Connecticut
Medicaid Managed Care Council
Behavioral Health Oversight Subcommittee
Legislative Office Building Room 3000, Hartford CT 06106
(860) 240-0321 Info Line (860) 240-8329 FAX (860) 240-8307
www.cga.state.ct.us/ph/medicaid
Transition Subcommittee
Meeting Summary: October 25, 2005 (Draft)
(Next meeting: Tuesday Nov. 29, 11 AM in LOB RM 1A)
Attendance: Stephen Fahey & Susan Zimmerman (Co-Chairs), Rose Ciarcia, Mark Schaefer (DSS), Stacey Gerber (DCF), Steve Larcen & Judi Miller (Natchaug), Vickie Veltri (GHLA), Erin Clark (CCPA), Gina Hoff & Ed Hackett (Wheeler), Alice Farrell & Louise Ladden (CCCFS), Barbara Sheldon, Janice Wood (family advocates), VOI – Linda Guillorn, Jennifer Pease, Lisa Carrico, David Glazer; Anthem: Myrka Laffitte-Guillen, Gail DiGioia, Susan Canning; Health Net: Janice Perkins, Maggie Taylor, Colleen Chesney; CHNCT – Lynn Childs, Rich Spencer, Kevin Colvin; WellCare/PONE- Christoher Savold, Tony Tedeschi; Susan Halpin (Robinson & Cole), M. McCourt (council staff).
Consumer Transition Issues
ü Outreach to clients is coordinated with DSS/DCF/VOI – (see doc 1 & 2 below)
ü Favor will communicate with families; list of other advocate groups that reach out to families can be sent to staff (mariette.mccourt@cga.ct.gov).
ü BHP brochure to raise awareness of BHP program is being developed for HUSKY A/B, DCF voluntary and other DCF clients. In the course of the next year there will be a broader dissemination. BHP asked to clarify target population at the Nov BHP Council meeting.
ü MCO/CTBHP numbers and processes to connect MCO members to BH reviewed (see doc. 5). PONE will continue their contract with CompCare and BH calls will still go the BH subcontractor for 8 months. CompCare will identify if the call is urgent & connect client directly to ASO; if not urgent, will give member ASO 1-800 number. Other plans will have “warm transfer” of calls to the MCO connected to ASO center directly.
ü Family Advisory Committee will work with the State & VOI regarding family engagement process.
ü Members may ask their BH provider to seek enrollment in the BHP (providers can enroll and be on a “no-referral” list or dis-enroll when that client completes treatment). Members need to be informed, through mailings from BHP & MCOs about the program change 1/1/06. Members change addresses and do not receive information. Important to:
o Engage both practitioners in telling their patients about the change as well as community-base grass roots organization to spread the information.
o Legal Aid can assist is this outreach and help with translation of notices into other languages.
1 2 3 4 5
MCO Transition
Document is still being updated for coverage & coordination of medical & BH services.
• A Memorandum Of Understanding (MOU) between ASO/MCOs will establish communication protocols and problem resolution.
• BHP is developing tacking of service utilization for services that remain under the MCO (i.e. transportation, pharmacy, home health service). The Agency is putting in safeguards to coordinate these services.
Provider Network Transition Issues
• VOI summarized communication with providers credentialed in behavioral health MCO’s not in FFS Medicaid.
• DSS indicated that the disruption analysis may be exaggerated by providers listed within facilities.
• DSS to report on expected provider disruption at November 29th meeting.
• Providers offered to assist in provider requirement to minimize disruption. If lists of providers are available to providers, hospitals and clinics, they can assist with provider recruitment.
• VOI plans to meet with provider groups and trade associations. It was suggested that DSS plans to meet with Connecticut Hospital Association be combined with a VOI meeting with CHA.
• DSS indicated a limited window for retroactive credentialing of providers not in Medicaid FFS who want to provide continuing care to members/clients.
Provider Transitional Issues
VOI/BHP & EDS interface (See doc. 4 above).
ü There will be continuity of care for services authorized prior to 1/1/06.
ü VOI working with plans to obtain service authorizations ahead of 1/1/06 so that these services will be in the system for 1/1/06 and providers will not be required to call to obtain transfer of authorizations. Concern was raised if all authorizations would terminate on 12/31 and new authorizations required on 1/1.
ü VOI and EDS (pays Medicaid claims) are meeting weekly regarding interface of the ASO & EDS system.
ü VOI will have daily exchange of data with EDS, which does claims processing every 2 weeks. VOI’s daily data monitoring will allow early identification and correction of claims errors. BHP has an independent contractor with a readiness tool to test the systems.
ü BHP has asked EDS to extend FFS web portal to all providers so BH providers can check their claims status.
ü Provider education regarding claims and authorization is planned for December 1, 2005 9AM-12 Noon at the Crown Plaza in Rocky Hill. There will be break out sessions for hospitals, clinics and individual providers.
Transitional Claims/Appeal process (See CHNCT & PONE docs below)
ü VOI will honor the same type of service authorization on 1/1/06 as was in place 12/31/05
ü The MCOs emphasized that timely claim filing & appeal times remain during the transition.
ü Two provider reports submitted highlighted common barriers to resolution of A/Rs that include:
o Subcontractor delayed mailing of checks/denials. Appeal/re-submission then falls outside the timely appeal period and is rejected.
o Claims denied for “no authorization” in Subcontractor system, but provider has this in their system.
o BH subcontractor system issues require provider re-submission of claims with the revenue code or resubmission because claims to BH subcontractor didn’t get into MCO claims system.
o HUSKY providers are urged to review their outstanding claims and work with BH subcontractor/MCO to resolve A/R issues (click on above MCO presentations).
o Question of interest payments for claims payments that are held by payers beyond 45 days was raised and the MCOs will investigate.
Summary of handouts for MCO/BH subcontractor claims/appeal processes
Claims/appeal |
Anthem/VOI |
HN/VOI |
CHNCT/VOI |
PONE/CompCare |
Timely filing of claims from Date of Services (DOS) |
*120 days from DOS for provider/hospital *Coordination benefits 90 days from primary payment |
* 90 days from (DOS) |
Prior 8/31/05- Submit within 120 days to: Magellan Health Services P.O. Box 1027 Maryland heights, MO 63043 Attn: Claims 9/1/05-12/31/05: 120 days for all providers. Submit to: ValueOptions 240 Corporate Blvd Norfolk, VA 23052 Atten: CHNCT Claims |
60 days for all providers |
Provider Appeal submission |
Submit to Anthem 60 days from date shown on provider remittance |
Defined in VOI provider contract |
1st level appeals Prior to and on 8/31/05 submit within 120 days to: Magellan Health Services 199 Pomeroy Road Parsippany, N.J. 07054 Attn: Appeals 9/1/05-12/31/05 Submit within 60 days of receipt of denial letter or disputed claim payment to: ValueOptions PO Box 1884 New York, NY 10116-1884 Attn: Appeals 2nd level appeals: submit within 60 days of 1st level decision to: CHNCT Appeals Department 11 Fairfield Boulevard Wallingford, CT 06492 |
Appeals Prior to 1/1/06, submit within 30 days of EOB or denial letter. All appeals are addressed within time guidelines specified by state or within 30 days of receipt of the appeal. |
Other Information |
Transition period: *Claim questions or issues: Member Services 1-800-828-2239 Manager: Jeanna Walsh *Claims unit will have access to PA info. & will process claims for DOS prior to 1/1/06 after BH CO |
*Claims Questions for DOS prior to 1/1/06 be directed to: Claims/customer Service 1-866-440-6820 *Escalated issues -Stephen Soohoo, VOI 212-560-7656 -David Glazer, VOI 212-560-7611 -Colleen Chesney, HN 203-225-8752 |