IMPORTANT – Behavioral Health Managed Care Claims Testing for July 1, 2016 Implementation

Hi everyone – I went to a meeting on Friday and one of the lessons learned from the NYC transition is that you must TEST your claims processes with the plans before you go live.   EVEN IF YOU ARE CURRENTLY BILLING PLANS FOR OTHER SERVICES you must test your claims for the services going in or may not get paid.  Please look at these links and contact the plans so that you can TEST.

2016-6-1 Provider Claims Testing-MCO Billing Department Contact Info

2015-10-6 OMH ManagedCare Question Form

Of course, this has nothing to do with residential, which is not going into MC yet.  This is about clinic, PROS, ACT, CDT, IPRT,  etc.

It is THE Single most important take-away from the NYC transition.

From: OMH-Managed-Care <[email protected]>
Date: June 1, 2016 at 12:20:06 PM EDT To: OMH-Managed-Care <[email protected]>
Subject: Behavioral Health Managed Care Claims Testing for July 1, 2016 Implementation

To:      Behavioral Health Providers
From:  NYS Office of Mental Health NYS Office of Alcohol and Substance Abuse Services
Date:   June 1, 2016
Re:      Behavioral Health Managed Care Claims Testing for July 1, 2016 Implementation

The Medicaid behavioral health benefit transition and HARP implementation date for counties outside of New York City is July 1, 2016.  This is a major change for both health plans and providers.  Based on lessons learned during the NYC implementation, it is critical that providers prepare to test claims submissions with health plans.  While the plans and Managed Care Technical Assistance Center (MCTAC) have begun providing technical assistance to prepare providers for billing, testing your systems is an important step in the process of readiness for the transition to managed care.

It is very important that providers test their claiming and remittance system. During the NYC transition, a number of behavioral health providers did not test their systems and ran into significant challenges submitting claims to Managed Care Organizations.  While some providers may already be submitting clinic claims to MCOs, this does not mean claims for other behavioral health services will pass through properly.  Behavioral Health agencies should test claims for each type of behavioral health service provided.

Below is a list of the Plans with their direct billing department contact information.  Providers must proactively reach out to their contracted Plans to begin conversations around steps for testing.  If for any reason you are unable to reach the Plan for technical assistance with your claims submission process, please document your concern in the attached OMH Managed Care Question Form or the OASAS mailbox: [email protected].

Plan Name MCO Billing Department Contact Information
Affinity James Sweeney, VP Operations & Claims Phone: (718) 794-6875 Email: [email protected] James Robinson, AVP Claims (Beacon Health Options) Phone: 1(888) 249-0478 Email: [email protected]
AmidaCare Natacha Julien, AVP of Network Operations Beacon Health Options Phone: (781) 970-6671 Email: [email protected]
Blue Cross Blue Shield of Western NY John Godfrey Email: [email protected]
CDPHP [email protected]

BH Access Center at 1-888-320-9584

For any testing questions, the form directs providers to [email protected]

Crystal Run Michelle Reay, VP Operations Phone: (845) 703-3411 Email: [email protected]
Emblem Beacon Health Options:

To enroll in provider testing with Beacon Health Options, please call or email our EDI Help Desk at:

·         Phone: (888) 247-9311 (Available between the hours of 8 am – 6 pm eastern standard time)

·         Fax: (866) 698-6032

E-mail: [email protected]

Empire BCBS HealthPlus Amanda Haider

Phone: (212) 563-5570 x67061

Email: [email protected]

Excellus Teresa Linthicum

Quality Lead

315-671-6708

[email protected]

Fidelis [email protected]

This information is also available on our website at https://www.fideliscare.org/providers.aspx .

HealthFirst Kaleena Marie Colón Phone: (212) 209-6490 Email: [email protected]
Independent Health Association Beacon Health Options:

To enroll in provider testing with Beacon Health Options, please call or email our EDI Help Desk at:

·         Phone: (888) 247-9311 (Available between the hours of 8 am – 6 pm eastern standard time)

·         Fax: (866) 698-6032

E-mail: [email protected]

MVP Beacon Health Options

Phone: (888) 247-9311 (Available between the hours of 8 am – 6 pm eastern standard time)

Fax: (866) 698-6032

E-mail: [email protected]

TotalCare Beacon Health Options:

To enroll in provider testing with Beacon Health Options, please call or email our EDI Help Desk at:

·         Phone: (888) 247-9311 (Available between the hours of 8 am – 6 pm eastern standard time)

·         Fax: (866) 698-6032

E-mail: [email protected]

United Healthcare General Inquiries: (866) 362-3368 Elevated issues/concerns: Svetlana Kats, MBA Director, Provider Services for New York Phone: (212) 898-3182

Claims call center: (866) 362-3368

WellCare Milna Thomas Sr. Mgr. Network Management Phone: (917) 229-1984 Email:[email protected]
YourCare Provider Call Center: 1(888) 638-7149 Kimberly Hamer Phone: (585) 256-8437 Email: [email protected] Mario Macais Phone: (585) 256-8451 Email: [email protected] Beacon Health Options:

To enroll in provider testing with Beacon Health Options, please call or email our EDI Help Desk at:

·         Phone: (888) 247-9311 (Available between the hours of 8 am – 6 pm eastern standard time)

·         Fax: (866) 698-6032

E-mail: [email protected]

 

 

 

Office of Mental Health

44 Holland Avenue, Albany, New York 12229

(518) 474-6911|

 

www.omh.ny.gov

 

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