Behavioral Health Provider Training: Program Overview & Helpful Information
Agenda • Passport Behavioral Health Services Overview • Steps to Joining Passport Health Plan’s Network – Getting a Medicaid Number – Enrolling in the Passport Health Plan Network – Enrolling as a Behavioral Health Service Organization (BHSO) • Working with Passport Behavioral Health – Utilization Management & Pre-Authorizations – TeleHealth Services – Case Management – eServices – Claims Also, please see Claims Tutorial • Contact Information • Q & A
Passport Health Plan’s Behavioral Health Services Overview
Overview • The Passport Behavioral Health Program provides members with access to a full continuum of recovery and resiliency focused behavioral health services through our network of contracted providers. • The primary goal of the program is to provide medically necessary care in the most clinically appropriate and cost- effective therapeutic settings. • By ensuring that all Passport members receive timely access to quality, clinically-appropriate behavioral health care services, we believe we can achieve our mission of improving the health and quality of life of our members. • Passport Health Plan (Passport) has contracted with Beacon Health Strategies, LLC to assist in the delivery of behavioral health services for Passport members.
Behavioral Health Program Philosophy Improve the health and quality of life of our members. • Enhance continuity and coordination with behavioral health care • providers as well with physical health care providers. Establish innovative preventive and screening programs to decrease • the incidence, emergence or worsening of behavioral health disorders. Ensure members and advocates receive timely and satisfactory service • from the Passport network of providers and the Passport benefit administrator. Maintain positive and collaborative working relationships with • network practitioners and ensure provider satisfaction. Responsibly contain health care costs. •
The Clinical Approach • We believe effective clinical programs always begin with the individual. We believe in recovery: consumers should live and thrive in the community, with family and friends, engaging in gainful activity. • We drive value for members and support consumer recovery by increasing information flows, building care systems, and measuring outcomes across behavioral health, medical, social and medication domains. • Analytics, informed by local knowledge and reality, drive better decision-making and meaningful improvement in health status.
Integrated Partner Model combines physical, behavioral and social systems of care • BH Specialists • On-site at health plan partner • After School Programs • Primary Care • Behavioral Health clinicians co-located • Rec. Programs • BH in Medical with Medical Management team • Home Housing Services • • Passport Hospitals Mentoring Services Health Plan • • Diversionary Faith-based agencies Services Community • Providers Mobile Crisis Integrated Services Teams Partner Model • Member • Schools Advisory • Mental Health Committee • Child Welfare • Families & NAMI Government • Advocates Courts • Partners Consumer • Strategies Medicaid • • Education / DD/MR Outreach • • Peer Specialists • Parent Advocates Together, Passport and Beacon help provide connective tissue in a fragmented system of care.
Steps to Joining Passport Health Plan’s Network
Enrolling in Passport’s Network • Get an NPI number • Get a Medicaid number • Go to Passport’s website and request an enrollment packet • Complete and submit packet • Await notification of enrollment via welcome letter • Set up eServices • Services provided during the approval process would require single case agreements provided you have a Medicaid number.
Getting a Medicaid Number
Who Needs a Medicaid Number? • Any provider type that is approved to provide Medicaid services. • Any approved provider who wants to join an MCO’s network. • Both the group and individual providers practicing in the group need Medicaid numbers. • Those who practice under supervision use his or her supervisor’s Medicaid number.
Group Medicaid Number • As a solo practitioner, we will use your individual NPI, Tax ID, and Medicaid number to identify you as an individual provider as well as your practice. • If you are a solo practitioner but you have incorporated your practice, we recommend getting a group Medicaid number. • If you choose to use your individual Medicaid number for your practice, you will need to notify us, and you will not be able to have other clinicians join your practice.
Group Medicaid Number • If you want other clinicians to be linked to your practice, your practice/group must have its own NPI, Tax ID, and Medicaid number. • If you are currently set up in our system as a solo practitioner but would like to now have other clinicians work with you, you will have to apply for a group Medicaid number and notify our Enrollment department of the requested change.
How Do I Get a Medicaid Number? • Complete a Medicaid application called a MAP 811 • Determine which MAP 811 form and supporting documents you need to complete by finding your Provider Type Summary individual practitioners or groups. http://chfs.ky.gov/dms/provEnr/Provider+Type+ Summaries.htm • MAP 811 forms can be found at http://chfs.ky.gov/dms/provEnr/Forms.htm
Submitting Your MAP 811 • If you are joining an MCO’s network, you will submit your MAP 811 application to the MCO. • You only need to submit one Medicaid application, so if you are joining multiple MCOs, submit your MAP 811 to just one. • The MCO will submit your Medicaid application to Department of Medicaid Services (DMS) on your behalf. • DMS has 90 days to issue a Medicaid number. • Submit your MAP 811 application and your MCO credentialing packet concurrently. • If you have already submitted your MAP 811 to another MCO, write “Pending” on forms that request Medicaid number.
Enrolling in the Passport Health Plan Network
Joining the Passport Health Plan Network Provider Enrollment Provider Submits Online Packet Emailed Returns Packet Enrollment to Provider to Passport Request Within a week of receiving request Contracts & Load into Load into Enrollment Passport’s BH System Process System 2-3 weeks 30-45 day process 2-3 weeks
Online Enrollment Request www.passporthealthplan.com
Enrollment Packet • Within a week of receiving your online request, Passport will email you a contract and enrollment forms. • Use the provided checklist to make sure you submit all necessary forms & documents. • Your effective date is based on when Passport receives a completed packet. • You can email, fax, or mail your completed packet. – Trevor.Bales@passporthealthplan.com – 502-585-8200 – 5100 Commerce Crossings Drive Louisville, KY 40299 Attn: Contracts Department
Enrollment Packet Checklist
Enrollment Process • When Passport receives your packet, our Contracts department logs your contract, IRS letter, and W-9. If these are not submitted, the packet stays in Contracts until the documents are received. • Once Contracts logs the information, the packet is sent to our Provider Enrollment department. • Provider Enrollment representatives review to make sure all necessary paperwork has been submitted. • If the packet is complete, it is considered a “clean application” and the effective date is assigned. • If not, you will be contacted for missing information. This delays the process and the effective date.
Enrollment Process • Credentialing verification process begins. – Processed by our business partner, Aperture. – You will receive a letter from Aperture to let you know they are working on your credentialing. – If your CAQH account is missing information, Aperture will contact you. Please respond to all requests from Aperture. – Once Aperture component is finished, Passport will then complete the final review. • If approved, provider information is loaded into Passport’s system.
Enrollment Process • Once provider is approved, provider information is sent to the Passport Behavioral Health system for loading . • A welcome letter is sent with provider numbers • The overall process can take between 45-60 days.
To Check Your Enrollment Status • Please contact our Provider Enrollment department to for any enrollment questions or to check on your status in the enrollment process. • You can reach the Provider Enrollment department via email or phone. – Passport.Credentialing@passporthealthplan.com – Credentialing Hotline: 502-588-8578
Adding New Practitioners to an Existing Group • To add practitioners to an existing group, please complete an Adding Practitioner form for each clinician. • If the clinician does not have a Medicaid number, please complete the appropriate MAP 811 form. • The Adding Practitioner form is found on our website at the following link: http://passporthealthplan.com/wp- content/uploads/2014/11/adding-a-practitioner- form.pdf • Please submit completed form to our Provider Enrollment department at Passport.Credentialing@passporthealthplan.com
Recommend
More recommend
