va dmas cmhrs, residential, epsdt behavioral therapy (aba
TRANSCRIPT
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VA DMAS CMHRS, Residential, EPSDT Behavioral Therapy (ABA), and TFC Case Management Service Request Process
Presented by: Katie Richardson, Lead IT Analyst
Rick Kamins, Ph.D., Chief Clinical Officer, Magellan Public Sector Solutions
November 2013
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What is the purpose of this webinar?
• Learn how to register a service or request a service authorization
• Learn which services need registration or service authorization
• Learn about the various methods to register services or obtain a service authorization
• Services not covered in this Webinar
– Inpatient, psychiatric
– Traditional Outpatient, psychiatric and substance use disorder
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Start on the Magellan of Virginia website
To access the option to register or request authorization for services (and to access other tools for your practice that require a sign in to the Magellan provider website) start at the MagellanofVirginia.com website, and select the Provider Website link associated with the Provider Resources tab.
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Users are redirected to www.MagellanProvider.com. To access secure applications containing member information, you must sign in with your username and password.
Sign In Page
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After signing in to the Magellan provider website with your secure username and password, you see the My Practice page:
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If your sign-in is associated with more than one Magellan MIS # and/or more than one location, the Start page will display, otherwise this screen is bypassed.
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Start by searching for the member.
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Select the appropriate member from the search results.
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If you need to check the Service Limits used, click the link on the member name to access this information.
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Eligibility Details
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Service Limit details
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To submit a service registration, click the Start New Registration button.
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Common services that require Registration
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Crisis Stabilization (H2019) Substance Abuse Case Management (H0006)
Crisis Intervention (H0036) Substance Abuse Crisis Intervention (H0050)
Medication Management (using the appropriate outpatient E&M code)
Substance Abuse Day Treatment (H0047)
Mental Health Case Management (H0023) Substance Abuse Day Treatment for Pregnant Women (H0015-HD)
Opioid Treatment (H0020) Substance Abuse Intensive Outpatient (H2016)
Outpatient (Individual, family or group) psychiatric or substance abuse first year of accessing benefit
Substance Abuse Residential Treatment for Pregnant Women (H0018-HD)
Psychological Testing (up to 7 hours/6 months)
Temporary Detention Order (TDO) and Emergency Custody Order (ECO)
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Providers must submit registration requests on this screen.
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Providers will review and submit the request or they can click Revise to modify the submission information prior to submitting.
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This is the submission complete page.
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Magellan’s Review of Service Request Applications (SRA)
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• Medical Necessity based on DMAS criteria (including InterQual criteria for Level A, B, and C Residential and Outpatient Mental Health and Substance Use Disorder)
– Basis for clinical authorization or denial
• Service Component Requirements
– Quality of Care determination
– Improve audit outcomes
• Required attachments (e.g., Certificate of Need; CANS, Plan of Care)
– Absence may result in administrative denial
– 90 day transition period
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To request a service authorization, click the Start New Authorization button.
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Services that require Authorization:
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Day Treatment/Partial Hospitalization (H0035-HB)
Mental Health Skill-building Services (H0046)
EPSDT Behavioral Therapy (ABA) (H2033)
Outpatient (Individual, family or group) psychiatric or substance abuse after first year of accessing benefit
Inpatient Psychiatric Psych Testing (more than 7 hours/6 months)
Intensive In-Home (H2012) Psychosocial Rehabilitation (H2017)
Intensive Community Treatment (H0039) Therapeutic Day Treatment (H0035-HA)
Level A, B, and C Residential Treatment Foster Care Case Management (T1016)
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Users will select a Level of Care for the authorization request. This is an example showing Psychosocial Rehab.
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This shows the top portion of the Initial Psychosocial Rehab entry page.
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Additional information on the Psychosocial Rehab entry page.
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Psychosocial submission complete page
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Therapeutic Day Treatment (TDT) Child and Adolescent Continued Auth Request
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TDT entry screen (initial portion)
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TDT additional fields
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Upload screen for adding attachments
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Q & A