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

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

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.

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)

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

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)

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