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Question and Answer section for Providers in Blair, Somerset/Bedford, Franklin/Fulton, and Lycoming/Clinton Counties









 
 
 
 
1. When the "switch" takes place on July 1, how is the conversion handled? Does CBHNP honor the last authorization in place? When does the provider request the new authorization? What about TCM? Providers do not necessarily get a "hard copy" of an authorization.
See attached basic Transition policies. All prior DPW authorizations are honored for RTF and BHRS. Partial Hospitalization, inpatient mental health and substance abuse will require a phone call to CBHNP within the first week of start up. TCM and Outpatient are registration services so Providers will simply request authorization by completing and faxing a form to CBHNP or using Provider Connect to request the authorization for Members in treatment. Links to Transition Policies are located here:
 
2. Is there a "standard" number of units authorized for TCM?
Yes.
ICM - 1 year - 500 Units.
RC - 1 year - 250 Units.
 
 
3. For BHRS initial packets, can the initial treatment plan be written by a bachelor's level staff?  If the Master's level person is writing the treatment plan for the initial packet, is it billable and how (if this is an initial and authorization is not in place yet for the provider)?
Medical Assistance Bulletins and billing requirements always apply and need to be followed. BHRS providers are not required to have a full Treatment Plan submitted with the initial packet; however goals must be identified.  This usually occurs at a very basic level at the ISPT meeting.  There is a form for this. The formal Treatment Plan is not completed until after the authorization and services begin.
 
 
4. If  a Provider has a child due for BHRS services June 1, can they submit to the state for the authorization for only one month and also submit a request for authorization to CBHNP beginning July 1 simultaneously?
A Provider could do this but would result in double work for the provider.  The Provider needs only to make the normal request (4-months or up to 12 months, if ASD, as applicable) to the State FFS system. On July 1, the Provider needs only to submit a transition packet which is essentially a copy of the packet submitted to the State along with the Prior Authorization Notice (PAN) for TSS.  For MT or BSC only cases the state does not give an approval notice for these services, in this case the provider would submit a copy of the Plan of Care (POC) signed by the County Authorizing Agent along with a copy of the packet.  CBHNP then honors the existing auth as a transition packet.  
 
 
5. If a member wants to transfer services, who is responsible for transferring the services?
CBHNP requests the provider take the lead on transferring the service to another provider.  This includes the current provider working to secure the new provider, unless the member has already identified which provider they want to use. BHRS Evalutation Process Clarification
 
 
6. How do we, as providers, know when a member goes back and forth from FFS to CBHNP?
The provider is responsible for checking EVS on a regular basis (CBHNP recommends daily).
 
 
7. What services can the MT, BSC, and TSS bill for?
A reference, as this could be altered to some degree in the new health choices are, can be reviewed in the link below: