||Once we see that a consumer is getting up to almost the ten hours of therapy and we need to request reauthorization how far ahead of time can we submit that?
||You can submit it as far ahead of time as you feel comfortable being able to show that this service remains medically necessary.
||So if the initial process to get somebody reauthorized takes 7 business days and the appeal process can take up to 15 business days, it's realistic that we have to give ourselves 22 business days considering worst case scenario if someone is denied. Which is a month and a few days. So we'll be requesting authorization a little over a month in advance, correct?
||From the demo it seemed like you needed to have at least 3 Axis I and 3 Axis II diagnosis. Even if you only have a single Axis I diagnosis you must enter None for the other 5 fields. Can just one suffice?
||You must enter "no diagnosis" for any of these fields for which that applies.
||We here offer a service called Sparks. It's a 16 session treatment modality evidence-based for adolescents. It's kind of like DBT for adolescents and it's 16 sessions. If we already knew that we were going to put a client through that should I submit that request at the beginning or wait until closer to the tenth session?
You are welcome to submit it as early as you think you've got the documentation that shows that there's medical necessity for it and they're benefiting from it.
We do know that many of the evidence-based therapies are longer than ten sessions, and this information is being included in the training of the CCMs who will complete the authorizations.
||Will we have the option of submitting that ahead of time before we even started them in getting authorization for those 16 sessions?
Part of the authorization criteria is showing that they are benefiting from the treatment. So you might not want to submit before they have the first session, but once they are involved and you see and can document that they're benefiting from it you can certainly submit it and not wait until the eighth session for instance.
The other piece of that is you wouldn't be requesting the entire 16 hours either, since the first 10 do not require authorization.
||Can I request 10 hours of each modality of therapy counseling, or only 10 hours total.
||You don't have to request increments of 10 hours for the authorization. When you put in the number of hours that you're requesting to be authorized you want to request the number that you expect to provide.
|| Can we request a reauthorization for more than 10 hours of therapy and/or more than 200 hours of PSR if we believe that it is medically necessary for this consumer? That is, if we can provide clinical evidence/documentation to support the medical necessity of an additional 500 hours of PSR based on the progress demonstrated by the consumer over the first 200 hours allowed, would we be able to request for this much additional time? Or are we limited to only asking for 200 hours of PSR or 10 hours of therapy at a time?
||There is no set number of hours or units that can be requested at the time of authorization. The clinician should use their best judgment in estimating the number of hours necessary to obtain treatment goals for the individual.
||Since PSR and CSG services are combined for the determination of the 200 hour initial service provision, when we seek reauthorization do we need to individually request these services (with a separate line item and separate start/end date and number of units for each service) or can the form filled out on-line under "Services Requested" which says "Service Name:" list both PSR and CSG with a combined number of units for both?
||PSR and CSG are separate requests within ProviderConnect. The same supporting documents can be securely attached to both requests. However, if a provider is faxing the additional documentation and want it to be considered for both requests, this must be indicated (along with the Consumer RIN/Name) on the fax cover sheet.
||If a service is delivered in the community Therapy/Counseling,CSG) what site do we use as the site being authorized?
||You should use the site in which the clinician is based.
|| Is the L the only person that can do the authorization because we have a lot of clinicians that are masters level but are not Ls but they're supervised by Ls?
||On the Collaborative side of the authorization, the Clinical Care Managers must be Ls. There is no such requirement on the provider side for the clinician requesting the authorization.
||Okay so the clinician is a Q. They can submit this on their own then, a masters level Q?
||Yes. Some of the documents they'll be submitting of course per Rule 132 have to have the L signature, but as far as if an individual clinician is a Q and they're doing therapy certainly they can make that request, DMH just requires that the person reviewing the medical necessity be an L
||Can we talk to a collaborative case manager to make as sure as possible that it would be covered?
||What I would recommend is that you actually talk with your regional staff who can involve other people within the division if necessary. But that's really where you would take questions about specific programs. If after speaking with your contract manager, you determine that submitting an authorization request is what is the next step for you, and you are questioning the documents that you need to send, you can certainly contact a CCM for technical assistance regarding any documentation.
I guess I'm wondering if it would not be something to consider maybe some technical support kinds of things put into place with the clinical case managers initially in the first number of months that this program has started. So that everyone can expedite a process that can take 30 days, 15 days and 30 days for an appeal before a person can get services.
Maybe some kind of a technical support kind of component for initially for this program to kind of help the centers get up to speed and kind of figure out what we need to do to minimize those kinds of situations.
|Certainly the clinical care managers will provide technical assistance as needed.
It is important to note that DMH will continue to reimburse a provider for services during any period of time where there is a request for reconsideration or appeal.
Certainly what we hope is that the appeal process or the reconsideration process will be a very rare occurrence.
||On Page 35 of the slide the middle dot point says and the provider LPHA deems additional hours are medically necessary. Does that mean an LPHA has to be the one that asks for the additional hours, or does that mean you want LPHA signature, what does that mean?
||What that means is that an LPHA is always the person who according to Rule 132 is determining medical necessity. It does not mean that the LPHA is necessarily the actual treatment provider.
||So on yesterday's call it was indicated I don't think it was a final decision that if we electronically submitted the MHA and ITP we just needed one signature of the case manager. Does that have to be an LPHA for the authorization to be accepted?
||It was the electronic signature of the staff person. So if you're a person completing the treatment plan that your agency your plans are done online and there is an electronic signature on your treatment plan that's required when you submit it.
||And if it's not the LPHA is that okay? Will you accept that?
||For authorization purposes, yes.
||Is the start date the date of the last mental health assessment or the original, you know, start date, maybe they started in '08 but they've obviously had a new mental health assessment done more recently? So which would be the start date?
||The requested start date is actually the date you're seeking authorization for.
||There was another section that said that the date that the client started in treatment.
||Yes that would be the date they started in treatment.
If multiple people on our team are providing service to one person when you say provider specific that means any staff working at the agency location that you're referring to is that correct?
So within our team if one person submits the authorization but they happen to be out sick we have other people cover each other and we submit is that okay?
||Is there a limit to how many staff we can add to requests authorizations?
|| There is no limit on user names and passwords for staff at an agency.
||Logins - given the clinical nature of the authorizations we may need to provide additional logins to staff. Is there a way to limit these logins to specific portions of the system? Is there a maximum number of logins?
||There is no limit on user names and passwords for staff at an agency. There is no way to block other applications in Provider Connect. Claim submission requires a separate box to be checked on the paper form, so if the provider did not want the user to have access to this functionality, they would leave it blank.
Why is it that if we are required to fill in the client's diagnosis, LOCUS scores, Devereaux scores, Columbia Scale scores, etc. for a
registration, that we must re-enter all of this information every time we have to get an authorization? This will make additional "paper work" for clinicians, when they could be using this time to help the client. It seems like there could be a way to automatically fill in the information from the registration.
|The requirement to supply this information at the time of the authorization request is to ensure that the Clinical Care Manager making the authorization determination has the most up to date information on the individual receiving the service. Because functional scores are likely to change with treatment, the scores entered at the time services were initiated may not be reflective of an individual's current status.
||Multiple Sites. Authorizations are provided at specific sites. A question was raised what happens if a client shows up at another site? As a follow-up - sometimes we need to transfer our clinicians from one site to another and sometimes their open cases go with.
||They would submit the request under the primary service provision site, but as long as it is the same provider, they would not require a separate auth request for each service site.
||Will the Collaborative provide paper authorization forms for our staff to complete and send to our billing office for submission? This is currently in place for ACT and CST.3)
||Authorization requests must be done electronically through the same system all providers se to register individuals for DHS/DMH reimbursement.
|| combine PSR/CSG requests into a single form rather than having to do it twice
||A provider may request authorization for multiple services in one request, but must provide details for each requested service.
||Will an option for batch electronic submission of authorization requests be available? If agencies cannot submit authorizations via batch electronic submission, can some of the requested information be uploaded electronically without having to manually type it in via Provider Connect?
||We are interested in ways to streamline the process, and eliminate redundancies where possible, but there are also system limitations that we are dealing with.