Magellan Health Services, Inc'

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Magellan Health Services, Inc.
2008 Indiana Health Coverage Programs Provider
Seminar Hoosier Healthwise Medicaid Programs
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Agenda

• Introductions
• Covered Services
• Authorization
• Coordination of Care
• Mid-Level Behavioral Health Providers
• Claims Submission
• Magellans Provider Website
• QA

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Provider Handouts

• For your convenience, you will find the following
• handouts in your Magellan Folder
• Presentation
• Quick Reference Guide
• Billing Instructions for Indiana Medicaid
  Mid-level CMHC Members
• Billing Instructions for Indiana Medicaid
  Mid-level Group Members
• Standard CPT Code-Buckets
• Behavioral Health Treatment Information Data
  Sharing Form
• Treatment Request Form

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General Magellan Contact Information

• Business hours are 700 a.m. 700 p.m.
• 24 hour coverage for urgent situations
• Toll free access number 1-800-327-5480
• IVR (Interactive Voice Response) and web site
  available for providers
• Provider Handbook with Indiana Medicaid
  Supplement available at www.MagellanHealth.com.

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1-800-327-5480 Who Are You Talking To?

• The number on the ID card is answered by Magellan
  with an average speed of less than 30 seconds
• Magellan line is staffed by Customer Service
  Associates and Care Managers who can
• Verify benefits
• Authorize care
• Assist with problems
• Assist with claims issues
• Care Managers are independently licensed
  behavioral health professionals.

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Membership Enrollment

• To verify member eligibility, you may
• Call Magellan at 1-800-327-5480
• Check eligibility at www.MagellanHealth.com
• Verify eligibility at https//interchange.indianam
  edicaid.com/administrative/logon.asp
• Verify eligibility via the AVR at 1-800-738-6770
• Through Omni

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Covered Services
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Covered Behavioral Health Services

• Three benefit packages, depending on the members
  category of aid.
• Families and adults with dependent children
• Pregnant women
• Children

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Benefit Grid Anthem Blue Cross and Blue Shield
(Anthem)Indiana Hoosier Healthwise Medicaid
Program Members
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Benefit Grid Anthem Blue Cross and Blue
ShieldIndiana Hoosier Healthwise Medicaid
Program Members
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Benefit Grid Anthem Blue Cross and Blue
ShieldIndiana Hoosier Healthwise Medicaid
Program Members
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Benefit Grid Anthem Blue Cross and Blue
ShieldIndiana Hoosier Healthwise Medicaid
Program Members
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Benefit Grid Anthem Blue Cross and Blue
ShieldIndiana Hoosier Healthwise Medicaid
Program Members
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Benefit Grid Anthem Blue Cross and Blue
ShieldIndiana Hoosier Healthwise Medicaid
Program Members
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Benefit Grid Anthem Blue Cross and Blue
ShieldIndiana Hoosier Healthwise Medicaid
Program Members
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Benefit Grid Anthem Blue Cross and Blue
ShieldIndiana Hoosier Healthwise Medicaid
Program Members
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Benefit Grid Anthem Blue Cross and Blue
ShieldIndiana Hoosier Healthwise Medicaid
Program Members
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Benefit Grid Anthem Blue Cross and Blue
ShieldIndiana Hoosier Healthwise Medicaid
Program Members
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Benefit Grid Anthem Blue Cross and Blue
ShieldIndiana Hoosier Healthwise Medicaid
Program Members
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Pre-Authorization
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Pre-authorization Requirements

• All services require prior authorization EXCEPT
• Initial evaluation and first five routine
  outpatient visits per provider
• Emergency services
• CPT Codes 90801,90802,90862,90805,90772 and 99212
  provided by an IHCP psychiatrist, whether
  contracted with Magellan.
• Medication management (CPT Codes 90862, 90805
  and 90772)

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Preauthorization

• Requests for additional routine outpatient
  sessions
• Go to www.MagellanHealth.com, or
• Submit the Treatment Request Form included in
  your authorization letter to 1-800-501-0185.
• Higher levels of care must be reviewed by
  calling1-800-327-5480
• Authorization requests for all levels of care can
  be made by calling Magellan at 1-800-327-5480
• Requests for psychological testing must be made
  on the Request For Psychological Testing
  Preauthorization form, which can be found at
  www.MagellanHealth.com.

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Transition of Care Between MBHOs

• The Hoosier Healthwise program mandates that each
  MCO honor the previous MCOs authorizations for
  services provided 30 calendar days after the
  members transition between various managed care
  organizations.
• Though the majority of members prior
  authorizations will be covered through the
  current Magellan process of one initial
  evaluation followed by five routine outpatient
  services not requiring prior authorization
  Magellan has established the following processes
  to ensure continuity of care for its Hoosier
  Healthwise members who transition between plans

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Transition of Care Between MBHOs cont

• In cases where the previous MCO authorized more
  than five routine outpatient visits or more
  specialized outpatient services such as
  psychological testing, the provider should send
  via facsimile 1-888-656-1643, with a copy of the
  previous MCOs authorization letter along with a
  cover sheet explaining the reason for submission,
  i.e. previous MCOs authorization.
• In cases where a member is or was in a higher
  level of care, such as inpatient hospitalization,
  at the time of transition, the provider should
  contact Magellan immediately at 1-800-327-5480
  and ask to speak to an inpatient Care Manager.

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Concurrent Review

• Concurrent utilization management review is
  required for all services except medication
  management.
• Requests for additional routine outpatient
  sessions
• Go to www.MagellanHealth.com, or
• Submit the Treatment Request Form included in
  your authorization letter to 1-800-501-0185.
• Higher levels of care must be reviewed by
  calling1-800-327-5480.

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Appeal and Grievance Process

• Appeal rights are in all non-authorization
  letters
• Provider may appeal on behalf of member
• Grievances must be filed within 60 days of date
  of decision
• Appeals must be filed within 30 days of date of
  decision
• External independent review must be requested
  within 45 days of appeal/grievance resolution
• Medicaid hearing must be requested within 30 days
  of the initial action that is being reviewed
• Must exhaust appeals process prior to filing
  Medicaid hearing

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Appeal and Grievance Process contd

• Send appeals to
• Magellan Health Services
• 10101 Alliance Road, Suite 201
• Cincinnati, OH 45242
• Send Second Level Appeals to
• Attn Grievance/Appeals Dept.
• Anthem Blue Cross and Blue Shield
• P.O. Box 6144
• Indianapolis, IN 46209
• Request a Medicaid Hearing on a members behalf
  in writing
• Indiana Family Social Services Administration
• Hearings and Appeals Section MS-04
• 402 W. Washington St., Room E034
• Indianapolis, IN 46204-2773

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Coordination of Care
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Coordination of Care

• Facilitate reciprocal exchange of health
  information between physical and behavioral
  providers
• Ensure the coordination of physical and
  behavioral healthcare among all providers
  treating the member.
• Coordinate services for individuals with multiple
  diagnoses of mental illness, substance abuse and
  physical illness.
• Quarterly behavioral health profile sent to PMP.

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Coordination of Care

• Notify Magellan within five days of first visit
  at www.MagellanHealth.com with the following
• Summary of treatment session
• Primary and secondary diagnoses
• Findings from assessments
• Medication prescribed
• Any other relevant information
• Option to print so you can fax to PMP
• You can also request authorization for more
  visits
• Check auth status at www.MagellanHealth.com

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Mid-Level Behavioral Health Providers
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Mid-level Behavioral Health Providers

• Mid-level behavioral health providers -(newly
  graduated individuals who received a master
  degree in Social Work, Marriage and Family
  Therapy, or Counseling / Psychology, Clinical
  Nurse Specialists / Practitioners, and those who
  are post-doctorate psychologists) for the Indiana
  Medicaid insurance plan.

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Mid-level Behavioral Health Providers

• Supervising IHCP Psychologist / Psychiatrist are
  required to be contracted with Magellan as a
  group practice and be credentialed by Magellan.
• All Mid-level clinicians who are supervised by an
  IHCP HSPP Psychologist or Psychiatrist must be
  covered under the supervising IHCP Psychologist /
  Psychiatrists Magellan contract in order for
  these clinicians to be reimbursed when billing
  for those services according to the IHCP provider
  manual (supervisor is reflected as the rendering
  provider with the appropriate mid-level
  modifier).

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Mid-level Behavioral Health Providers

• Magellan contracted group practices employing an
  IHCP HSPP Psychologist or Psychiatrist that
  employs mid-level clinicians who currently meet
  Magellans credentialing standards may be
  reimbursed for these clinicians when billing for
  those services according to the IHCP provider
  manual (supervisor is reflected as the rendering
  provider with the appropriate mid-level
  modifier). These providers will be credentialed
  by Magellan according to its credentialing
  criteria and NCQA standards.
• Magellan group contracted practices employing
  licensed social workers (LSW) as clinicians will
  be individually credentialed by Magellan.

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Mid-level Behavioral Health Providers

• Magellan group contracted practices employing
  non-licensed clinicians who do not meet
  Magellans credentialing standards will not be
  individually credentialed by Magellan.
• Magellan contracted group practices will be
  required to follow all applicable state and
  federal regulations / laws governing the Indiana
  Medicaid insurance plan with regard to IHCP
  supervision and billing requirements.

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The National Provider Identifier (NPI)
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How can I apply for my NPI?

• For the most efficient application processing and
  the fastest receipt of an NPI, use the Web-based
  NPI application process. Log on to the National
  Plan and Provider Enumeration System (NPPES) and
  apply online at https//nppes.cms.hhs.gov/NPPES/We
  lcome.do.
• You may wish to obtain a copy of the paper NPI
  Application/Update Form (CMS-10114) by contacting
  the Enumerator
• By phone [phone] or TTY 1-800-692-2326
  By e-mail customerservice_at_npienumerator.com
• By mail NPI EnumeratorP.O. Box 6059Fargo, ND
  58108-6059
• Please see the CMS Web site for Tips to Expedite
  your NPI Application.

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How do I submit my NPI to Magellan?

• You can submit your NPI online by signing in with
  your secure username and password on this Web
  site (www.MagellanHealth.com/provider), select
  Display/Edit Practice Information, and complete
  the NPI request field.
• You can also submit your NPI by mail or fax by
  sending us a copy of your NPI notification letter
  or e-mail from NPPES
• Magellan Health ServicesAttn Data
  Management14100 Magellan Plaza Maryland
  Heights, MO 63043Fax number 314-387-5584 (for
  providers and groups)Fax number 314-292-1265
  (for organizations)

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NPI Instructions for Sole Providers

• A sole proprietorship is a form of business in
  which one person owns all of the assets of the
  business and is solely liable for all the debts
  of the business in an individual capacity.
  Therefore, sole proprietorships are not
  considered organization health care providers for
  purposes of the NPI Final Rule and thus cannot
  obtain organization NPIs. In terms of NPI
  assignment, a sole proprietor would be an Entity
  Type 1 (Individual) and would be eligible for a
  single NPI. As an Individual, the sole
  proprietor cannot have a subpart and cannot
  designate subparts.
• If you are an individual who is a health care
  provider and is incorporated, you need to obtain
  an NPI for yourself (Type 1) and an NPI for your
  corporation or LLC (Type 2).Health care providers
  who are individuals are eligible for an Entity
  Type 1 (Individual) NPI. If these individuals
  incorporate themselves (i.e., if they form
  corporations) and the corporations are health
  care providers, the corporations are organization
  providers that are eligible for an Entity Type 2
  (Organization) NPI. If either of these health
  care providers (the individual or the
  corporation) are covered providers (i.e.,
  providers that send electronic transactions)
  under HIPAA, the NPI Final Rule requires them to
  obtain NPIs. Visit the CMS Web site for more
  information.

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NPI Instructions Group Members

• If you are an individual who is a health care
  provider and is incorporated, you may need to
  obtain an NPI for yourself (Type 1) and an NPI
  for your corporation or LLC (Type 2).
• Health care providers who are individuals are
  eligible for an Entity Type 1 (Individual) NPI.
  If these individuals incorporate themselves
  (i.e., if they form corporations) and the
  corporations are health care providers, the
  corporations are organization providers that are
  eligible for an Entity Type 2 (Organization) NPI.
  If either of these health care providers (the
  individual or the corporation) are covered
  providers (i.e., providers that send electronic
  transactions) under HIPAA, the NPI Final Rule
  requires them to obtain NPIs.  Visit the CMS Web
  site for more information.

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Claims
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When will Magellan reject the old version of the
CMS-1500 form and the UB-92 form?

• As of June 1, 2007, providers must submit only
  the revised CMS-1500 form (version 08/05)
  CMS-1500 form (version 12/90) is no longer
  accepted.
• As of May 23, 2007, providers must submit the
  UB-04 form the UB-92 is no longer accepted.
• You can order CMS-1500 forms from a variety of
  sources, including the American Medical
  Association and the U.S. Government Printing
  Office.
• American Medical AssociationP.O. Box
  10946Chicago, IL 60610 Attn Order Department
  1-800-621-8335
• U.S. Government Printing OfficeSuperintenden
  t of DocumentsWashington, DC 20402(202)
  512-1800
• Order UB-04 forms from your current claim forms
  vendor.

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Claims Information

• Claims questions 1-800-327-5480 or check claims
  status at www.MagellanHealth.com
• Claims submission address
• Magellan Health Services
• PO Box 1006
• Maryland Heights, MO 63043
• You must submit claims within 180 days of the
  date of service
• Magellan does not reimburse laboratory or other
  related medical charges
• You must accept Magellans payment as payment in
  full you may not bill the member
• Indiana code requires we process electronic
  claims faster than paper claims. We encourage
  you to file electronically!

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Elements of a Clean CMS-1500 Claim

• Box 24D-CPT code (s) and Modifier (s) if
  appropriate
• Box 24J-Rendering provider id -This can only be
  AN IHCP MD or HSPP PHD who rendered or supervised
  the care.
• top portion of box-reserved for local use
  (rendering provider's name or MIS may be entered
  here) / the bottom portion of box - NPI
• Box 31-Enter name of rendering provider. (If
  services were performed by a mid-level provider,
  this box must contain the name of the supervising
  IHCP MD or HSPP PHD)
• Box 32a-Enter NPI number of service facility
  location
• Box 32b-Can enter Magellan service facility MIS
• Box 33a-Billing provider NPI number
• new field (24j will also be needed if rendering
  provider info is indicated on the claim)
• Box 33b-Can enter Magellan billing provider MIS

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Website-MagellanHealth.com
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Web Tools Available --24/7 Access

• Features
• Web site sign-in demonstration
• Provider orientation
• Claims inquiry
• Check eligibility
• Initial Outpatient Authorization (IOA) not
  available for all health plans
• Authorization tracking
• Treatment Request Form (TRF) submission
• Electronic claims submission/information

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Web Tools Available --24/7 Access

• Features (Continued)
• Provider Focus newsletter
• HIPAA billing code set guides
• Clinical Practice Guidelines
• Medical Necessity Criteria
• Employee Assistance Program (EAP) forms
• Behavioral health information to share with
  members
• Provider Data Change Form

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Web Tools Available --24/7 Access

• Features (Continued)
• Magellan National Provider Handbook and
  supplements
• Electronic Funds Transfer (EFT)
• Print authorization letters
• View and print explanation of benefits (EOB)
• View member outcomes reports
• Look up contact information
• Password must be changed every six months
• Session logout time 60 minutes

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Online Claims

• Professional claims submissions via CMS-1500
• Magellan electronic claims submission
  optionsPayerpath
• MedAvant Healthcare Solutions
• Emdeon Business Services
• Availity
• NaviNet Claims
• Claims Courier on Magellan Web site free
• Direct Submit through Magellan (high-volume
  claims) free
• HIPAA rules apply when submitting online claims

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Magellan Provider Welcome
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Menu Options
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(No Transcript)
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National Medicaid Care Management Center Contact
List

• Care Management Center 1-800-327-5480
• Network Management 1-800-285-5480
• Cheryl Perkins RN, General Manager 1-513-794-5280
• Walter Butler MD, Medical Director 1-513-794-7067
• Jodi Stevenson, Regional Network Director
  1-314-387-4595
• Barbara Tepe RN, Quality Director 1-513-794-7007
• Julia Linkova PCC-S, Care Management
  Supervisor1-513-794-7058
• Tina Hurt LCSW, IN Medicaid Account Manager
  1-317-582-3445

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Provider Communication Channels

• Magellan Provider Services Line 1-800-788-4005
• www.magellanhealth.com
• Field Network Management Contacts
• Johanna Griffin Rocker, Network Coordinator
  Indiana
• Phone [phone], press option 3
• Email jhgriffin_at_magellanhealth.com
• Regional Facility/Organizations Contacts
• Kurt Boldt, Area Contracting Manager- Indiana
• Phone [phone]
• Email keboldt_at_magellanhealth.com

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Questions and Answers
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THANK YOU FOR COMING!