Please dial 405-521-4496
106802#
*6 to mute
DO NOT put this call on “HOLD”
Authorization of services is not a guarantee of payment.
The provider is responsible for ensuring that the eligibility,
medical necessity, procedural, coding, claims submission,
and all other state and federal requirements are met.
Should you be on this training?
• It depends how are you contracted with
OHCA/ODMHSAS
– LBHP/Group
• If you can do CDC 27 to get testing authorization
• You are not an Agency
– TXIX Agency, DMH CMHC/SA, State Op
• If you can do CDC 21 to get PG038
– DMH Specialty
• If you can get instant auths, like ResCare, Homeless
programs or Correction contracts
Outline – DMH Specialty
•
•
•
•
•
•
Current Process – CDC Only
– CDC coverage file will stop 3/31/2013
Grandfathered PA
– Modifications need to be made prior to 1/15/2013
– Any changes made on/after 1/15/2013 will require modification form
Instant Authorizations (DMH Only)
Exceptional Case, Modification & Corrections
– Fax forms
Important Dates
Contact Info – PICIS Helpdesk
Current Process – CDC Only
• For claims with
service dates
between 10/01/2011
and 1/14/2013, a
CDC must be on
submitted to
ODMHSAS to cover
claims.
Current Process – CDC Only
• Example:
– CDC 23 is submitted
with a transaction date
of 2/15/2012.
– Claims with service
dates of 2/15/2012 to
8/14/2012 will be
covered for payment.
– For outpatient
behavioral health, each
CDC covers six months
of service.
– It does not necessarily
follow the treatment
plan dates, but may.
Current Process – CDC Only
• This coverage
process is
accomplished by
ODMHSAS sending a
file to OHCA each
night.
Current Process – CDC Only
• However, ODMHSAS
will stop sending that
file on 3/31/2013.
Current Process – CDC Only
• What does that
mean?
• If you want service
paid which occurred
between 10/01/2011
and 1/14/2013, the
CDC to cover those
dates must be
submitted by
3/31/2013.
Current Process – CDC Only
• Please note, that after
2/17/2012, all the data
elements needed for
an authorization will
be required, regardless
of the CDC transaction
date.
• Ignore slide. We will
allow them to skip
diags for CDC dates
prior to 1/15/2013.
Current Process – CDC Only
• Summary:
– All CDCs to cover
services between
10/01/2011 and
1/14/2013 must be
submitted by
3/31/2013.
– There will be NO
possible way to get
services for those
dates covered after
3/31/2013.
Grandfathered PA
• Based on active CDCs
• Grandfathered PAs based on transaction date
• For 6 month PAs, extra 30 days added
– End the grandfathered PA early, if needed to match up to treatment plan
dates.
• Report is ready now.
• Can be modified until 1/14/2013. After that, same process to modify as
regular authorization.
• CDC 21/PG038 will be good for 12 months for transaction dates prior to
1/15/2013 (agencies only), as long as no other PA requested.
• Providers need to make sure authorization are appropriate.
– What could cause problems?
• Problems with Grandfathered PAs?
– Contact mareynolds@odmhsas.org or dmelton@odmhsas.org.
CDC 21 - PG038
• Coverage is for 90 days, but can be extended
up to one year, or until customer is admitted
– Same process as current extension
• Dollar Amounts:
– Adults: $483
– Children: $493
Instant Authorizations – DMH Only
• Instant authorizations do not require the
additional data elements for an authorization.
• Submit the CDC as you always have and an
authorization will be instantly created.
• PA tab will not be visible until you save the
CDC record.
Instant Auths – DMH Only
Level of Care
N/A
CI
CL
HA
OO
SC
SN
Transaction
Type
ServiceFocus
23, 40, or 42
01 - mental health
DH507
DH510
DH511
DH509
23, 40, or 42
02 - substance abuse
DH507
DH506
DH511
DH509
DH505
23, 40, or 42
03 - drug court
DH507
DH506
23, 40, or 42
06 - MH & SA
DH507
DH506
DH511
DH509
DH505
23, 40, or 42
09 - special populations
23, 40, or 42
11 - other
23, 40, or 42
13 - co-occurring
DH509
DH505
23, 40, or 42
23 - day school
DH508
23, 40, or 42
24 - med clinic only
DH517
DH504
DH504
21
26 - mobile crisis
23, 40, or 42
27 - long-term inpatient
23, 40, or 42
30 - State Operated Only
21
All service focuses EXCEPT 26
DH502
DH510
DH507
DH506
DH503
DH511
DH514 ***
DH516
DH504
PG038
DH504
DH504
DH504
Instant Auths – DMH Only
Level of Care
N/A
CI
CL
HA
OO
SC
SN
Transaction
Type
ServiceFocus
23, 40, or 42
01 - mental health
DH507
DH510
DH511
DH509
23, 40, or 42
02 - substance abuse
DH507
DH506
DH511
DH509
DH505
23, 40, or 42
03 - drug court
DH507
DH506
23, 40, or 42
06 - MH & SA
DH507
DH506
DH509
DH505
23, 40, or 42
09 - special populations
23, 40, or 42
11 - other
23, 40, or 42
13 - co-occurring
DH509
DH505
23, 40, or 42
23 - day school
23, 40, or 42
24 - med clinic only
DH504
DH504
21
26 - mobile crisis
23, 40, or 42
27 - long-term inpatient
23, 40, or 42
30 - State Operated Only
21
All service focuses EXCEPT 26
DH511
DH502
DH510
DH507
DH506
DH503
DH511
DH508
DH517
DH514 ***
DH516
DH504
DH504
DH504
PG038
Examples
Service Focus
ResCare
11
SA ResTx
02/03/06/13
SA Detox
02/06/13
Crisis Unit
01/02/06/13
Inpatient CMHC 01/02/06/13
Housing
01
SPTU
11
Homeless
11
Day School
23
Level of Care
CL
CI
SN
SC
HA
CL
OO
OO
OO
Authorization
DH510
DH506
DH505
DH509
DH511
DH510
DH503
DH503
DH508
DH504
List of Instant Auths, Caps and Length
Authorization
PA Group
units Adult cap Child cap
Length
Prison Related Services
DH502
9999
Recovery Services
DH503
Non-DMHSAS/Non-OHCA Funded
DH504
9999
6 months
SA Detox
DH505
8
8 days
SA Halfway House
DH506
9999
6 months
Residential Treatment
DH507
9999
6 months
Day School
DH508
9999
6 months
Community-based Structured Crisis Care
DH509
Housing Services
DH510
9999
6 months
Mental Health Inpatient
DH511
10
10 days
Mobile Crisis
DH514
9999
6 months
Long-term Mental Health Inpatient
DH516
9999
6 months
DMH Medication Clinic Services Only
DH517
9999
6 months
6 months
4186.00 4186.00 6 months
2364.00 2364.00
8 days
Instant Authorizations – DMH Only
• Additional Notes:
– CMHCs who want a housing and an outpatient
authorization at the same time, have to follow the
same process previously identified.
– Once the Instant Auth is accepted, the
authorization tab will show the dates covered and
the PA Number.
Exceptional Case, Corrections & Rehab
Request for Rehab (0-5 year olds)
• Step 1: Get authorization
• Step 2: Go to online form and request change
– Note: If online form is not available by 1/15/2013,
fax form will be available.
• Step 3: ODMHSAS will review and send email
response.
– A clinical reviewer will review Exceptional Case
and Rehab Request
– PICIS Helpdesk staff will review correction request.
Important Dates – DMH Specialty
–
–
–
–
Grandfathered PA should be ready to view by 12/17/2012
Authorization Process begin 1/15/2013
CDC Coverage ends 3/31/2013
FYI - Dates of Service
• 1/14/2013 and 1/15/2013 cannot be on the same claim
Other information
• Recording of webinars will be available at
http://www.odmhsas.org/arc.htm.
Who to contact?
PICIS Helpdesk
gethelp@odmhsas.org
521-6444 or 855-521-6444
Reminder:
Authorization of services is not a guarantee of payment. The
provider is responsible for ensuring that the eligibility,
medical necessity, procedural, coding, claims submission,
and all other state and federal requirements are met.