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.

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

• Instant Authorizations (DMH Only)• Exceptional Case, Modification & Corrections

– 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?

– Contact [email protected] or [email protected].

CDC 21 - PG038

• Coverage is for 90 days, but can be extended up to one year, or until customer is admitted– Same process as current extension

• Dollar Amounts: – Adults: $483– Children: $493

Instant Authorizations – DMH Only

• Instant authorizations do not require the additional data elements for an authorization.

• Submit the CDC as you always have and an authorization will be instantly created.

• PA tab will not be visible until you save the CDC record.

Instant Auths – DMH Only

N/A CI CL HA OO SC SN

Transaction Type ServiceFocus

23, 40, or 42 01 - mental health DH507 DH510 DH511 DH509

23, 40, or 42 02 - substance abuse DH507 DH506 DH511 DH509 DH505

23, 40, or 42 03 - drug court DH507 DH506

23, 40, or 42 06 - MH & SA DH507 DH506 DH511 DH509 DH505

23, 40, or 42 09 - special populations DH502

23, 40, or 42 11 - other DH510 DH503

23, 40, or 42 13 - co-occurring DH507 DH506 DH511 DH509 DH505

23, 40, or 42 23 - day school DH508

23, 40, or 42 24 - med clinic only DH517

21 26 - mobile crisis DH514 ***

23, 40, or 42 27 - long-term inpatient DH516

23, 40, or 42 30 - State Operated Only DH504 DH504 DH504 DH504 DH504 DH504

21 All service focuses EXCEPT 26 PG038

Level of Care

Instant Auths – DMH Only

ExamplesService Focus Level of Care Authorization

ResCare 11 CL DH510SA ResTx 02/03/06/13 CI DH506SA Detox 02/06/13 SN DH505Crisis Unit 01/02/06/13 SC DH509Inpatient CMHC 01/02/06/13 HA DH511Housing 01 CL DH510SPTU 11 OO DH503Homeless 11 OO DH503Day School 23 OO DH508

N/A CI CL HA OO SC SN

Transaction Type ServiceFocus

23, 40, or 42 01 - mental health DH507 DH510 DH511 DH509

23, 40, or 42 02 - substance abuse DH507 DH506 DH511 DH509 DH505

23, 40, or 42 03 - drug court DH507 DH506

23, 40, or 42 06 - MH & SA DH507 DH506 DH511 DH509 DH505

23, 40, or 42 09 - special populations DH502

23, 40, or 42 11 - other DH510 DH503

23, 40, or 42 13 - co-occurring DH507 DH506 DH511 DH509 DH505

23, 40, or 42 23 - day school DH508

23, 40, or 42 24 - med clinic only DH517

21 26 - mobile crisis DH514 ***

23, 40, or 42 27 - long-term inpatient DH516

23, 40, or 42 30 - State Operated Only DH504 DH504 DH504 DH504 DH504 DH504

21 All service focuses EXCEPT 26 PG038

Level of Care

List of Instant Auths, Caps and Length

Authorization PA Group units Adult cap Child cap Length

Prison Related Services DH502 9999 6 months

Recovery Services DH503 4186.00 4186.00 6 months

Non-DMHSAS/Non-OHCA Funded DH504 9999 6 months

SA Detox DH505 8 8 days

SA Halfway House DH506 9999 6 months

Residential Treatment DH507 9999 6 months

Day School DH508 9999 6 months

Community-based Structured Crisis Care DH509 2364.00 2364.00 8 days

Housing Services DH510 9999 6 months

Mental Health Inpatient DH511 10 10 days

Mobile Crisis DH514 9999 6 months

Long-term Mental Health Inpatient DH516 9999 6 months

DMH Medication Clinic Services Only DH517 9999 6 months

Instant Authorizations – DMH Only

• Additional Notes:– CMHCs who want a housing and an outpatient

authorization at the same time, have to follow the same process previously identified.

– Once the Instant Auth is accepted, the authorization tab will show the dates covered and the PA Number.

Exceptional Case, Corrections & Rehab Request for Rehab (0-5 year olds)

• Step 1: Get authorization• Step 2: Go to online form and request change– Note: If online form is not available by 1/15/2013,

fax form will be available.• Step 3: ODMHSAS will review and send email

response.– A clinical reviewer will review Exceptional Case

and Rehab Request– PICIS Helpdesk staff will review correction request.

Important Dates – DMH Specialty

– Grandfathered PA should be ready to view by 12/17/2012– Authorization Process begin 1/15/2013– CDC Coverage ends 3/31/2013– FYI - Dates of Service

• 1/14/2013 and 1/15/2013 cannot be on the same claim

Other information

• Recording of webinars will be available at http://www.odmhsas.org/arc.htm.

Who to contact?

PICIS [email protected] or 855-521-6444

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.