Please dial # *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 or

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

List of Instant Auths, Caps and Length AuthorizationPA GroupunitsAdult capChild capLength Prison Related ServicesDH months Recovery ServicesDH months Non-DMHSAS/Non-OHCA FundedDH months SA DetoxDH50588 days SA Halfway HouseDH months Residential TreatmentDH months Day SchoolDH months Community-based Structured Crisis CareDH days Housing ServicesDH months Mental Health InpatientDH days Mobile CrisisDH months Long-term Mental Health InpatientDH months DMH Medication Clinic Services OnlyDH months

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 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

Who to contact? PICIS Helpdesk or 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.