Tag: IMC

Resources and contacts received to date:

MCO & BH-ASO Contact List – updated Jan 2020

MCO FAQ compilation

Care Coordination Contacts

Companion Guides

Complaints & Grievances

Prior Authorization resources – updated Jan 2020

Shared Provider Roster template – updated with MCO contacts 4/29/19

Symposium materials

WISe forms & Tracker submission

837 Batch Sample Files

CMS Guidance – Use of Modifier 59

Contracts & Reconciliation Contacts

• Molina – Megan Gillis Megan.Gillis@MolinaHealthCare.Com

• Amerigroup – Kathleen Boyle Kathleen.Boyle2@amerigroup.com

• CHPW – Cathy Neiman Cathy.Neiman@chpw.org

Updating practice demographic data (address, hours, tax ID, etc.)

• Amerigroup – Form is on our website https://providers.amerigroup.com/pages/wa-forms.aspx under Provider Data Update Forms. The best place to send the completed form is waopsrequest@amerigroup.com. You can also use that email address or call 1-800-454-3730 with questions.

• CHPW – “Clinic & Group Change Term” form available on website https://www.chpw.org/for-providers/documents-and-tools/ under Tools & Resources. Ask for 30 days notice thru the form. Contact directly if shorter timeline than that.

• Coordinated Care – reach out to your contract contact.

• Molina – will send specific email box for that.

Forms and resources about the MCO’s authorization processes will be posted below as they are received.

MCOs have shared a Prior Authorization Services reference guide for Behavioral Health providers. This guide shows prior authorization requirements and length of authorization by service type across the different MCOs.

Combined MCO Prior Authorization Reference Guide – updated Jan. 2020

HCA Guidance on Prior Auth Process from Correctional Facility to Residential – added 03/27/29

Amerigroup
SUD Inpatient Prior Auth & Continued Care Form

Coordinated Care
Contact Information and PA Check Tool
Prior Authorization Summary Guide

Molina
Molina BH Auth Request Form
Contact Information – Behavioral Health UM Team information
BH Provider Lists Landing Page on Member Public Website
Spokane BH Provider Grid – In Network Agencies and Community Health Centers

CHPW
Notification – Inpatient notification to CHPW is done one of two ways, fax or via our online portal. 

Prior Auth page – the below link is to our prior auth website which contains the information providers need to know on what requires prior authorization as well as links to the various forms that we provide for submission via fax and information to guide providers how to sign up and start sending authorizations online.
https://www.chpw.org/for-providers/prior-authorization-and-medical-review/

The specific forms (which are on the website above) are:
Inpatient Notification: https://www.chpw.org/resources/Forms_and_Tools/Inpatient_Admission_Form_Updated_9.24.2018.pdf
SUD Request Form: https://www.chpw.org/resources/Providers/Prior_Authorization/IMC_SUD_Service_Request_Form_1.pdf
Mental Health Request Form: https://www.chpw.org/resources/Providers/Prior_Authorization/Mental_Health_Service_Request_Form.pdf

Where to look to identify network providers for CHPW. Our provider directory is located on the website and provides the most accurate and real time information for our network providers and facilities: https://www.chpw.org/provider-search/

Provider Manual Link : https://www.chpw.org/for-providers/provider-manual1/

Integrated Managed Care Providers:

HCA is committed to a successful transition to Integrated Managed Care and supporting providers through this transition. This communication is to remind providers that if you are experiencing challenges, HCA is available to provide assistance. To contact the MCP team for assistance with issues, send your email to HCAMCPROGRAMS@HCA.WA.GOV.

 The HCA Managed Care Programs (MCP) provides direct oversight of the Managed Care Contracts and can assist with finding strategies for resolution. 

When sending an email to the HCA MC Programs mailbox, we will need the following information:

• Overview of your concern:

  • What is the concern?

  • Is your concern specific to a single MCO or multiple MCOs?

  • Have you contacted the MCO with your concern? If so, who did you communication with?

  • What was the MCO response to concerns

• Contact information for who HCA should follow up with from your organization.

• Specific examples that HCA can use to look into issues, including:

  •  The name of the impacted managed care enrollee(s)

  • Enrollee Date of Birth(s) and ProviderOne number(s)

  • Date(s) the service occurred

  • Type of service (SUD, Durable Medical Equipment (DME), pharmacy, Inpatient, physician)

• Any other relevant information or detail you think would be helpful to HCA to assist with problem-solving.

 

Encrypted Emails

All emails with client information should be sent encrypted to ensure confidentiality. If you do not have a secure email system please send an email to HCAMCPROGRAMS@HCA.WA.GOV asking for a secure email to be sent.  We will send a secure email and if you reply to that email the information contained will remain protected.

 Questions? 

If you have any questions, contact us at HCAMCPROGRAMS@HCA.WA.GOV.  We can reach out to you directly by email or schedule a phone call to answer any questions.