Please dial 405-521-4496 106802# *6 to mute DO NOT put this call on “HOLD” Authorization of services is not a guarantee of payment. The provider is responsible for ensuring that the eligibility, medical necessity, procedural, coding, claims submission, and all other state and federal requirements are met.
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Please dial 405-521-4496 106802# *6 to mute DO NOT put this call on “HOLD” Authorization of services is not a guarantee of payment. The provider is responsible.
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Please dial 405-521-4496106802#
*6 to mute
DO NOT put this call on “HOLD”
Authorization of services is not a guarantee of payment. The provider is responsible for ensuring that the eligibility, medical necessity, procedural, coding, claims submission,
and all other state and federal requirements are met.
Should you be on this training?
• It depends how are you contracted with OHCA/ODMHSAS
– LBHP/Group• If you can do CDC 27 to get testing authorization• You are not an Agency
– TXIX Agency, DMH CMHC/SA, State Op• If you can do CDC 21 to get PG038
– DMH Specialty• If you can get instant auths, like ResCare, Homeless programs
or Correction contracts
Outline – DMH Specialty• Current Process – CDC Only
– CDC coverage file will stop 3/31/2013• Grandfathered PA
– Modifications need to be made prior to 1/15/2013– Any changes made on/after 1/15/2013 will require modification form
– Fax forms• Important Dates• Contact Info – PICIS Helpdesk
Current Process – CDC Only
• For claims with service dates between 10/01/2011 and 1/14/2013, a CDC must be on submitted to ODMHSAS to cover claims.
Current Process – CDC Only
• Example: – CDC 23 is submitted with
a transaction date of 2/15/2012.
– Claims with service dates of 2/15/2012 to 8/14/2012 will be covered for payment.
– For outpatient behavioral health, each CDC covers six months of service.
– It does not necessarily follow the treatment plan dates, but may.
Current Process – CDC Only
• This coverage process is accomplished by ODMHSAS sending a file to OHCA each night.
Current Process – CDC Only
• However, ODMHSAS will stop sending that file on 3/31/2013.
Current Process – CDC Only
• What does that mean?
• If you want service paid which occurred between 10/01/2011 and 1/14/2013, the CDC to cover those dates must be submitted by 3/31/2013.
Current Process – CDC Only
• Please note, that after 2/17/2012, all the data elements needed for an authorization will be required, regardless of the CDC transaction date.
• Ignore slide. We will allow them to skip diags for CDC dates prior to 1/15/2013.
Current Process – CDC Only
• Summary:– All CDCs to cover
services between 10/01/2011 and 1/14/2013 must be submitted by 3/31/2013.
– There will be NO possible way to get services for those dates covered after 3/31/2013.
Grandfathered PA• Based on active CDCs• Grandfathered PAs based on transaction date• For 6 month PAs, extra 30 days added
– End the grandfathered PA early, if needed to match up to treatment plan dates.• Report is ready now.• Can be modified until 1/14/2013. After that, same process to modify as
regular authorization.• CDC 21/PG038 will be good for 12 months for transaction dates prior to
1/15/2013 (agencies only), as long as no other PA requested.• Providers need to make sure authorization are appropriate.
– What could cause problems?• Problems with Grandfathered PAs?
Reminder:Authorization of services is not a guarantee of payment. The
provider is responsible for ensuring that the eligibility, medical necessity, procedural, coding, claims submission, and all other state and federal requirements are met.