How many of you were excited when you saw this released by the state?
I know I was. I’ve spent several months trying to get agencies together with MCO contacts, information sessions offered by BHBS, anything to get critical information passed on and shared that might assist us in getting through the literally, horrific turn of events that have transpired since the beginning of this process January 1st, 2018. Resulting in decreased access to care, increased administrative expense and financial stress on almost every Behavioral Health agency in Ohio.
I personally have reached out to State contacts and MCO’s repeatedly recommending a round of “Post Redesign meetings” so that ODM can get a true picture of what agencies are going through right now and offer real assistance.
Then one of our clients asked if I had seen the agenda. To be honest, I was so excited, I didn’t even look. The original notice is available here. Then I looked at the agenda and this is what I discovered. Also, this meeting is full in person but available by webinar.
So it’s possible that ODM heard similar complaints from other agencies but either way, the time of the meeting Tuesday has changed and the webinar will remain open for people that can’t attend. In addition, they are using a question app to accept participant questions throughout the day on May 29th. See here for the update. In addition, yesterday we discovered a significant issue that ODM has been notified about. I posted it on linkedin but in case you aren’t connected, the post is below.
We (BHBS) discovered a substantial issue today that I want to make everyone aware of.
3 of the MCO’s, CareSource, Molina and UHCCP do not appear to be sending denials in 835’s that agencies are receiving. They are being “Processed as Primary or Secondary” with a zero payment amount.
This is a substantial issue because on the MCO side, some of the claims are showing as denied and can be simply rebilled. Any on the MCO side that show Processed as Primary or Secondary without a payment, the claim must be submitted with a frequency code and the ICN of the denied claim otherwise, the rebill of the claim will deny as either a duplicate OR a replacement claim denial.
If you are seeing this issue, you need to contact the MCO and request a list of what they have determined are denied claims. That way those can just be re-billed once corrected and the rest of zero pays will need resubmitted with a frequency code indicating replacement claim and the denied claim ICN needs to be reflected on the claim. This has been reported to ODM and will hopefully be resolved quickly, however, until that happens, this process must be followed.
HOLD MAY 29TH FOR BEHAVIORAL HEALTH
STAKEHOLDER UPDATE & DISCUSSION
The Ohio Department of Medicaid and the Ohio Department of Mental Health and Addiction Services will sponsor a stakeholder update and discussion session on Wednesday May 29th, 10:00 am – 4:30 pm at the Ohio State Highway Patrol Training Academy, 740 East 17th Avenue, Columbus OH 43211.
Not bad so far, right? Then it goes on.
The meeting will provide an overview of the DeWine Administration’s vision, values, and priorities for:
•Investing in recovery & improving treatment for those with substance use disorders and mental illness;
•Increasing resources for Ohio children and their families including children and youthserved by multiple systems;
•Considering the implications of Family First Prevention and Services Act and implicationsfor youth and their families in need of behavioral health services;
•Other relevant updates on the Ohio Biennial Budget.
State agency staff will facilitate topical discussions with stakeholders regarding the initiatives listed above, all of which are in varying stages of development. Written materials describing various initiatives and their current status will be distributed ahead of the meeting to help inform the discussion. State agency staff will be prepared to discuss mechanisms for future stakeholder input.
In my opinion, this is very important information that needs to be shared. But this is a political statement being made, not the information that agencies need and believe is going to be discussed at this meeting.
Is this what we need today? When every other day, I get another call from an agency struggling that is two payrolls away from shutting their doors.
The answer is a resounding “NO”
What do agencies in the state of Ohio need today?
My belief, that stems from my contact with agencies, is that IF agencies are going to survive this, they need several things right now.
1. Agencies need direct contact with the MCO representatives in their county to discuss issues they are having, build relationships, information from the MCO’s on several specific processes including prior authorizations and the medical necessity requirements required, the appeal process, and what exactly is needed for getting and staying contracted with them.
2. Agencies need information. At BHBS, we get calls every day about everything. What is allowed? What is required? What are the clinical implications of _______? What do I do if I see this type of denial and I know it is wrong? The communication throughout this process has been extensive, however, it obviously missed a significant portion of the agencies in Ohio. We need a forum to ask questions, get answers so that agencies can move forward.
3. Agencies need financial relief. Every week, we hear of another agency that has closed it’s doors. We need to stop playing politics and get serious, immediate relief to the agencies across Ohio that need it before they go out of business.
So while i’m aware this is not going to make me a favorite of anyone at the Statehouse, ODM, OhioMas or any other political area in Ohio, I can’t stand by and not voice my opinion that this approach is simply wrong.
In the meantime, I’m going to reach out to my contacts at the MCO’s and see if we can pull together something that might be more along the lines of what is needed right now. I will let you know if we manage to pull anything together. In the meantime, if your agency needs help, please feel free to contact me direct at firstname.lastname@example.org.