1 / 12

Taxonomy Commission

This document provides a summary of the Taxonomy Commission meeting held on March 1, 2019. The meeting covered the review of the recommended taxonomy and treatment modalities, as well as the recommended process for validating specialties.

rkinkead
Download Presentation

Taxonomy Commission

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Taxonomy Commission Executive Office of Health & Human Services Lauren Peters, Undersecretary March 1, 2019 9:00-11:00 am One Ashburton Place Boston, Mass.

  2. Agenda Welcome Review Feb. 14 meeting minutes (Vote) Review of recommended taxonomy and list of treatment modalities (Vote) Recommended process for validating specialties Next Steps

  3. Welcome Lauren Peters (Chair) Undersecretary, Health & Human Services Matthew Veno Commissioner of Insurance Deirdre Calvert, LICSW Column Health KiameMahaniah, MD Lynn Community Health Center Kate Ginnis, MSW, MPH, MS Boston Children's Hospital Scott Weiner, MD, MPH Brigham and Women’s Hospital Claudia Rodriguez, MD Brigham and Women’s Hospital Diana Deister, MD Boston Children’s Hospital Sarah Coughlin, LICSW, LADC-I National Association of Social Workers Sarah Chiaramida, Esq. Massachusetts Association of Health Plans Ken Duckworth, MD Blue Cross Blue Shield of Massachusetts

  4. Vote: Approval of Jan. 17 meeting minutes

  5. Recommended Taxonomy

  6. Recommended Taxonomy

  7. Recommended Taxonomy The taxonomy will be recommended for the following purposes: • Referenced in the forthcoming amendments to DOI’s managed care regulations governing provider directories • Incorporated into standard provider application and change form • Standardize language across payers’ provider directories • Incorporated into the Network of Care platform

  8. Vote: Approval of recommended taxonomy and list of treatment modalities

  9. Recommended Validation Process “The commission shall recommend a process that may be used by carriers to validate a licensed behavioral health clinician’s specialty.”

  10. Recommended Validation Process Option 1: Require carriers use a third-party provider credentialing entity (i.e., Aperture). How does Aperture work? • Provides “end to end” credentialing services • Performs primary source verification across ~150 provider certifications, including behavioral health • Accredited by URAC and NCQA • Receives provider information submitted through the CAQH platform Current process:

  11. Recommended Validation Process Option 2: Retrospective validation based on claims data • Define provider threshold of patient mix or patient volume with a certain diagnosis to qualify as specialist. • E.g., provider required to have 10% of patient mix or 25 patients per year diagnosed with eating disorder to identify as eating disorder specialist • Charge relevant professional licensing board or other appropriate entity to conduct periodic examinations of CHIA claims data to verify diagnosis codes for patient encounters. • Note: CHIAs APCD will not account for private pay and self-insured patient encounters. • Require providers who have indicated a specialty but their patient encounters do not meet the established threshold, to update their credentialing information; multiple findings of could result in referral to relevant licensing board.

  12. Next Steps • Next scheduled meeting: March 20 • Report submission deadline: March 31

More Related