An Overview of ProviderConnect. For Applied Behavior Analysis (ABA) Providers

Transcription

1 An Overview of ProviderConnect For Applied Behavior Analysis (ABA) Providers

2 ABA and ProviderConnect ProviderConnect is an easy-to-use online application that providers can use to complete everyday service requests. Providers have the ability to access information 24 hours a day, 7 days a week. Providers can use ProviderConnect to: Obtain information about member eligibility and benefit status Enter authorization/notification requests Search claims and authorizations View and print correspondence Access and update practice profiles Submit EDI claims and inquiries to the Beacon Customer Service Department Send messages to and receive messages from Beacon Attach documents 2

3 Covered Codes for Authorizing ABA Assessment and Services CPT Code Description Limitations Provider Assessment Services 0359T Comprehensive Assessment - Once per year - Daily Max: 1 unit - Initial Assessment ONLY BCBA-D/BCBA/LABA 0360T Assessment/Treatment Plan/*Re-Assessment--First 30 min - Daily Max: 1 unit BCBA-D/BCBA/LABA X X* 0361T Assessment/Treatment Plan/*Re-Assessment Addt l 30 min BCBA-D/BCBA/LABA X X* X Note: 0359T, 0360T/0361T may be authorized up to 8 hours for initial assessment 0360T/0361T may be authorized up to 3 hours for re-assessment* 0364T ABA Therapy First 30 min - Daily Max: 1 unit BCBA-D/BCBA/LABA BCaBA/RBT/BT 0365T ABA Therapy Addt l 30 min BCBA-D/BCBA/LABA BCaBA/RBT/BT 0366T ABA Therapy in a group First 30 min - Daily Max: 1 unit - Group limited to 2-8 participants BCBA-D/BCBA/LABA BCaBA/RBT/BT X X X 0367T ABA Therapy in a group --Addt l 30 min - Group limited to 2-8 participants BCBA-D/BCBA/LABA BCaBA/RBT/BT 0368T Supervision/*Parent Training First 30 min - Daily Max: 1 unit BCBA-D/BCBA/LABA/BCaBA* X X 0369T Supervision/*Parent Training Addt l 30 min BCBA-D/BCBA/LABA/BCaBA* X Note: 0368T/0369T used for supervision must be done with the child present by any of the following BCBA-D/BCBA/LABA 0368T/0369T used for parent training must be done with the child present by any of the following BCBA-D/BCBA/LABA/BCaBA* 0370T Parent Training with/without child present - Daily Max: 1 unit BCBA-D/BCBA/LABA/BCaBA X 0371T Group Parent training without child present - Daily Max: 1 unit - Group limited to 2-8 participants 0372T Social skills group - Daily Max: 1 unit - Group limited to 2-8 participants BCBA-D/BCBA/LABA Licensed Master Level /BCBA- D/BCBA/LABA/BCaBA X X 3

4 Covered Codes for Authorizing ABA Services for Severe Behavior Severe Behavior Codes CPT Code Service Description Limitation Provider Assessment Services 0362T Assessment/Treatment Plan (Severe Behavior) First 30 min - Daily Max: 1 unit Psychologist/BCBA-D/BCBA + 1 or more BCaBAs/RBTs/BTs X 0363T Assessment/Treatment Plan (Severe Behavior) Addt l 30 min Psychologist/BCBA-D/BCBA + 1 or more BCaBAs/RBTs/BTs X 0373T ABA Therapy/ Supervision and/or parent training; child is present (Severe Behavior) First 60 min -Daily Max: 1 unit Psychologist/BCBA-D/BCBA + 2 or more BCaBAs/RBTs/BTs X 0374T ABA Therapy/ Supervision and/or parent training; child is present (Severe Behavior) Addt l 30 min Psychologist/BCBA-D/BCBA + 2 or more BCaBAs/RBTs/BTs X 4

5 ProviderConnect Advantages 5

6 Services Verify member benefits and eligibility View and print forms Request and view authorizations Download and print authorization letters Submit claims and view status Access Provider Summary Vouchers (PSV) Submit updates to provider demographic information Submit credentialing applications Submit customer service inquiries Access ProviderConnect message center Disclaimer: Please note that ProviderConnect may look different and have different functionalities based on individual contract needs, therefore some functions may not be available or may look different for your specific contract. 6

7 Benefits Free and secure online application, available 24/7 Reduces the need to call for routine information Integrates with practice management software Decreases labor expenses, paper files, and postage Efficient processing allows for quicker payment Less risk of human error or mishandling Mobile device friendly Mac and Windows compatible INCREASED CONVENIENCE, DECREASED ADMINISTRATIVE PROCESSES 7

8 How to Access ProviderConnect SM 8

9 How to Access ProviderConnect 9

10 How to Access ProviderConnect Go to choose Providers and Beacon Health Options (formerly ValueOptions) Providers Click on ProviderConnect on the right side of the screen and choose the appropriate portal. 10

11 ProviderConnect SM Registration Providers register online with ProviderConnect SM In order to register, you will use your Beacon ID Number If you do not have a Beacon ID Number e-supportservices@beaconhealthoptions.com After submitting your online registration form, you will receive a ProviderConnect SM log-in with instructions so that you can begin using ProviderConnect SM ProviderConnect SM has three different types of user accounts Super User Facility/Group Administrator Managed User Staff account administered by Super User Standard User Staff account administered by Beacon Health Options 11

12 ProviderConnect SM Registration Forms Complete the Provider online services registration by completing all of the required fields. Please note that claims are managed directly by the plan, so you do not have to check off Claims Submission to be able to submit claims through ProviderConnect SM 12

13 Logging into ProviderConnect SM Enter your User ID and password and then click the Log In button 13

14 Logging into ProviderConnect SM Read the ProviderConnect Use Agreement and click I Agree to continue 14

15 Logging into ProviderConnect SM 15

16 Verifying Participant Eligibility 16

17 Checking Participant Eligibility 17

18 Checking Participant Eligibility Enter the participant s information that you are checking eligibility for and click the Search button 18

19 Authorizations 19

20 Authorizing ABA Services ABA services through Beacon require prior authorization as requested within ProviderConnect SM The authorization will contain the approved date range, procedure codes, and authorized units of service for that participant. 20

21 Entering an Authorization Request 21

22 Disclaimer Read the Disclaimer and click the Next button 22

23 Entering an Authorization Request Enter the participants information that you are requesting authorization for 23

24 Entering Authorization Request Ensure correct participant is identified Click Next 24

25 Release of Information 25

26 Service Address 26

27 Service Location 27

28 Selection of Assessment or Services Level of Service: Outpatient Community Based Type of Service: Mental Health Level of Care: Outpatient Type of Care Select ABA Assessment for initial assessment requests Select ABA Services for treatment requests 28

29 ABA ASSESSMENT REQUEST 29

30 ABA Assessment 30

31 ABA Assessment 33

32 ABA Assessment Behavioral Diagnosis 34

33 ABA Assessment Medical Diagnosis 35

34 ABA Assessment Social Elements Impacting Diagnosis 36

35 ABA Assessment Requested Services 38

36 ABA Assessment Requested Services 39

37 ABA Assessment Results 40

38 ABA SERVICES REQUEST 41

39 Selection of ABA Services To enter a request for ABA treatment, complete the following steps 1. Select Level of Service: Outpatient/Community Based; Type of Service: Mental Health; Level of Care: Outpatient; and Type of Care: ABA Services 42

40 ABA Services 43

41 ABA Services 44

42 ABA Services Behavioral Diagnosis 45

43 ABA Services Medical Diagnosis 46

44 ABA Services Social Elements Impacting Diagnosis 47

45 ABA Services 48

46 ABA Services Current Impairments 49

47 ABA Services Current Skills Impairments 50

48 ABA Services Progress 51

49 ABA Services Requested Services 54

50 ABA Services Requested Services 55

51 ABA Services ABA Report 56

52 Concurrent Requests

53 Concurrent Requests 58

54 Concurrent Requests 59

55 Concurrent Requests Behavioral Diagnosis 60

56 Concurrent Requests Medical Diagnosis 61

57 Concurrent Requests Social Elements Impacting Diagnosis 62

58 Concurrent Requests 63

59 Concurrent Requests Current Impairments 64

60 Concurrent Requests Current Skill Impairments 65

61 Concurrent Requests Progress 66

62 Concurrent Requests Upload Treatment Plan 67

63 Concurrent Requests Requested Services 68

64 Concurrent Requests Requested Services 69

65 Concurrent Requests ABA Report 70

66 ProviderConnect TIP There is an option to click Save Request as Draft in case additional information or approval is needed before submitting to Beacon Indicate the authorized user if another department or supervisor needs to review the request Keep in mind, saved drafts are not automatically submitted to Beacon be sure to go back, complete the draft, and submit in a timely fashion NOTE: Attach all documents prior to submission as attachments do not save on drafts 71

67 Locate Save as Draft 72

68 Review an Authorization

69 Review an Authorization 74

70 Search Authorizations 75

71 Authorization Search Results Authorization letter can be accessed by clicking the paper icon Hyperlink shows additional details specific to the participant and authorization 76

72 Authorization Search Results Providers can submit an inquiry to Beacon utilizing the Send Inquiry function 77

73 Authorization Search Results 78

74 Contact Information 79

75 Contact Information National Provider Service Line Monday through Friday 8 a.m. 8 p.m. ET Phone: ProviderConnect Technical Questions Monday through Friday 8 a.m. 6 p.m. ET Phone: e-supportservices@beaconhealthoptions.com 80

76 Thank you 81