Outpatient Changes for Contracted Behavioral Health Providers · 2018-08-21 · • For new enrollees seeking MHR services on or after September 1, 2018, providers will need to obtain

Prior Authorization Requirement for Mental Health Rehabilitation Services and Evidence-Based Practices

Outpatient Changes for Contracted Behavioral Health Providers

BH1563_08/2018 United Behavioral Health operating under the brand Optum 2018 Optum, Inc. All Rights Reserved


• Kendell Andrus - Behavioral Health Network Trainer

• Alexandra Thorn, LCSW – National Director A.L.E.R.T. Outpatient

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Today’s speakers


• Why are we implementing these changes?

• What are the new requirements for Mental Health Rehabilitation (MHR) services?

• What services will require prior-authorization?

• How will UnitedHealthcare Community Plan implement these changes?

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Today’s agenda


The state has requested for us to move to requiring authorization for all MHR and EBP services in order to more closely manage the care of individual members. We believe this new process will ensure that appropriate care is delivered to the members based on medical necessity.

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Why the changes?


Beginning September 1, 2018, UnitedHealthcare Community Plan will require prior-authorization for MHR Services and EBPs not previously requiring authorization.

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What is the new requirement?

What services will require Prior-Authorization?

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• Beginning September 1, 2018, all MHR services will be prior authorized through a portal located on the Provider Express Website.

• To access the request form link go to: providerexpress.com > Our Network > Welcome to the Network > Louisiana > Authorization Templates

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How will these changes be implemented?

Note!! This link will not be available

until September 1, 2018

http://www.providerexpress.com/

Provider Express Louisiana page

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Member Information

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Step 1:

Member Information (continued)

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Provider Information

Step 2:

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Provider Information (continued)

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Authorization Info

Step 3:

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Authorization Info (continued)

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Authorization Info (continued)

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Clinical Information

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Step 4:

Clinical Information (continued)

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Acknowledgement and Submit

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Documents To Be Attached

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Step 5:

Documents To Be Attached (continued)

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Documents To Be Attached (continued)

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Saved Documents

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Step 6:

Saved Documents (continued)

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Error Messages

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• UnitedHealthcare Community Plan will create a one-time authorization for all enrollees currently receiving MHR services and will be sending providers notification of the authorization number, and end date of authorization. Providers will not need to take any action for these enrollees until these one-time authorizations expire.

• Members receiving MHR services will be identified through claims information.

• Once the units authorized are used, the provider will be required to complete the on-line request via the portal.

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What about members currently receiving MHR services?


• For new enrollees seeking MHR services on or after September 1, 2018, providers will need to obtain prior authorization from UnitedHealthcare Community plan using the new portal.

• The following information will be needed for all new and subsequent authorization requests for MHR services. – Level of Care Utilization System (L.O.C.U.S). Assessment – Children and Adolescent Level of Care Utilization System (C.A.L.O.C.U.S.)

Assessment – Member Choice Form

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New members requiring MHR services


• To request more units for new or existing members: – Go to: providerexpress.com > Our Network > Welcome to the Network >

Louisiana > Authorization Templates – Complete the Healthy Louisiana Mental Health Rehabilitation and

Evidence Based Practices Request Form – Include the LOCUS and/or CALOCUS Assessment – Member Choice Form

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Need more units for new or existing members?

https://www.providerexpress.com/content/ope-provexpr/us/en.html


• A decision will be made in 5 calendar days.

• A licensed Care Advocate may contact the provider to review the case if more information is needed to make the authorization decision. – These reviews will mirror current medical necessity, reviews are being

completed now. – Once a decision has been made, an authorization letter will be mailed to

the mailing address associated with the request. – Please ensure your contact information is updated to ensure quick

processing of these request.

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How long is the authorization process?

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Staying current with “My Practice Info”

Keeping your information up to date ensures that referrals will find you, and that you get reimbursed promptly and accurately.


• All members must complete and sign a Member Choice Form (MCF) prior to the start of MHR services and when transferring from one MHR provider to another.

• These services include CPST and PSR. Previous authorizations of these services will be amended to adhere to the member preference.

• The previous provider will be notified of the change in authorization. The MCF is required to be submitted with the initial L.O.C.U.S./C.A.L.O.C.US. assessment and be a part of the member’s clinical record. This information is subject to audit upon request.

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Member Choice Form


• Members may only receive MHR services from one provider unless one or both of the following exceptions are met: – A member is receiving tenancy support through the Permanent Supportive Housing

Program. – The UnitedHealthcare Community Plan of Louisiana Medical Director makes the

determination that it is medically necessary and clinically appropriate to receive services from more than one MHR provider. The justification must be supported by the member’s assessment and treatment plan. This decision must be reviewed at each medical necessity review.

• Providers must notify the member’s health plan immediately if it is suspected that a member is receiving MHR services from more than one provider.

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Exceptions to the MHR policy


• UnitedHealthcare Community Plan will monitor the duplication of services via prior authorization, Algorithms for Effective Reporting and Treatment (A.L.E.R.T.) and Practice Management.

• The plan will attempt to contact members and/or families as needed to ensure continuity of care.

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MHR service duplication monitoring

UnitedHealthcare Community Plan

Provider Call Center 1-866-675-1607

or [email protected]

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mailto:[email protected]