This unique network connects you with provider partners like texas health resources, ut southwestern medical. Provider manuals provider manuals these manuals are official publications of the virginia department of medical assistance services dmas and their contents are to the extent appropriate incorporated by reference into participation agreements signed by providers enrolled in the virginia medicaid program. For behavioral health providers as of december 1, 2015, aetna better health of louisiana will be offering behavioral health services to all our members. You received a letter from us informing you cigna healthsprings behavioral health provider network management will be integrated with cigna behavioral health effective 61 2015. At aetna better health, were committed to providing accessible, high quality service to our members in west virginia.
The provider manual gives you easy access to information about a wide variety of topics, ranging from how to file a claim, which services are covered for aetna better health members, to grievance and appeals processes. This manual has information about our specialty programs and clinical practice guidelines, along with information on. Publications and resources humana behavioral health. The content of a clean claim is set forth in appendix u to this provider manual. Provider manual health plan contra costa health services. The pcp and behavioral health provider are asked to share pertinent history and test results within 24 hours of receipt of results in urgent or emergent cases, and notification within 10 business. Siu coordinator po box 569150 dallas, tx 753569150. This guide is intended to be used for quick reference and may not contain all of the necessary information. The primary care physician refers patients, as clinically indicated, to the behavioral health clinician. The community behavioral health provider manual is updated quarterly throughout each state fiscal year and is posted one month prior to the effective date.
Preenrollment flyer sent to 119,668 households that certified community behavioral health clinic cchbc july 1. Coordination between behavioral health and physical health services. We hope you find this information and the enclosed documents useful to your office operation and in serving your patients our members. Behavioral health provider manual april 2016 page 2 introduction our company kepro is a qiolike entity designated by the centers for medicare and medicaid services. The behavioral health clinician maintains a problemsolution focus and sees patients for up to three sessions within the primary care setting. There is no cost for ohio medicaid providers to practice icd10 coding in collabt. Chipas clinical practice guidelines help ensure quality care for our members. Aetna better health of new jersey publishes provider notices containing uptotheminute information you may need to know from our regulators, new codingclaims processing rules, or any other new plan information.
You can print a copy to keep handy, or bookmark this page on your computer. The provider manual is an essential resource for all of our providers. Starting december 1, 2015, aetna better health of louisiana will cover specialized behavioral health services which include mental health and substance use treatment. Different members may be covered for different services. While there are differences with the onboarding journey for other types of providers, this video serves as a guideline.
Print a copy to keep handy, or bookmark this page on. Please refer to the covid19 alerts and updates page for specific changes and updates. To select a capitated provider, pcps should call our provider service center at. Community provider manuals georgia department of behavioral. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. The policies and procedures referenced herein are subject to change as federal or state. Aetna and its affiliates provide certain management services for innovation health. Refer to the rural health clinics rhcs and federally qualified health centers fqhcs section in this manual for general billing inform. Providers are required to notify aetna better health of louisiana when a member has suffered an adverse incident. And we greatly appreciate all our practitioners and providers efforts in helping us achieve that goal. Behavioral health providers are required to adhere to standard appointment. Providers must ensure services are delivered in accordance with the medicaid service provider manual and any. This manual will provide you with information about molina and will describe how we will work together as you care for your patients health care needs. Updates and changes to this manual will be forwarded to your office as they become available.
You can also report directly to aetna better health any providers or clients you suspect of waste, abuse or fraud. This manual serves as a resource to practitionersproviders and outlines operations for aetna better health of west virginia. Behavioral health is defined as both acute and chronic psychiatric and substance use disorders as referenced in the most recent diagnostic and statistical manual of mental disorders dsm of the american psychiatric association. With aetna providing certain management services for innovation health plan, your innovation health patients now have access to the following aetna programs.
Aetna medicaid has been a leader in medicaid managed care since 1986 and currently serves just over 3 million individuals. With ambetter, you can rely on the services and support that you need to deliver the best quality of patient care. Npn manages behavioral health authorizations and adjudicates claims for humana. All medicaid members now get their behavioral health services through a health plan. This manual is a resource for working with our ohio health plans. Provider newsletter aetna better health of missouri. The behavioral health clinician communicates on a regular basis with the primary care physician and provides written reports. Mho3171 bh managed care resource document molina health.
Parkland community health plan provider manual aetna. Magellan behavioral health providers of texas, inc. As an aetna better health of california provider, there are certain procedures and protocols you need to know. Medicaid behavioral health provider resources louisiana. Refer to the list below to contact the office in the members county. Ste b jeferson city, mo 65109 10991 nw airworld dr. Well give you valuable tools to help you work with us and provide highquality service to our members. Behavioral health bh managed care organizations mco in each county. As an aetna better health of louisiana provider, there are certain procedures and protocols you need to know. Integrated primary care behavioral health program aetna. The intent of the service provider manual is to present useful information and guidance to providers participating in the louisiana medicaid program. If a member elects to use amwell for virtual behavioral health services, the members benefit plan must have both the. If you are a licensed behavioral health professional and are interested in joining our provider network, please contact provider relations at 8007793825, then follow the prompts to the appropriate department.
In order to meet the behavioral health needs of our members, aetna better health of new jersey will provide a continuum of services to members at risk of or suffering from mental, addictive, or other behavioral disorders. As an aetna better health of new jersey provider, there are certain procedures and protocols you need to know. Top sites aetna aba provider application 2019 latest. There has been an amendment to the provider manual by the department of medical assistance services dmas. Parkland community health plan provider manual september 2015 2777 stemmons freeway, suite 1750 dallas, tx 75207. Due to the world health organization declaring coronavirus disease covid19 a pandemic, the west virginia bureau for medical services bms has expanded certain services and waived certain requirements that may be listed in the medicaid provider manual. Providers must ensure services are delivered in accordance with the medicaid service provider manual and any other authorities in effect on the date of service.
Chapter1 welcome to aetna better health of west virginia werepleased that youre part of our network. Health information programs provide general health information and are not a substitute for diagnosis. All discontinued manuals no longer contain active information and are strictly available for historical purposes. Good communication among our providers and our plan administrators is key to the delivery of quality health care services. The transition to icd10 on october 1, 2015 is required for everyone covered by the health insurance portability accountability act hipaa. Aetna behavioral health behavioral health providers by town test provider type. Questions, problems, or concerns that the manual doesnt fully. Dbhdd publishes its expectations, requirements, and standards for community providers via policies and the respective behavioral health or developmental disabilities provider manuals. Providers who meet aetna s eligibility requirements should watch for a caqh registration package via u. Our behavioral health programs focus on the important role of mental health on a persons overall wellbeing. Provider manual, in turn, is referenced in the cbh provider agreement and serves as. The electronic medicaid provider manual contains coverage, billing, and reimbursement policies for medicaid, healthy michigan plan, childrens special health care services, maternity outpatient medical services moms, and other healthcare programs administered by the michigan department of health and human services mdhhs. In 2015, aetna better health sm will begin serving the community in three service regions in the state of michigan. Plans and programs for aetna medicare advantage plans participating physicians, hospitals and other health care providers are independent contractors.
Evening appointment availability, family therapy, group therapy, home visits, play therapy. Refer to the june 2015 provider newsletter in the provider news section of our public website. Your partnership helps us create powerful care solutions, and our network team is always ready to join forces on new, innovative approaches to care. We invite all interested behavioral health providers to join our network. Mental health resources from aetna behavioral health. Both current and discontinued manuals have historical versions available. The manual is divided into two major components, a general information and administration chapter and individual program chapters. Enrollees who receive all their physical and behavioral health services from us. Overview of the pharmacy plan drug list formulary 42. Behavioral health care providers can contact staff during normal business hours 8 a. Information is shared between aetna better health of california behavioral health and medical providers to verify interactions with the member result in appropriate coordination between medical and behavioral health care.
Health benefits and health insurance plans contain exclusions and limitations. Coronavirus covid19 what you need to know about the coronavirus. For more information on aetna better health fraud, waste, and abuse program, refer to the provider manual. At aetna better health of louisiana, we value our provider partners. Behavioral health services quick facts and phone guide. Blue premier and myblue health provider manual behavioral health services. Behavioral health services quick facts and phone guide as a global health service company, cigna aligned with healthspring in 2012 to assist the growing market of americans, aged 65 and older, transition from career into retirement. The total health care provider manual is a resource to assist providers and staff in understanding the network structure, products and the policies and procedures of the plan. The manuals are updated quarterly throughout each fiscal year july june, and are posted one month prior to the effective date.
Aetna is the brand name used for products and services provided by one or more of the aetna group of subsidiary companies, including aetna life insurance company and its affiliates aetna. Aetna premier care network aetna premier care network plus provider guide behavioral health provider manual this manual has information about our specialty programs and clinical practice guidelines, along with information on credentialing. To see a complete list of behavioral health services requiring precertification, view our list online. Through the manual, practitioners and providers should be able to identify information on the majority of issues that may affect working with aetna better health. We want to work with you to provide timely, safe and effective health care to our members. Parkland chip covered persons can also selfrefer to a participating behavioral health specialist by calling the vendor listed on appendix a of this provider manual. Information is believed to be accurate as of the production date. Virtual behavioral health services are subject to member cost sharing in accordance with their. Provider manuals for fy 2020 fy 2020 provider manual for community behavioral. Aetna better health of new jersey opened in 2015 and is currently active in all 21 counties.
We created this health care professional office manual for our participating physicians. Fall 2015 volume 10, issue 2 aetna behavioral update your. Learn about provider education and manuals from aetna to get more information on free cme courses and aetna policy guides. The medicare access and chip reauthorization act of 2015. Aetna behavioral health behavioral health providers by town. County bh mcophone number adams community care behavioral health 18667389849. If you do not have medicare coverage in addition to health net access, your behavioral health service provider will still be mercy maricopa integrated care. Dec 6, 2016 october 28, 2016 aetna better health of missouri submitted a protest to the office stakeholders. For over 50 years, mhbp has served all federal and postal employees and annuitants, offering comprehensive benefits at affordable rates.
Managed care update missouri department of social services. Appendix l behavioral health mental health substance abuse. Youll find most of the information you need in the provider manual. Learn more about our health plans, behavioral health services and virtual care app. By collaborating with providers like you, we improve access to quality behavioral healthcare and encourage wholeperson health for our members. Beginning october 1, 2015 if you have medicare coverage in addition to health net access dual coverage, your behavioral health service provider will be health net access. The incident must be addressed within 24 hours of the occurrence involving a health plan member, whether it occurs at the provider s location or at another location. Aetna officelink updates all regions katz brunner healthcare. Behavioral health appointment waiting times behavioral health providers are required to adhere to standard appointment wait times, regardless of provider type. Aetna offers health insurance, as well as dental, vision and other plans, to meet the needs of individuals and families, employers, health care providers and insurance agentsbrokers. Mhbp, formerly known as the mail handlers benefit plan is a worldwide health plan backed by the strength of the aetna network. Behavioral health services are covered for members who are clients of the division of developmental disabilities ddd.
Please refer to health plan provider manuals for specific policies and procedures. Magellan provides and coordinates all behavioral health care and services for blue cross and blue shield of texas bcbstx plan members. At humana caresource, we call healthcare providers our health partners. The manual is divided into two major components, a general information and administration chapter. Youll learn which services are covered for our members.
John carpenter freeway, irving, texas 75063 by nov. Premier plan is a health plan that contracts with the state of michigan to provide benefits to people 21 and over who qualify for both medicaid and medicare. Community behavioral health hereinafter, cbh became the third operating arm of what later referred to as the philadelphia behavioral health system hereinafter, bhs alongside the county office of mental. Through the provider handbook, providers should be able to identify information on the majority of issues that may affect working with aetna better health. If services are not available through an innetwork ohio state provider, students will use the aetna network. Behavioral health provider forms aetna better health of louisiana will accept your behavioral health assessments, locus score sheet, plan of care documentation, if appropriate, in whatever format you choose to use for your convenience, we are adding the bayou health behavioral health assessment to our website our prior authorization. Provider manual this behavioral health provider manual, the eap manual of care residential treatment, partial hospital and intensive. Failure to include icd10 codes on claims filed on or after oct. Community mercy health partners, catholic health partners, mercy health. This manual is an extension of your contract with us. Meritain health covid19 resources we support you in maintaining health and ensuring access to care. The aetna better health of louisiana provider manual is available in hard copy form or on cdrom at. The pcp and behavioral health provider are asked to share pertinent history and test results within 24 hours of receipt of results in urgent or emergent cases, and notification within 10 business days of receipts of results for nonurgent or nonemergent lab results.
For detailed information, refer to the provider manual. The example in this section is to help providers bill rural health clinics rhcs and federally qualified health centers fqhcs services on the ub04 claim form. This provider handbook services as a resource and outlines operations for aetna better healths integrated care program and our aetna better health premier plan program. Community behavioral health provider manuals from previous fiscal years. Aetna careunify is a population health management system for healthcare providers and health plan resources to connect and manage patients continuity of care through multiple care settings. Jun 16, 2017 the provider manual is an essential resource for all of our providers. The combination of kepro and aps healthcare in 2015 created an organization with unequaled experience with utilization management and prior authorization across. It is important that you fax the incident report to. Parents of parkland chip perinate newborn covered persons should call covered person services at 18888142352 and ask for the medical management department for assistance. Objections to the revised provider manual must be in writing and sent to humana behavioral health, attn. Aetna behavioral health optumhealth behavioral solutions anthem blue cross provider manual edi.
Access to behavioral health services that includes a dedicated hotline and crisis intervention. The provider manuals page is divided into two sections. Aetna medicaid affiliates currently own, administer or support medicaid programs in 15 states. Ncqa has added an additional standard, which is the care for nonlife threatening emergency appointment, which is within six 6 hours of the request.
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