Description Manual Magellan Health Services, Inc. | 9

10. Clinical

11. CSoC � Plan of Care � Post March 1 Plan of Care (POC) Simultaneous to referral to an IA, a referral to Wraparound Agency (WAA) and Family Support Organization (FSO) is made to begin POC development process. Parent/Guardian is engaged Initiate formation of a Child and Family Team (CFT) � to include child, family, any state agency representatives and natural supports The POC should then be completed through the collaborative CFT by doing the following: Completion of a strengths discovery Identification and prioritization of child and family needs Identification of service options connected to each prioritized need Involved State Agencies (DCFS, OJJ and/or DOE) PCP and any other involved specialist should be included in plan development Magellan Health Services, Inc. | 11

12. Clinical Practice Guidelines (CPGs) Magellan adopts CPGs based on sound scientific evidence, clinical best practices and member needs. Magellan requires all of its providers to be familiar with these CPGs. A link to Magellan�s CPGs is available through www.MagellanofLouisiana.com. Magellan Adopted Clinical Practice Guidelines Acute Stress Disorder & Post-Traumatic Stress Disorder ADHD Autism Bipolar Disorder Depression Eating Disorders Generalized Anxiety Disorder Managing Suicidal Patients Obesity Obsessive-Compulsive Disorder Panic Disorder Schizophrenia Substance Use Disorders Magellan Health Services, Inc. | 12

13. Each year Louisiana QI Department clinical reviewers will audit provider compliance against three CPGs. In 2012, clinical reviewers will review for compliance with the following CPGs: Either Schizophrenia or Depression (to be determined) Substance Use Disorder ADHD (children and adolescents) Clinical Practice Guidelines (CPGs) Magellan Health Services, Inc. | 13

14. In addition to reviews for compliance with CPGs, Louisiana QI Department clinical reviewers will review provider program compliance through use of the following tools: Magellan�s Public Sector Treatment Record Review Tool Quarterly chart reviews for members served under the SED waiver Monitoring Tool Specific to the WAA All treatment record review tools will be available through www.MagellanofLouisiana.com. Other Review Activities Magellan Health Services, Inc. | 14

15. Magellan believes that provider input, including complaints, concerning our programs and services is a vital component of our quality program. Provide complaints, comments and compliments: Through the Magellan provider website, which is accessible by links from www.MagellanofLouisiana.com, (click FAQs/Feedback or My Messages after secure sign-in), or By contacting the Louisiana Care Management Center Network providers will not be penalized for filing a complaint Your cooperation and assistance is expected during the investigation of member complaints, adverse incidents and quality-of-care concerns if necessary. Provider Complaints, Comments and Compliments Magellan Health Services, Inc. | 15

16. Claim Submission and Tracking

17. Who Are the LBHP-eligible populations?Children Magellan Health Services, Inc. | 17

18. How Will We Know Who Is Eligible for the LBHP? Magellan Health Services, Inc. | 18

19. What Are the Eligible Services for each Population?  Magellan Health Services, Inc. | 19

20. Eligibility Verification  Eligibility can be found in Clinical Advisor (CA) and on the Magellan provider website (www.MagellanHealth.com/provider), accessible via links on www.MagellanofLouisiana.com  Magellan Health Services, Inc. | 20

21. Looking up Eligibility by Signing in to MagellanHealth.com/provider www.MagellanHealth.com/provider is available to contracted Magellan providers It can be accessed through links on www.MagellanofLouisiana.com Magellan Health Services, Inc. | 21

22. Magellan Provider Website Eligibility Client Look-Up Magellan Health Services, Inc. | 22

23. Magellan Provider Website Eligibility Client Look-Up continued  Magellan Health Services, Inc. | 23

24. Magellan Provider Website Eligibility Client Look-Up continued  Magellan Health Services, Inc. | 24

25. Claim Submission and Tracking

26. Submitting Claims for Services Rendered Magellan should receive claims only for dates of service of March 1, 2012 and beyond. Electronic Claims Submission (for providers not submitting via the CA system): Sign in to the Magellan provider website (link accessible via www.MagellanofLouisiana.com) or through a clearinghouse. When submitting claims electronically, use submitter ID # 01260 for all except Emdeon 837I which is submitter ID# 12X27 Paper Claims - Mailing address (for paper claims): Magellan Health Services Attention: Claim Department P.O. Box 2064 Maryland Heights, MO 63043 Magellan Health Services, Inc. | 26

27. Find basic billing tips on the Magellan provider website, www.MagellanHealth.com/provider, (accessible via www.MagellanofLouisiana.com) and click the �Getting Paid� top-menu item. Preparing Claims � Claims Filing Procedures, Elements of a Clean Claim, Claims Tip Sheets, Coordination of Benefits HIPAA � Coding Information for Professional and Facility/Program Services, Code Sets, Resources Electronic Transactions � Options to submit transactions/claims electronically to Magellan, Companion Guides, Clearinghouse Information, Electronic Funds Transfer, National Provider Identifiers (NPI) Paper Claim Forms � We highly recommend electronic submission, but accept paper claims on CMS-1500 and UB-04 forms Magellan Health Services, Inc. | 27

28. EDI Claims Submission - What�s in It for You? Improved Efficiency No paper claims. No envelopes. No stamps. Prompt confirmation of receipt or incomplete claim Improved Quality Up-front electronic review ensures higher percentage of clean claims Secure process with encryption keys, passwords, etc. Magellan Health Services, Inc. | 28

29. Electronic Claim Submission Options Claims Courier - Magellan�s Web Option For smaller-volume submitters It�s free! Web-based, just sign in securely to the Magellan provider website (accessible via www.MagellanofLouisiana.com) Manually key info like you would a CMS-1500 form Info is saved and can be copied for new dates of service Direct Submission to Magellan For medium- to high-volume submitters It�s free! Send HIPAA-compliant transactions directly to Magellan using your existing software Clearinghouse For larger-volume submitters Magellan works with preferred clearinghouses, which accept both professional (CMS-1500) and institutional (UB-04) claims Commonly tie in with practice management software Check with each clearinghouse for their fees When submitting claims electronically, Magellan�s submitter ID is 01260 or 12X27 for Emdeon 837I) Magellan Health Services, Inc. | 29

30. Timely Filing Timely filing for submission of claims is 365 days. Magellan will deny claims not received within 365 days. Your responsibility Submit a complete claim for services you have provided within 365 days. Magellan Health Services, Inc. | 30

31. Louisiana Website www.MagellanofLouisiana.com Magellan Health Services, Inc. | 31

32. Welcome Page Magellan Health Services, Inc. | 32

33. For Providers Magellan Health Services, Inc. | 33

34. For Providers �Features to Note� Training & Events Provider Handbook Provider Website Providing Care Clinical Practice Guidelines Check Eligibility Claims Medical Necessity Criteria Medication-Assisted Treatment for Substance Use Disorders Quality Improvement and Outcomes Magellan Health Services, Inc. | 34

35. Provider Training & Events Page Magellan Health Services, Inc. | 35

36. For Providers �Features to Note� Provider Handbook The Magellan National Provider Handbook outlines the policies and procedures with which providers are required to comply when serving members whose care is managed by Magellan and/or its affiliated companies. Magellan National Provider Handbook (PDF) Magellan National Provider Handbook Appendices Organizational Provider Handbook Supplement (PDF) Louisiana Behavioral Health Partnership Handbook Supplement (coming soon) Provider Website Visit www.MagellanHealth.com/provider for a wealth of information and online applications pertinent to providers serving Magellan members, including: Secure online tools to submit and check claims, view authorizations, update practice data, and more Online training, including demos of user-friendly online tools Free continuing education courses Provider discounts on computers and office supplies Medical Necessity Criteria Clinical Practice Guidelines Outcomes Library And much more! Magellan Health Services, Inc. | 36

37. Questions