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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 - LBHPs• 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

• LBHP/Groups– CDC 27 – Testing– New Data Elements– Types of Authorizations, Length of Time, Dollars/Units

• Rules for submission, back dating

• Exceptional Case, Modification & Corrections– Fax forms

• Letters of Coll/Term – Not needed until 3/1/2013• 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

• 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.• Providers are able to view grandfathered PAs.• 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 mareynolds@odmhsas.org or dmelton@odmhsas.org.

LBHPs

• If LBHP Under Supervision, report the CDC/PA under the supervising LBHP.

• In PICIS, all LBHPs should be set up under their own name, except for those under supervision.

LBHP Authorizations

• Testing (contact CDC 27s)– PG028, PG029, PG013

• Initial Treatment (admission CDC 23s)– PG026, PG030

• Treatment Extensions (extension CDC 42s)– PG027, PG040

Adult ChildAuthorization Type PAgroup Units Cap Cap lengthInsure Oklahoma - LBHP Initial Treatment PG026 8 0.00 0.00 6 monthInsure Oklahoma - LBHP Initial Extensions PG027 8 0.00 0.00 6 monthInsure Oklahoma - Psych Testing PG028 8 0.00 0.00 12 monthLBHP Testing PG029 8 0.00 0.00 12 monthLBHP Initial Treatment PG030 8 0.00 0.00 6 monthLBHP Additional Treatment PG040 8 0.00 0.00 6 monthLBHP CALOCUS, Brief Intervention, & Referral PG013 0 0.00 140.00 6 month

New Data Elements

Example of Grandfathered PA

CDC 27 - Testing

• Instant PA– All that is needed is the 27, service focus ’01’– If 27 is complete, DMH will give you the

appropriate testing authorization• For Medicaid customers– PG029 will be created

• For Insure OK customers– PG028 will be created

• CALOCUS

CDC 23 – Initial Treatment

• Provider will do the full admission (23)– Provider will request the appropriate authorization

from below– Providers will still be able to back date the initial

treatment 30 days; however, payment will not be allowed until CDC is accepted and PA sent to HP

• For Medicaid customers– PG030

• For Insure OK customers– PG026

CDC 42 – Treatment Extension

• Provider will do CDC 42– Provider will request the appropriate

authorization from below• For Medicaid customers– PG040

• For Insure OK customers– PG027

LBHP: Corrections Request

• 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.– PICIS Helpdesk staff will review correction request.

Important Dates

– Grandfathered PA are ready to view– Authorization Process begin 1/15/2013– Back dating end for agencies for 2/17/2013– Letters of Collaboration/Termination begin 3/1/2013– 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 Helpdeskgethelp@odmhsas.org521-6444 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.