ProviderConnect Registered Services Autism Service Provider User Manual ASD Behavioral Assessment, Treatment Plan and Program Book Development

Transcription

1 ProviderConnect Registered Services Autism Service Provider User Manual ASD Behavioral Assessment, Treatment Plan and Program Book Development Created 9/1/17

2 Table of Contents Introduction... 3 Accessing ProviderConnect... 5 ProviderConnect Basics... 7 Features... 9 Completing a Registration Request for ASD Behavioral Assessment, Treatment Plan and Program Book Development...10 Appendix A: Documentation Templates

3 Introduction Introduction The ProviderConnect application provides a variety of self-service functions to help providers access and view information about members and authorizations. For CT BHP providers, additional functionality is available including: Obtaining authorizations for the CT BHP Behavioral Assessments, Treatment Plan and Program Book Development What is Covered in this Module? This module covers general functions within ProviderConnect as well as requests for Autism Service providers, which includes the following key functions: Registration of Behavioral Assessments, Treatment Plan and Program Book Development authorization requests for Autism Services Training Objectives As a result of this training module, you will be able to: Log in to ProviderConnect Search for and view Member records. Complete a request for Behavioral Assessments, Treatment Plan and Program Book Development NOTE: Autism Service Providers Behavioral Assessments, Treatment Plan and Program Book Development For dates of service on or after January 15, 2018, the telephonic authorization process will transition to web-based requests. Those providers who offer Behavioral Assessments, Treatment Plan Development and Program Book Development will request these services using the CT BHP web portal, ProviderConnect. Prior authorization requests will pend to the ASD Clinical team for review. While these changes reduce the administrative burden for providers, these changes will not alter the authorization parameters or Level of Care Guidelines that are currently required. Approved requests for Behavioral Assessments will result in 3-month authorization for up to 10 units/hours. Approved requests for Treatment Plan Development will result in a 90-day/1 unit authorization. (Re-registration allowed prior to the 90-day end date and based on medical necessity). Approved requests for Program Book Development will result in a 3-month/3 unit authorization. (Re-registration allowed prior to the 90-day end date and based on medical necessity). 3

4 Introduction, continued Navigation Features Throughout the ProviderConnect screens, navigation features are available to make it easier to move through the fields and screens. Below are a few basic features available. Feature What it Looks Like Description Breadcrumbs Asterisk Back Button Calendar Icon Cancel Button Checkboxes Tabs with titles of each request screen will display on all of the request screens to show progress through the process. Any field with an asterisk next to it indicates that the field is required and a data item must be entered or selected in order to complete the request. Conditionally required fields will not have asterisks. A Back button is available on most ProviderConnect screens to help navigate to previous screens. The Back button on the ProviderConnect screens should only be used when navigating to the previous screen. Do not use the back button on your Internet browser. For date fields, a pop-up calendar can be accessed by clicking the calendar icon. When the calendar opens, click the date desired and the date field will automatically update with the selected date. A Cancel button is available within some screens to allow a user to exit from the function. Any data items with checkboxes next to them indicate that more than one data item can be selected for that field. Click inside of the box to select the value. Expand/Collapse Hyperlinked Codes Hyperlinked Field Titles Radio buttons Save Request as Draft Submit Text Boxes Any title with an arrow ( ) to the left of the title indicates that it is a section that can be expanded to display fields or information. Click on the title to expand or collapse the section. Any underlined codes that are input options for a field will populate the field when clicked. Any underlined field title will open screens, help text, a list of codes, etc. when clicked. Any data items with radio buttons next to them indicate that only one data item can be selected for that field. Click inside of the circle to select the value. A Save Request as Draft button is available on the Request for Services screens, which will save the record when clicked. As a saved record, it is only available within ProviderConnect and is not available to access in CareConnect. A Submit button is available on some screens, which will submit the record when clicked. Any open text box indicates that free form text can be entered into the box. 4

5 Accessing ProviderConnect Obtaining an ID and Password CT BHP ProviderConnect User Manual Autism Services In order to obtain a ProviderConnect login ID and password, complete the following steps. 1. Go to the CT BHP website at 2. Click on the For Providers button. 3. Under the Templates section, click on the Online Services Account Request Form hyperlink. 4. Complete the form and fax it back to the Provider Relations department at (855) Completed forms can also be scanned and ed back to Provider Relations at ctbhp@beaconhealthoptions.com. 5. User ID s and passwords will be created within 48 hours. Once the ID and password are created, you will be sent an with your ProviderConnect login details. 6. If you have any questions, feel free to contact the CT BHP Provider Relations department at

6 Accessing ProviderConnect, continued CT BHP ProviderConnect User Manual Autism Services Logging In The ProviderConnect web application can be found on the CT BHP website: 1. Go to 2. Click on For Providers. 3. Click on Log In. 4. Enter User ID and Password. 5. Click Log In. 6

7 ProviderConnect Basics Searching for and Viewing Member Records One function that is used often to for various ProviderConnect functions is searching and viewing member records. Below are the key actions for completing this step. Any field with an asterisk indicates that the field is required. 1. Click Specific Member Search from the navigational bar or Find a Specific Member on the Home page. 2. Enter values for the Member ID and Date of Birth a. Note: The As of Date (MBR Eligibility Date) will auto-populate with today s date. To search a previous eligibility date, users can enter a previous date. 7

8 ProviderConnect Basics, continued CT BHP ProviderConnect User Manual Autism Services Review Members record details 3. Demographics (Displays basic member information (i.e. address, phone, etc.) 4. Enrollment History (Displays active and expired enrollment records for member 5. COB (Displays information on other insurance policies) 6. Additional Information (Displays claims mailing address for the member) 7. View Member Auths (Displays Member specific authorizations) 8. Enter Auth/Notification Request (Initiates the Request for Services process) 9. View Clinical Drafts (Display member specific Clinical Drafts) 10. View Referrals (For Residential/Group Home Providers Only) 11. NOTE: Enter Member Reminders through View Behavioral Analysis Date functions are currently not utilized for the CT BHP Providers These functions should not be accessed and information should not be entered into any of these categories. 8

9 Features Saving Requests as Drafts While working with requests for authorizations in ProviderConnect, providers have the ability to save a request as a draft in the event that they cannot complete it at the time the request was started. Saved drafts can be viewed and opened by providers from the View Clinical Drafts screen accessible from the ProviderConnect homepage. Saved drafts are available for completion and submission for 30 days from the initial date the record was saved. If the record is not submitted within the 30 days, it is automatically expired. When a record is saved as a draft, it is NOT available for CT BHP clinical staff to review. 9

10 Completing a Registration Request for Behavioral Assessments, Treatment Plan and Program Book Development Key Step 1: Initiate a Request for Authorization The first key step is to initiate the request for authorization function, which starts from the ProviderConnect Homepage. The function can also be initiated when the Member record is located first and then the Enter an Auth Request button is clicked. Below are the key actions for completing this step. Any field with an asterisk indicates that the field is required. 1. Click enter an Authorization Request link from either the left navigational or Home page of ProviderConnect. 2. Review the Disclaimer and click the Next Button. 10

11 Completing a Registration Request for Behavioral Assessments, Treatment Plan and Program Book Development, cont. 3. Search for Member Record a. Enter Member s Medicaid ID and Date of Birth b. Click Next 4. Click the Next button on the Member record to continue. 5. The Select Service screen will display 6. Locate and select the Service Address/Vendor. a. NOTE: For Clinics and Group Practices users should always ensure they are picking the correct vendor location for authorization of services. Group Practice users should ensure that they are selecting the appropriate address, followed by the correct licensure level for authorization requests (i.e 123 Main St. BCBA, 123 Main St. LCSW). 7. Click the radio button next to the Service Address to select record. The record selected will be attached to the request and authorization that will be created. 8. Click the Next button to continue. The Requested Service Header will display. 11

12 Completing a Registration Request for Behavioral Assessments, Treatment Plan and Program Book Development, cont. Key Step 2: Complete Initial Entry Request Screen The second key step is to complete the initial entry screen of the request where the requested start date of the service is entered and the specific level of care and service is selected. This screen displays for all types of requests. However, the information entered determines which clinical screens will display and which authorization parameters will be applied to the request. Any field with an asterisk indicates that the field is required. 9. Enter the Requested Start Date (The Requested Start Date is the date for the authorization to begin in order to cover requested services.) 10. Select the Level of Service = Outpatient/ Community Based. (When the level of service is selected, the screen will update with the required fields specific to the level of service.) 11. Select the Type of Service = Mental Health 12. Select the Level of Care = Outpatient 13. Select the Type of Care = ABA Assessment 14. Attach a Document NOTE: This function is included in the next registration request screen. Users completing requests for Behavioral Assessments, Treatment Plan and Program Book Development should NOT attach documentation at this time but in the registration request. 15. Click Next 16. Click OK on the pop up window that displays. 12

13 Completing a Registration Request for Behavioral Assessments, Treatment Plan and Program Book Development, cont. Key Step 3: Complete the Clinical Screens For Behavioral Assessments, Treatment Plan and Program Book Development requests, the clinical screen workflow will display. This workflow consists of five (2) screens. 1. ABA Assessment 2. Requested Services 3. Results Below is information for completing each screen. Key Step 3: Complete the Clinical Screens - Tips for Working through the Clinical Screens The screens will display in the order listed above when the Next button is clicked within each screen. Requests are completed in order. All required fields are completed to move to the next screen. Previous screens are accessed by clicking the Back button. However, you must click the Next button to proceed forward. Within any clinical screen the request can be saved as a draft by clicking the Save Request as Draft button within the screen header. IMPORTANT NOTE: Saving Requests as Drafts Once the clinical screens in ProviderConnect are accessed, providers have the ability to save a request as a draft in the event that they cannot complete it at the time the request was started. Users can click Save Request as Draft on the top right of the screen. Saved drafts can be viewed and opened by providers from the View Clinical Drafts screen accessible from the ProviderConnect homepage. (See pg 9.) 13

14 Completing a Registration Request for Behavioral Assessments, Treatment Plan and Program Book Development, cont. Key Step 4: Complete the Clinical Screens ABA Assessment Screen The Type of Services screen is the only screen that will display after the Initial Entry screen. Much of the information is required for completion on this screen. Documentation of Primary Behavioral Condition is required. Provisional working condition and diagnosis should be documented if necessary. Documentation of secondary co-occurring behavioral conditions that impact or are a focus of treatment (mental health, substance use, personality, intellectual disability) is strongly recommended to support comprehensive care. Authorization (if applicable) does NOT guarantee payment of benefits for these services. Coverage is subject to all limits and exclusions outlined in the member s plan and/or summary plan description including covered diagnoses. Below are the key actions for completing this screen. Any field with an asterisk indicates that the field is require Step Action 1 Are you requesting ABA Services for a member with a behavioral health diagnosis? Click Yes 2 Enter the Name of the Professional who gave the diagnosis, the Licensure Type of the Professional and the Date of the diagnostic assessment/diagnosis. 3 Attach a Document - Behavioral Assessments, Treatment Plan and Program Book Development require additional documentation. Documentation samples provided in Appendix A of this user manual. NOTE: Attached documentation should NOT be a copy of the Diagnostic Evaluation. See Appendix A for Templates and Examples of Documentation for Behavioral Assessments, Treatment Plan and Program Book Development. 4 Choose ASSESMENT/EVAL from the Document Description Drop down Menu. 5 Click Upload File 14

15 Completing a Registration Request for Behavioral Assessments, Treatment Plan and Program Book Development, cont. 1. A pop up window to Upload File window will appear. 2. Click Browse. a. Search for the file/document you want to attach. b. Double click on the file. 3. The pop up window will now list the file chosen. 4. Click Upload. 5. The attached file will be listed on the page. a. If the wrong file was selected users can click the checkbox next to the document, click Delete and Repeat steps Click the Next Button a. If a document has not been attached, a warning message will pop-up to confirm if you want to proceed without attaching a document. Click the OK button to proceed. 15

16 Completing a Registration Request for Behavioral Assessments, Treatment Plan and Program Book Development, cont. Step Action 6 *The Primary Diagnostic Category 1 is the main diagnosis (i.e F84.0) 7 Enter the partial Diagnosis Code 1 (see image below) or a brief Description and select the hyperlink above the text field. System users can enter a partial diagnosis and then click on the hyperlink to view a filtered list of ICD-10 codes that match their search criteria. Once a user clicks on the appropriate code in any of the pop-up windows, all other fields will populate. 8 System users then enter a Primary Medical Diagnostic category. Autism Service Providers can select None or Unknown from the Diagnostic Category. No Diagnosis Code or Description are needed if the selection is None or Unknown. Step Action 9 System users then enter a Primary Medical Diagnostic category. Autism Service Providers can select None or Unknown from the Diagnostic Category. No Diagnosis Code or Description are needed if the selection is None or Unknown. 16

17 Completing a Registration Request for Behavioral Assessments, Treatment Plan and Program Book Development, cont. Step Action 10 Social Elements Impacting Diagnosis: To complete this section, simply click the check boxes for any of the factors that impact the member. It is okay to select more than one check box. At least 1 check box must be selected. 11 NOTE: Users entering registration requests for Behavioral Assessments, Treatment Plan and Program Book Development must choose Other Psychosocial and Environmental Problems. When Other Psychological and Environmental Problems is selected, an open text field will open and require an entry. This text field should be used for the following: 1. Contact Name and Telephone Number of requestor. CT BHP ASD Clinical staff may have to outreach to the requestor directly for additional information. Please include phone extension, if applicable. 2. Requested level of care, time frame and units being requested (if not already outlined in the attached documentation). 3. For concurrent reviews: Which assessment tools are being utilized? Why now? What has driven the need for reassessment? 12 The next section is named Functional Assessment. Users are not required to enter any information in this section as it is optional. 13 Click Next at bottom of page 17

18 Completing a Registration Request for Behavioral Assessments, Treatment Plan and Program Book Development, cont. Key Step 5: Entering Requested Services Once the Next button is clicked, the Requested Services Screen will display. The Requested Services Screen allows ASD providers to enter a listing of the services and modifiers that they are requesting in this registration. Below are the key actions for completing this step Step Action 1 Click on the Click Here to Add or Modify Service Codes 2 Choose the service or services that are being requested H0031 is for ABA Behavioral Assessments H0032 TS is for APB Treatment Plan/Program Book Development 3 Click Save 4 Click Submit at bottom of screen. 18

19 Completing a Registration Request for Behavioral Assessments, Treatment Plan and Program Book Development, cont. Key Step 6: Submit Request and Confirm Submission Once the Submit button is clicked, the submission screen will display. Behavioral Assessments, Treatment Plan and Program Book Development, requests will be pended to the CT BHP ASD Clinical Team for review. Pended Requests Step Action 1 Confirm submission of request. o Status will indicate Pended at the top of the screen with a message indicating that the request requires further review. The Results screen provides a summary of information about the request as well as the CT BHP authorization number (U0######). 2 Print the request. Click the Print Authorization Result button to print a copy of the Results page. Click the Print Authorization Request button to print a copy of all the screens/fields completed for the request, including the clinical screens and the Results page. 3 Download the request. Click the Download Authorization Request button to save a copy of the request either in pdf format or xml. NOTE: THIS WILL BE THE ONLY OPPORTUNITY FOR PROVIDERS TO DOWNLOAD and save/print a copy of the authorization request. 4 Exit the Request for Authorization function. Click the Return to Provider Home to exit the Request for Authorization function. 5 Users may proceed with another menu function on the ProviderConnect homepage or log out of the system. 19

20 Appendix A: Documentation Templates Behavioral Assessments, Treatment Plan and Program Book Development 20

21 HAPPY KIDS AND FAMILIES ORGANIZATION 123 Play Street Wonderful, CT Member Name Wonder Kid Member DOB Member ID DATE OF REQUEST Name of clinician and license (LCSW; BCBA; Ph.D) Service Type Code Hours/unit request Behavioral assessment/fba H0031 up to 10 hours for initial Treatment plan/bip H (can happen every 90 days) Program book H0032ts (up to 3 hours) can happen every 90 days Statement of purpose and what assessment tools you will be using during the assessment process Date range Signature 21

22 HAPPY KIDS AND FAMILIES ORGANIZATION 123 Play Street Wonderful, CT Member Name Super Child Member DOB Member ID DATE OF REQUEST Name of clinician and license (LCSW; BCBA; Ph.D) Service Type Code Hours/unit request Treatment plan/bip H (can happen every 90 days) Program book H0032ts (up to 3 hours) can happen every 90 days Clinical rationale for need at this time and date range needed. For example: Super Child has made significant behavioral growth and mastered several skill acquisition targets which is driving the need for updated treatment planning and program creation. 22

23 ABC ASD Group Practice 123 High Street Hometown, CT Name of Client DOB Address Clinician Overseeing Case Anita Services 05/05/ Service Way Nice, CT Oh Susana, BCBA Background Information: Anita has a current diagnosis of Autism given by Dr. Diagnosis on March 3th, Anita has had a history of significant behavioral concerns that include, but are not limited to, noncompliance, limited attending, repetitive behaviors, and aggression on a daily basis. Anita demonstrates a history of aggression across all settings that includes, but is not limited to pushing, pulling hair, and pinching. Anita demonstrates a history of noncompliant behaviors, and has difficulty following more than a one-step direction. Anita demonstrates repetitive behaviors such as hand flapping when excited or bored. Anita communicates using one word phrases Anita demonstrates limited social skills that included, but are not limited to eye contact, shared enjoyment, imitation, joint attention, functional play, and restricted and repetitive play behaviors based on results from a recent ADOS. Assessment Request: 10 hours of time for a comprehensive FBA- using components of the VB-MAPP, and Vineland, as well as file review, parent interview, and direct observation. An additional 1 unit to create a behavior intervention plan, as well as 3 units for program book. Service Type Code Hours/units requested Behavioral H Assessment/FBA Treatment H Plan/BIP Program book H0032- TS 3 Proposed Date of Completion: January 16 th,

24 Concurrent Review Request Template ABC ASD Group Practice 123 High Street Hometown, CT Name of Client DOB Address Clinician Overseeing Case Anita Services 05/05/ Service Way Nice, CT Oh Susana, BCBA Background Information: Anita has been receiving services since January 18 th, 2018 Services have been delivered by a technician for 10 hours per week, with 1 hour Observation and Direction by BCBA, and 1 hour per week direct by BCBA. Assessment Request: 2 hours of time for an update to the VB-MAPP are requested at this time as Anita has mastered many of the Level 1 objectives. An additional 1 unit to update her behavior intervention plan, as well as 3 units for updates to the program book. Service Type Code Hours/units requested Behavioral H Assessment/FBA Treatment H Plan/BIP Program book H0032- TS 3 24