Behavioral Health Partnership Oversight Council

Transition Subcommittee

Legislative Office Building Room 3000, Hartford CT 06106
860) 240-0321 Info Line (860) 240-8329 FAX (860) 240-5306
www.cga.ct.gov/ph/medicaid

Meeting Summary: May 5, 2006
Next meeting: Friday June 2 @ 12:30 in LOB RM 1A

Appointment of Co-Chair
Dr. Steve Larcen welcomed Lorna Grivois, parent advocate, as co-chair the subcommittee. The Subcommittee welcomes the active participation and insights of family advocates.

ValueOptions (VOI)/CTBHP Report on Transition Issues (click on icon to view presentation)

Key points:

• Operations update:
o Total authorizations/concurrent review by level of care (LOC) – 52% RTC, 24% inpatient, 14% IOP/PHP. Range of provider time on the phone is 28 minutes, with a range from 17 seconds to 56 minutes. VOI was asked if the system will be more efficient, less time-consuming for both entities when the system is fully operational. VOI stated that new staff are being trained in the processes and expects the time for reviews to diminish. VOI case management already has patient data on their screen, which reduces call time.
o Timelines for adding other LOC authorization/ concurrent review: Riverview and EDT June 1, Home-based services July 1, 2006.
o Authorizations on file at EDS can be researched on a web-based lookup; VOI should soon have a similar capacity for authorizations sent to EDS.
o Interactive Voice Response (IVR) and web technology for outpatient registration technology will be available August 1, 2006.
o On May 1 formal tracking of patients “stuck” in the ED was tested. VOI is drafting an educational alert to ED's about the new CTBHP system. VOI noted they may not hear from an ED until a patient has been there 5-6 days.
o Infoline 211 can now send discrete perinatal calls that may require BH services directly to VOI.
• Call management: a total of 3868 calls were received in April, a 36% increase from March, with 218 after hours and 129 crisis calls. Provider calls have increased as the review systems have been added.
• Network development status: added 595 providers and DCF RTC/Group homes have increased by 24 since 11/2005. Clinic providers have not decreased rather individual practitioners within clinics have merged into the clinic provider identifier.
• VOI will have a report ready in mid May that will quantify discharge delays in hospitals and EDs. Assessing these delays is the number one priority, identifying where the capacity issues are the reasons and proposed solutions.

Claims Report Summary: Teddi Creel, DSS (See description of reports under “claims summary report”)
A report is generated on CTBHP claims, which is an unduplicated denied claim detail count and percent by reason and authorization class by provider. As of 4/25/06, the percentage of paid claims was 82% and denied claims were 18%.

• The top two reasons for denied claims were “duplicate of a paid claim” (40%) and “exact duplicate of a claim in process” (22%).
o The former may involve paid claims not posted by the practice.
o The latter category is not impacted by a submitted claim before the eligibility is clarified in the system, as the claim would be suspended until the eligibility issue is resolved.
• 14.6% of the total denials are related to failure to bill the private carrier 1^st. EDS has a correction form that can be downloaded to correct errors in patient's primary carrier information. Submission of this form triggers DSS research on TPL. Provider claims may be rejected pending this research and providers will be expected to submit paper claims with the EOB denial for claims where the EDS system indicates TPL. This topic requires further clarification with providers; the CTBHP Response Team will help providers with their individual issues and process details will be included in provider workshops with VOI/EDS.

Outstanding Claims Update
Each MCO reported on the status of their claims resolution. CHNCT is diligently working with Magellan to reconcile claims, with CHNCT computing the payment issues and Sylvia Kelly, CEO, has been very flexible in working with providers. In the reports, not all providers have been sending in claims information. Without that, the MCO cannot move forward in resolving the claims. Eight to ten of the 29 providers in the CCPA report have responded and few hospitals have responded. One provider noted that they have to do added work because of contract changes. Health Net is working with the Children's Center, Hall-Brooke is submitting claims that day and Yale Child Studies Center claims are being submitted. The end date for submitting past unresolved or disputed claims is June 1, 2006.

Next Subcommittee meeting: June 2 @ 12:30 PM in LOB RM 1A.