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Florida AHCA BA Contract Introduction and Overview
Available Provider Trainings Behavior Plan Trends & Opportunities ProviderConnect: Behavior Documentation Process Tips for Writing a Behavior Analysis (BA) Assessment How to Register in ProviderConnect Q & A with the Clinical Director http://fl.beaconhealthoptions.com/provider/prv-training.html
Objectives Who is Beacon? Who is the Agency for Health Care Administration (AHCA)? Beacon and AHCA: Behavior Analysis (BA) Services ProviderConnect SM Registering in ProviderConnect Accessing ProviderConnect Verifying Recipient Eligibility* Submitting & Reviewing Authorizations Concurrent Requests Special Services Retrospective Reviews Questions 4
Who is Beacon? 5
Who We Are A health improvement company that specializes in mental and emotional wellbeing and recovery A mission-driven company singularly focused on behavioral health Largest privately-held behavioral health company in the nation 6
About Beacon Health Options Headquartered in Boston; more than 70 US locations 5,000 employees serving 50 million people 200 employer clients, including 41 Fortune 500 companies Partnerships with 80+ health plans Programs serving Medicaid recipients in 25 states and the District of Columbia Serving 8.5 million military personnel, federal civilians and their families Accreditation by both URAC and NCQA 7
Beacon Health Options Footprint 5,000 employees serving 50 million people LEADER IN QUALITY NCQA- and URAC- Accredited Companies KEY OPERATIONAL AREAS MEMBERSHIP CENTERS UM/CM QM IT Customer Service Data Analytics Reporting Processing Sales Support Over 2.5 Million 100,000 500,000 Corporate Headquarters LINES OF BUSINESS 1,000,000 2,500,000 500,000 1,000,000 Under 100,000 Regional Service Centers Corporate Operation Centers Engagement Centers Commercial EAP Exchange Federal Medicaid Medicare 8
Four Major Market Segments Commercial market featuring 200 local, regional and national employers (41 of America s Fortune 500 companies) as well as labor and trust funds Partnerships with 100 national and regional health plans covering Medicaid, Medicare, dual eligible, special needs and commercial populations State and local governments managing Medicaid populations and other publicly funded programs in 26 markets The Federal government, on behalf of the U.S. military, veterans, employees and their families 9
Who is the Agency for Health Care Administration (AHCA)? 10
Who is AHCA? The Agency for Health Care Administration (AHCA) is the single state agency responsible for operating the Florida Medicaid program Florida s Medicaid eligible population as of September 2016 was over 4 million 11
Beacon and AHCA: Behavior Analysis (BA) Services 12
Beacon & AHCA Behavior Analysis (BA) Services Behavior Analysis (BA) services are available to Florida Medicaid recipients under the age of 21 years requiring medically necessary BA services BA services provide highly structured interventions, strategies, and approaches designed to decrease maladaptive behaviors and increase or reinforce appropriate behaviors Eligible recipients (including those enrolled in health plans) will receive this service through the fee-for-service delivery system Florida Medicaid s current fiscal agent, DXC Technologies (formerly Hewlett Packard Enterprise (HPE)), will continue to be the payer of claims 13
Beacon & AHCA Behavior Analysis (BA) Services (cont d) Previous provision of applied behavior analysis (ABA) services for recipients with autism spectrum disorder as directed by the October 2015 Florida Medicaid Health Care Alerts through Community Behavioral Health, Early Intervention Services, and Developmental Disabilities Individual Waiver Services has been replaced by the new Behavior Analysis Services coverage policy effective October 2017. Community Behavioral Health What does this mean for recipients? Early Intervention Services Developmental Disabilities Home and Community Based Waiver Recipients previously receiving ABA services under the above referenced policies/programs will transition to receiving BA services. A copy of AHCA s Behavior Analysis Coverage Policy is available on the Agency s website. 14
Provider Type 39 Enrollment 15
Provider Type 39 Enrollment Providers must first be enrolled with AHCA as a Provider Type 39 with Florida Medicaid. Providers can then register for the online Beacon ProviderConnect system. Provider Type 39 Behavior Analysis (BA) service codes were activated by DXC Technologies (formerly HPE) on 3/1/17. Effective 5/15/17, submission of PA requests into ProviderConnect and a PA number IS required to pay for services. Beacon provides webinar trainings monthly training schedule posted on the website (http://fl.beaconhealthoptions.com). 16
How to Register for ProviderConnect 17
ProviderConnect ProviderConnect registration will occur in one of two ways: Manual by Beacon - Groups and individual practitioners enrolled with AHCA as Provider Type 39 must complete the online services account request form to request registration. Manual by Group Super User - All website users associated with a group will be registered by a Super User at your organization. 18
ProviderConnect Types of User Accounts: Super User A designation given to one or multiple administrators at an organization that have the ability to allow/disallow use of functions within ProviderConnect. This user also has the ability to create new user accounts for staff and disable accounts when necessary. Managed User A designation assigned by the Super User for staff members that will be using ProviderConnect. The user s ability to access functions on ProviderConnect is controlled by a Super User. Standard User A standard account created by Beacon for a user that is not controlled by an administrator. 19
ProviderConnect From the homepage http://fl.beaconhealthoptions.com/, click For Providers 20
ProviderConnect Registration Forms To access the Online Services Account Request Form, you must click the Register button as outlined below. The Online Services Account Request Form must be completed in it s entirety and sent to Beacon for processing. The username and password will be sent to the email address received on the form. 21
Managed Users (Super Users Only) 22
Managed Users Choose Manage Users from the left hand text bar 23
Managed Users Click the copy box from the right hand side and click OK in the warning box 24
Managed Users Enter all required fields noted with an asterisk and click Submit to generate the user account Note: The Super User is liable to provide the Managed User with their ID and password 25
Managed Users When creating new Managed User accounts for staff at your organization, use the following naming convention: Example: FLAUJS0001 User ID always begins with FLAU Staff initials: JS = John Smith Last four digits of Beacon Assigned ID; see Super User account When multiple staff members have the same initials, use first initial, and then follow with sequential numbers. The Super User is responsible for keeping track of Managed User IDs for their organization. 26
Managed Users Shown below is the newly created Managed User record 27
How to Access ProviderConnect 28
Accessing ProviderConnect If a provider is already registered for ProviderConnect as an AHCA BA provider, select Log In For assistance with your User ID and password, contact the: EDI Helpdesk 8 a.m. 6 p.m. ET, Monday through Friday Phone: 888-247-9311 Email: e-supportservices@beaconhealthoptions.com 29
Logging into ProviderConnect Enter your username and password and then click the Log In button 30
ProviderConnect 31
ProviderConnect 32
Verifying Recipient Eligibility 33
Checking Eligibility 34
Checking Eligibility 35
Checking Eligibility 36
Prior Authorizations 37
Covered Codes for Prior Authorizing BA Services Codes Descriptions H0031 BA Behavioral Assessment (per diem) H0032 BA Behavioral Reassessment (per diem) H2019 BA Behavior Analysis - Lead Analyst (quarter hour) H2012 BA H2014 BA Behavior Analysis - Assistant Behavior Analyst (quarter hour) Behavior Analysis Technician (quarter hour) H2014 BA GK Behavior Analysis Group (up to 6) (quarter hour) 38
Prior Authorizing BA Services BA services require prior authorization through Beacon An authorization letter will be generated to the recipient and the determination will be posted on ProviderConnect within one business day of the authorization being accepted into the DXC Technologies (formerly HPE) claims system The letter will contain the approved date range, procedure codes, authorized units of service, and Prior Authorization Number (PA#) that will be utilized to submit claims 39
To Enter an Authorization Request 40
Disclaimer 41
Search a Recipient 42
Recipient Information 43
Service Address 44
Selection of BA Assessment or BA Services 45
BA Assessment 46
BA Assessment Behavioral Diagnosis 47
BA Assessment Medical Diagnosis 48
BA Assessment Social Elements Impacting Diagnosis 49
BA Assessment Results 50
BA Services 51
BA Services 52
BA Services 53
BA Services Medical Diagnosis 54
BA Services Social Elements Impacting Diagnosis 55
BA Services 56
BA Services Current Impairments 57
BA Services Current Skills Impairments 58
BA Services Progress 59
BA Services BA Report 60
BA Services Results 61
Concurrent Requests
Concurrent Request 63
Concurrent Request Information from clinician 64
ProviderConnect TIP There is an option to click Save Request as Draft in case additional information or approval is needed before submitting to Beacon Indicate the authorized user if another department or supervisor needs to review the request Keep in mind, saved drafts are not automatically submitted to Beacon be sure to go back, complete the draft, and submit in a timely fashion NOTE: Attach all documents prior to submission as attachments do not save on drafts 65
Review an Authorization
Review an Authorization 67
Search Authorizations Recipient ID 68
Authorization Search Results Authorization letter can be accessed by clicking the paper icon Hyperlinked additional details specific to the recipient and authorization 69
Authorization Search Results Providers can submit an inquiry to Beacon utilizing the send inquiry function This functionality can be used for submitting special services requests or requesting additional units to an existing authorization that does not exceed the maximum benefit limits Recipient ID Recipient Name 70
Authorization Search Results Client Auth # will initially begin with a P this is not the number to use for claims payment Once DXC (formerly HPE) has accepted the auth for claims payment the Client Auth # will be updated to the number that is required for claims payment Recipient ID Recipient Name BA Services 71
Special Services 72
Special Services Request for services/hours that exceeds service-specific limits: More than one Behavior Assessment per fiscal year More than three Behavior Reassessments per fiscal year Services exceeding eight hours per day/40 hours per week of Lead Analyst, Assistant Behavior Analyst, Technician, and Group Lead Analyst will download the Multi-Specialty Services Authorization Request form from the AHCA BA Services website. The completed form will be submitted to Beacon for review. 73
Special Services Clinical Reviewer will review the case and reach out to the Lead Analyst if additional information is required. If there is a question of medical necessity being met, the Clinical Reviewer will review the case with a Florida licensed physician who will authorize the request or conduct a peer to peer evaluation. The approval letter will be generated to the recipient and the approval will be posted on ProviderConnect. If denied, a clinical denial letter will be sent to the recipient and the determination posted on ProviderConnect. If the Florida licensed physician cannot reach the Lead Analyst, a determination will be made based on the information available. 74
Retrospective Reviews 75
Retrospective Reviews Random retrospective chart audits will be conducted Charts should include: Order for BA treatment from a licensed physician Demographic information Releases of information Progress notes Treatment plans inclusive of goals and goal updates Evidence of supervision in cases involving BCaBA or technician/paraprofessionals Results will be shared with providers as part of quality improvement initiatives 76
Retrospective Reviews Assessment materials, including Beacon s BA Chart Review Tool located on the Provider Information Center 77
Contact Information 78
Contact Information Provider Customer Service (Utilization management and general question assistance) Monday through Friday, 8 a.m. 5 p.m. ET Phone: 866-827-7737 Or by email to Miami Provider Relations Email: Miami_Partners@beaconhealthoptions.com Beacon Health Options EDI Helpdesk (ProviderConnect Technical Questions) Monday through Friday, 8 a.m. 6 p.m. ET Phone: 888-247-9311 Email: e-supportservices@beaconhealthoptions.com 79
For provider questions, issues, or concerns: Ellen Livingston, Program Director Cell: 786-376-4690 Email: ellen.livingston@beaconthealthoptions.com Lauren DeBlasio, MPP, Central & North Florida Cell: 786-494-9271 Email: lauren.deblasio@beaconhealthoptions.com Michael Benvenuto, MPP, South Florida Cell: 786-216-9745 Email: Michael.benvenuto@beaconhealthoptions.com Monday through Friday, 8 a.m. 5 p.m. ET 80
Questions 81
Thank you 82