*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 - LBHPs 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 LBHP/Groups – CDC 27 – Testing – New Data Elements – Types of Authorizations, Length of Time, Dollars/Units Rules for submission, back dating Exceptional Case, Modification & Corrections – Fax forms Letters of Coll/Term – Not needed until 3/1/2013 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 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. Providers are able to view grandfathered PAs. 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

LBHPs If LBHP Under Supervision, report the CDC/PA under the supervising LBHP. In PICIS, all LBHPs should be set up under their own name, except for those under supervision.

LBHP Authorizations Testing (contact CDC 27s) – PG028, PG029, PG013 Initial Treatment (admission CDC 23s) – PG026, PG030 Treatment Extensions (extension CDC 42s) – PG027, PG040

AdultChild Authorization TypePAgroupUnitsCap length Insure Oklahoma - LBHP Initial TreatmentPG month Insure Oklahoma - LBHP Initial ExtensionsPG month Insure Oklahoma - Psych TestingPG month LBHP TestingPG month LBHP Initial TreatmentPG month LBHP Additional TreatmentPG month LBHP CALOCUS, Brief Intervention, & ReferralPG month

New Data Elements

Example of Grandfathered PA

CDC 27 - Testing Instant PA – All that is needed is the 27, service focus ’01’ – If 27 is complete, DMH will give you the appropriate testing authorization For Medicaid customers – PG029 will be created For Insure OK customers – PG028 will be created CALOCUS

CDC 23 – Initial Treatment Provider will do the full admission (23) – Provider will request the appropriate authorization from below – Providers will still be able to back date the initial treatment 30 days; however, payment will not be allowed until CDC is accepted and PA sent to HP For Medicaid customers – PG030 For Insure OK customers – PG026

CDC 42 – Treatment Extension Provider will do CDC 42 – Provider will request the appropriate authorization from below For Medicaid customers – PG040 For Insure OK customers – PG027

Exceptional Case, Corrections & Modification Step 1: Get authorization Step 2: Fax form to request change

LBHP: Corrections Request 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. – PICIS Helpdesk staff will review correction request.

Letters of Collaboration (LOC) Letters of Termination (LOT) LOC/LOT do not need to be reported until 3/1/2013. This will allow providers time to get used to the new authorization process and allow ODMHSAS an opportunity to improve reporting options.

Important Dates – Grandfathered PA are ready to view – Authorization Process begin 1/15/2013 – Back dating end for agencies for 2/17/2013 – Letters of Collaboration/Termination begin 3/1/2013 – 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.