Preparing for BH Redesign in My Care Medicaid

Preparing for BH Redesign in My. Care & Medicaid Managed Care

BH Redesign & Managed Care • • Timeline Update Common Terminology Provider Communications Provider Resources/Supports Panel Requirements Contracting/Credentialing Prior Authorization Process Testing & Technical Assistance

BH Redesign Timeline • January 1 – BH Redesign implementation – Coding changes – New services start – Medicaid claims billed to MITS – My. Care claims billed to MCOs • July 1 – Managed Care integration – All Medicaid claims billed to MCOs – Contracting is necessary – Continuity of Care period

Managed Care • There are 6 Managed Care Plans serving Ohioans eligible for Medicaid and My. Care: Aetna, Buckeye, Care. Source, Molina, Paramount and United Healthcare • Services in managed care designed by Ohio Medicaid and we must follow contractual requirements: (http: //www. medicaid. ohio. gov/PROVIDERS/Managed. Care/Program. Resou rce. Library/Combined. Provider. Agreement. aspx)

Common Terminology • • • Member Participating Provider (“PAR”) Business Associate Agreement Credentialing Timely Filing Limit Appeal/Reconsideration

Provider Communications • Provider Services Agreement – Amendments/Addendums • • Provider Manual (online/paper) Provider Newsletters (fax/email blasts) Provider Trainings (in person/online) Mailed letter campaigns

Provider Resources/Supports • • • Provider Contracting Member/Provider Contact Center Provider Services Representatives Rapid Response Teams Utilization Management teams

Panel Requirements • General requirements: • Access to Care • Other Standards • Cultural Competency • Physical Accessibility • Proximity to Public Transportation • BH Panel Requirements • Number by County • Intended to provide choice

Credentialing & Contracting • NCQA Standards for Credentialing (physician, facility, or group) • Credentialing Process • Information needed, based on standard • Paper form vs CAQH • Contracting Process • Request to Contract, timeline • Standard Contract Language • Single Case Agreement

PA Process • • No change in PA rules for 365 days ACT/IHBT/SUD Residential – expedited Standard PA form See Billing Guide for: – PA process – UM contacts

Training & Technical Assistance Pre-January • • • OAHP Regional Forums Trading Partner EDI/IT meetings My. Care Billing Grid, FAQs MCO Training Sessions MITS BITS Communications BH Redesign Website

Training & Technical Assistance Post-January • • MCO Weekly Technical Calls MCO Rapid Response Teams OAHP BH Collaborative ODM/MITS websites

Aetna Better Health of Ohio – Implementation Plan My. Care Preparations Leading to Jan 1 • Participation in ODM EDI/IT meetings & Stakeholder Forums • OAHP Regional Provider Forums • Provider education Webinars • Provider Services Team training • Readiness Review with State Current Testing Processes • Internal Testing in April through May • Provider Testing begin on May 15 th • Submit test files to OH_BH_Redesign@AETNA. com Post-Jan 1 Support System for Providers • Rapid Response Team for provider concerns • Daily office walk-in hours for each region • Designated mailbox: OH_BH_Redesign@AETNA. com • Weekly Provider Technical Assistance Webinars • Daily monitoring of claims denials and processing 7

Buckeye Health Plan – Implementation Plan My. Care Preparations Leading to Jan 1 • • • Readiness Review with State Begin provider file testing May 1 st All providers are loaded in system with Medicaid IDs Provider education Webinars Training Customer Service Team for FAQs from providers Current Testing Processes • Access Centene Edifecs Ramp Manager via https: //sites. edifecs. com/index. jsp? centene ; “Register for an account” • Navigate to Claims tab and submit 837 I or 837 P file • Run test and receive test results Post - Jan 1 Support System for Providers • Rapid Response team will be in place to expedite any issues that arise • Direct Access to Network Manager, Clinical Director for escalation • Daily reporting on claims denials and processing 7

Care. Source – Implementation Plan My. Care Preparations Leading to Jan 1 • • IT workgroup through OAHP EDI meetings with ODM Internal prep meetings for last year with all departments Regional Provider Forums in Spring, Summer, Fall with targeted agendas (technical assistance available 2 -3 hours) and will track agency participation Current Testing Processes • • Internal testing in May Targeted provider claims testing starting May Monitor claims and education plan to keep denial rate down Explore claims processing options to help correct claims Post - Jan 1 Support System for Providers • Rapid Response Team for Provider concerns • Weekly technical assistance calls • Provide summarized testing data to ODM and stakeholders 7

Molina Health. Care – Implementation Plan My. Care Preparations Leading to Jan 1 • • Participation in ODM EDI/IT meetings & Stakeholder Forums Network Communications – Provider Bulletins, Outreach OAHP Regional Provider Forums Provider Training Opportunities Current Testing Processes • Internal Testing in April/May • External Provider Testing started in May, currently open • ODM Readiness Review in October Post - Jan 1 Support System for Providers • • SWAT team meets daily to review trends & provider specific issues Weekly Technical Calls for Provider Q & A Dedicated email: BHProvider. Services@Molina. Health. Care. com Tracking/reporting of error trends & configuration issues 7

Paramount Health Care – Implementation Plan Managed Care Plan Preparations Leading to July 1, 2018 • Participation in ODM EDI/IT meetings & Stakeholder Forums • OAHP Regional Provider Forums • Provider Services Team training – Coordinated Outreach With Contracting Strategy • Readiness Review with State • Internal team training (Organization-wide “All Staff Update”) • Multi-pronged outreach approach through Provider Inquiry, Provider Relations and Contracting with standardized educational materials with critical resources information Current Testing Processes • Internal Testing in October, 2017 through June, 2018 • Provider Testing to begin on October/November 2017 through June 2018 • Finalized Edits to Testing Request Form and Resubmitting To Provider Entities Post-July 1, 2018 Support System for Providers • Rapid Response Team for provider concerns • Designated mailbox: Paramount. Behavioral. Health. Testing@Pro. Medica. org • 24/7/365 Call Center: 419 -887 -2557 • Provider Inquiry Contact: 419 -887 -2574 • Daily/Weekly monitoring of claims denials and processing to be shared with providers and ODM. • Ongoing FAQs to be sent to providers 7

United. Healthcare – Implementation Plan My. Care Preparations Leading to Jan 1 • • • Provider communications - Proactive Outreach Network recruiting, Contracting and Education Webinars at UHConline. com support for Provider Training Clinical staff training, IT system configuration Readiness Review with Ohio Medicaid EDI meetings with Medicaid and stakeholders Current Testing Processes • Internal claims/non-claims User Acceptance Testing in April and Sept • Prior authorizations, claims, and claims pricing • External provider testing groups in May, Sept, or Oct/Nov • Clearinghouses and individual providers Post - Jan 1 Support System for Providers • • Daily post-production monitoring Post go-live education targeting specific issues Network Management outreach Designated mailbox: Ohio. Network. Management@optum. com 7

How To Contact Us UNITED HEALTHCARE MOLINA HEALTHCARE Primary Contact: Tracey Izzard-Everett Primary Contact: Emily Higgins Phone: (614) 410 -7952 Phone: (614) 212 -6298 tracey. izzard-everett@optum. com Emily. Higgins@Molina. Healthcare. com CARESOURCE BUCKEYE (CENPATICO) Primary Contact: Terry R. Jones Primary Contact: Amber Bundy Phone: (614) 255 -4613 Phone: (866) 246 -4356 ext. 24477 Terry. Jones@caresource. com Amber. Bundy@envolvehealth. com AETNA BETTER HEALTH PARAMOUNT Primary Contact: Afet Kilinc Primary Contact: Hy Kisin Phone: (959) 299 -7278; (614) 254 -3229 cell Phone: (419) 887 -2251 Kilinc. A@AETNA. com Hy. Kisin@Promedica. org