1. BH Integration into Medicaid Managed Care
Preparing for
BH Integration into Medicaid Managed Care
February 15, 2018

2. OAHP – Provider Outreach and Readiness Efforts
Preparations Leading to July 1
BH Collaborative – standardized PA form, proactive identification of provider challenges and solutions, created BH provider resource document*
Provider Communications – MITS BITS, EDI meetings, Trade Association newsletters
Rapid Response Team – individual plan claims monitoring & outreach augmented with all MCP meetings to determine opportunities for training and outreach.
Seven (7) Winter Regional Provider Forums
In-person opportunity for discussion of payment issues and contracting or credentialing questions
ODM Reporting
Testing Activity and Results
Prompt Pay/Denial Rate Reporting
Contracting/Credentialing status
*All provider resources can be found at:

3. OAHP – Transitions of Care and Prior Authorizations
MCPs must allow the member to continue with out-of-network providers for 3 months post carve-in.
To ensure continuity of care, MCPs will:
Work with the service provider to add the provider to their network;
Implement a single case agreement with the provider; and/or
Assist the member in finding a provider currently in the MCP’s network.
Prior Authorization
The MCP shall follow the Medicaid fee-for service (FFS) behavioral health coverage policies through June 30, The MCP may implement less restrictive policies than FFS. After one year, the MCP may conduct a medical necessity review pursuant to OAC rule
MCPs must honor PA approved by ODM through expiration of the authorization.

4. OAHP – Credentialing and Contracting – Provider Panel Requirements
The MCP contracting process can take up to 90 days. In instances when a contract is not established prior to July 1, 2018, transition of care requirements are in place for 3 months.
The plan may execute a single case agreement with the provider or the plan can suggest in- network providers.
ODM Provider Panel Requirements
Medicaid Managed Care Plans are required to contract with a total of:
238 Provider Type (PT) 84s
216 Provider Type (PT) 95s

5. OAHP – Credentialing and Contracting Data

6. Current Testing Opportunities
Contracting Information
Testing of claims begins again March 1st through June 30th at
Click here for a list of trading partners Buckeye works with ders/resources/electronic-transactions.html
Weekly Webinar opportunities on Tuesdays at 9:00AM and Thursdays at 12:00PM. RSVP at ders/behavioral-health.html
Allow 90 days for the contracting/credentialing process-please start now
Contact: ers/become-a-provider/join-our- network.html

7. CareSource is accepting test EDI files through our trading partners
Current Testing Opportunities
Contracting Information
Join us on Wednesdays from 3 to 4pm ET for instructions and status updates
CareSource is accepting test EDI files through our trading partners
Use the ODM Beta Testing Scenarios
Use active CS Members
Use DOS > January 1, 2018
Submit test EDI files before June
Complete the New Health Partner Contract our-network/
Allow 90-days for the contracting/credentialing process
Be prepared with the following materials:
W-9 tax form
CAQH ID number
Tax ID number
NPI number(s) for both Provider Type 84 and/or 95 related certifications
Questions/Concerns: Call CareSource’s Rapid Response Team

8. We work with all participating clearinghouse to submit EDI claims
Current Testing Opportunities
Contracting Information
Contact to obtain an intake form and testing guidance
We work with all participating clearinghouse to submit EDI claims
Webinar opportunities to be scheduled end of February
Testing is currently open
Allow 90 days for the contracting/credentialing process-please start now
Contact: Ellen Landingham at (614) or

9. Current Testing Opportunities Contracting Information
Contact to engage in claims testing
We work with all participating clearinghouse to submit EDI claims ments/provider/clearinghouse-list.pdf
Intensive provider consultation available upon request (prior/post testing)
Testing claims are currently being accepted and will remain open through July 1, 2018 BH Redesign Implementation
Allow 90 days for the contracting/credentialing process-please start now
Contact:

10. We work with all participating clearinghouse to submit EDI claims
Current Testing Opportunities
Contracting Information
Contact to get member assignments-begins now
We work with all participating clearinghouse to submit EDI claims
Three (3) live webinar opportunities scheduled: 2/19; 2/21; 2/23 with one recorded/posted end of Feb.
Testing Medicaid claims begins week of March 7th through June 30th
Allow 90 days for the contracting/credentialing process-please start now
Be prepared with the following materials:
W-9 tax form
Tax ID number
NPI number(s) for both Provider Type 84 and/or 95 related certifications
Contact: