Behavioral Health Updates

Beacon Health Options of Pennsylvania – Reminder Regarding Reimbursement for Greene County HealthChoices Members

Greene County’s contract with Beacon Health Options of Pennsylvania (Beacon-PA) ended December 31, 2021. Beacon-PA established January 1, 2022 – June 30, 2022 as the claims run-out period. Timely Filing Requirements have continued to apply through the clams run-out period.

Beacon-PA has been sensitive to the fact that other primary insurances are often slow to pay or reject claims and the provider has little control over that. Therefore Beacon-PA has and will continue to pay secondary claims and claims requiring adjustments until June 30, 2022 as long as the explanation of benefits (EOB) and/or payment summary voucher is dated within the ninety (90) day timely filing limits. This is a reminder that all claims submissions must be received by June 30, 2022.

Should you have any questions regarding this notice, please contact your Provider Field Coordinator through our toll-free Provider Line at 877-615-8503.

Beacon Health Options of Pennsylvania – Mental Health Outpatient Services Serving Lawrence County HealthChoices Members within the School Setting of Head Start Program Request for Proposals (RFP)

Deadline for submissions is Noon, Friday, June 24, 2022. Please view the RFP in its entirety here: Lawrence County MH OP

Submissions: Email a completed copy of the signed RFP to: RFP-RFI4BeaconPA@beaconhealthoptions.com. Please type the title of the RFP and your organization’s name in the subject line.

Beacon Health Options of Pennsylvania – IBHS: Non-ABA Group Services Serving HealthChoices Child/Adolescent Members of Crawford, Mercer and Venango Counties Request for Proposals (RFP)

Deadline for submissions is 4:00 p.m., Thursday, June 16, 2022. Please view the RFP in its entirety here: IBHS: Non-ABA Group Services

Submissions: Email a completed copy of the signed RFP to: RFP-RFI4BeaconPA@beaconhealthoptions.com. Please type the title of the RFP and your organization’s name in the subject line.

Beacon Health Options of Pennsylvania – Open Network Armstrong and Indiana Counties

The following levels of care opened for Armstrong and Indiana Counties effective April 4, 2022: LSW, LCSW, LMFT.

Providers interested in joining the Beacon-PA HealthChoices network for these services, or any of the services listed on our Currently Open Network Service page, may contact their Provider Field Coordinator.

Community Care Behavioral Health (CCBH) – Provider Alert #9: Provider Requirements for Appointment Access

Click here to read corresponding Provider Alert regarding requirements related to member accessibility to care, as well as providers’ contractual obligation to notify Community Care when they are unable to accept new members or meet the required timeframes for initiating services.

Community Care Behavioral Health(CCBH) – Provider Alert #11: Provider Billing Tax Identification Number Reporting

Click here to read corresponding Provider Alert regarding the Federal “Transparency in
Coverage” rule (85 FR 72158) which requires the UPMC Health Plan to publish machine-readable files containing provider information, including the billing tax identification number for each provider. This may be either a Social Security Number (SSN) or a Federal Employer Identification Number (EIN). As of July 1, 2022, UPMC Health Plans machine-readable files will reflect the billing tax ID that is on file with Community Care.

To protect providers’ privacy, Community Care strongly encourages all providers currently billing under their Social Security Number to obtain an EIN and update their provider profile with Community Care no later than June 1, 2022.

For those providers also participating in a Community Care HealthChoices network(s), changing your billing tax ID will also require obtaining a group PROMISe enrollment for the new EIN. When completing the application for the new group enrollment you will need to ensure that you also assign your existing
individual PROMISe enrollment to the new group enrollment being requested.

Community Care Behavioral Health (CCBH) – Provider Alert #12: Community Care’s ePortal Introduces Member Services Enhancements

Click here to read corresponding Provider Alert regarding ePortal upgrades that will enhance the user experience for member related features, including authorization requests, significant member incidents (SMI) and Performance Outcomes Management System (POMS) reporting, and authorization history search.

Community Care Behavioral Health (CCBH) – Provider Alert #13: American Society of Addiction Medicine (ASAM) 2.1 Intensive Outpatient Program Performance Standards

Click here to read corresponding Provider Alert regarding new performance standards for ASAM 2.1 Intensive Outpatient Program.

Magellan – Provider Notice: Public Health Emergency (PHE) and Medical Assistance

Click here to read corresponding Provider Notice regarding preparation for the eventual end of the Public Health Emergency and resources available to keep you updated as there is not end date as of yet.

PerformCare – Updates for Substance Use Providers

PerformCare issued the following notices for Substance Use providers:

• SU 22 102: ASAM Minimum Rates Implementation (PDF)
  PerformCare’s system is updated with ASAM minimum rates in place for all levels of care. Effective May 18, 2022, PerformCare can accept corrected claims from any provider that needs to resubmit claims at the ASAM minimum rate for any service on or after January 1, 2022, if the provider previously submitted claims with a rate below the ASAM minimum rate.
• SU 22 103: Change in SU Partial Hospitalization Unit Definition (PDF)
  Beginning July 1, 2022, PerformCare will implement a change in the procedure code and the unit definition for Substance Use Partial Hospitalization (PHP) from the current one-hour unit to a 15-minute unit.

Access these and other notices on PerformCare’s website.

PerformCare – Reminder: Members’ Rights and Responsibilities

Annually, PerformCare reminds providers that members have certain rights and responsibilities. These can be found on the PerformCare website and in the provider manual. The most recent provider manual is available in the Provider section of PerfformCare’s website.

PerformCare – Resource: Clinical Practice Guidelines

PerformCare would like to remind providers that 11 clinical practice guidelines (CPGs) are available for provider review. The CPGs were readopted by the Provider Advisory Committee on March 1, 2022.

PerformCare – 2021 Quality Improvement Program Executive Summary

The 2021 executive summary for the Quality Improvement program is now available online:

• 2021 Executive Summary ― Providers (PDF)

Learn more about the Quality Improvement program in the Providers section of PerformCare’s website.

PerformCare – You’re Invited: Claims Training on June 21

PerformCare is excited to announce we are offering a training on our claims submission process in partnership with Change Healthcare. During the Claims Training (PDF) webinar on Tuesday, June 21, 2022, Change Healthcare will review their claims submission platform, touching on various topics including account setup and submitting electronic (primary and secondary) claims.

PerformCare network providers and their staff who process or submit claims are invited to join either of our two sessions offered via Zoom:

• Morning session: 10 a.m. – 12:30 p.m.
• Afternoon session: 1:30 p.m. – 4 p.m.

Register online by June 14.

If you have any questions regarding the training, please feel free to include those in your online registration or email Jennifer Temple at jtemple@amerihealthcaritas.com.

Community Behavioral Health (CBH) – Provider Bulletin 22-12: Journey of Hope Program American Society of Addiction Medicine (ASAM) Alignment

This Bulletin is to inform Providers about CBH making contractual changes for Journey of Hope programs to reflect the new PROMISe enrollment for ASAM 3.5 (Clinically Managed High-Intensity Residential Services).

Community Behavioral Health (CBH) – Provider Bulletin 22-13: American Society of Addiction Medicine (ASAM) 3.5 and 3.7 Utilization Review Parameters

This Bulletin is to inform Providers about the utilization review parameters for ASAM 3.5 and 3.7 levels of care.

Community Behavioral Health (CBH) – Provider Bulletin 22-14: Documentation Standards for Mental Health Outpatient Providers

This Bulletin is to inform Providers about the standards CBH Compliance audit teams will use to determine if sufficient care has been documented to substantiate billing and/or payment for mental health outpatient services.

Community Behavioral Health (CBH) – Provider Bulletin 22-15: Documentation Standards for Group Services

This Bulletin is to inform Providers about expectations around the documentation of group services in CBH Members’ clinical charts. 

Community Behavioral Health (CBH) – Data Governance Software Solution Request For Proposal (RFP)

CBH is seeking a vendor to implement a Software as a Service (SaaS) Metadata Management (MM) solution to support its data governance program. Click HERE to view the RFP.