Behavioral Health Assessments conducted at a Federally Qualified Health Center or Community Health Center, should be billed by the Primary Medical Provider (PMP) using a CMS 1500 form and using the appropriate CPT code series 96150-96155. Mid-level providers (LCSW, LMHC, LMFT) who conduct assessments within this setting must bill under a PMP using the same codes with modifier (AJ).

Claims should be submitted to the MHS claims address below:

Managed Health Services
P.O. Box 3000
Farmington, MO 63640-3802

All other services provided by a behavioral health provider, such as therapy (i.e. 90801, 90806, etc), should be submitted to Cenpatico for payment, on a CMS 1500 form, following current claim submission processes. Please be advised that the behavioral health provider will need to be credentialed through Cenpatico if billing with these codes. Please contact Cindy Smith, Provider Relations Specialist for Cenpatico at (317) 684-9478 extension 20268 to begin the credentialing process for your behavioral health provider(s).

The behavioral health claim submissions address is:

Cenpatico
ATTN: Claims Department
P.O. Box 6800
Farmington, MO 63640-3817

If you have any questions, feel free to contact MHS Provider Services at 1-877-647-4848.

Article from the Fall 2009 Provider Report, Cenpatico Quarterly Newsletter:
Provider Report Fall 2009
www.cenpatico.com

Cenpatico/MHS has found that while those meeting appointment availability standards have improved, it is still not meeting our goal to have 90% of our provider offices be available within 24 hours for urgent appointments and 10 calendar days for routine appointments. To ensure that your office meets these directives, it is important to provide education on these standards to the front office staff. Another is to allow time each day at lunch or before/after normal office hours to see those patients in crisis. Your front office staff needs to know you can be available during these hours if needed. If you are a solo practitioner and do not have front office staffs to rely on for making appointments, you could change the message that patients receive while you’re in session to reflect that you will return their call within two hours or whatever you see as possible.

Our quality department and network management staff are available to brainstorm ideas to help you meet standards that will work for you and your practice. Thank you to those of you who have been called and met the standards. We appreciate your commitment to our members.

Article from the Fall 2009 Provider Report, Cenpatico Quarterly Newsletter:
Provider Report Fall 2009
www.cenpatico.com

Webinar Invitation (PDF)

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You can view more pictures from this event on our event images page!

“So much primary care is behavioral, and many of the presentations are rooted in the stresses of people’s lives,” said Dr. Dennis Freeman, CEO of Cherokee Health Services, which serves patients in Knoxville and other parts of eastern Tennessee. “And a lot of intervention needs to be behavioral as well.”

Cherokee has been a pioneer in this area, thanks to Freeman’s decades-long belief in the benefits
of integrated care. By the mid-1980s, Cherokee had hired its first behavioral health consultant. “We’ve been at it a long time and it’s really catching on across the country,” Freeman said.
Cherokee has hosted many healthcare organizations who want to learn more, including Beth Wrobel,
HealthLinc’s CEO. About two years ago, Wrobel became aware of the integration concept and began working more closely with Porter-Starke’s behavioral health experts. The result? The right expert sees the patient sooner and helps take care of the problem earlier.

“It has freed up our physicians and nurse practitioners to better take care of the medical needs because so many of the needs are tied to mental or behavioral health issues,” Wrobel said. In Cherokee’s model, a behaviorist, usually a psychologist, is embedded within the primary care
team. That removes some of the fear patients might have of seeing a mental health professional and
adds to the number of people who actually get the behavioral health consulting they need.

“There is so much stigma attached to behavioral care that when patients are referred, less than 20 percent even make it to an appointment,” Freeman said. “We just bring it into the primary care environment and it’s a model that patients now prefer.” In fact, more than 90 percent of
Cherokee’s patients say that’s how they would prefer to receive care, according to Freeman.

“It helps us do a better job of taking care of common problems,” said Dr. Tim Ames, Medical Director
at HealthLinc—problems like patients who have high blood pressure or diabetes and who smoke.
“If they’d like to quit but don’t know how to or are under too much stress, that’s when it’s convenient to page our behavioral health consultant, introduce him as an expert at stopping smoking and have him start the conversation,” Ames said. “At the very least, I think it shows patients that we take this seriously, and we’re not just going to issue useless advice like, ‘Please stop smoking.’ We give specific guidance on how to do that.” The bottom line, Wrobel said, is that the managed care approach can achieve better coordination of care and hold down costs. “Models like this make a whole lot of sense,” she said. “It’s another set of hands that helps the whole body.”

The Lake Ridge school system in Gary has begun an initiative to offer school-based health clinics that
integrate physical and behavioral health in the primary care environment—a first for the area. They have teamed up with Gary Community Health Center and Southlake Community Mental Health Center to offer a coordinated approach to healthcare for Lake Ridge students. “We’ve been in discussions for
over two years concerning this initiative,” said Dr. Sharon Shirley, Lake Ridge Schools superintendent.
“We are creating a health facility that would help us keep kids well physically and mentally. A lot
of our families do not have health insurance. In this program, all children are served— whether they
are insured or not.”

The program will roll out in phases. The first phase will deal with Lake Ridge Schools students
and staff. If successful, they will open access up to the community, according to Shirley. Initially, the clinics will focus on health checks for athletes and physicals for kindergarteners. “This school system serves a high population of lower-income people on Medicaid, people who are otherwise
going without healthcare,” said Dan Smith, director of Child and Adolescent Services at Southlake
Community Mental Health Center in Merrillville. “Lake Ridge has noticed a huge absenteeism
rate and poor academic performance. A lot of kids are missing school because they are not being
provided basic healthcare.” He added that it’s important to integrate behavioral and physical
healthcare because physical problems often present because of an underlying mental issue, or vice versa.

“With the way the economy has been, there is a big need for healthcare, especially for uninsured people,” Smith said. “As far as an integrated care model, this is a first.” Janet Seabrook, M.D., executive director of the Gary Community Health Center, agrees. “There’s a lot of anxiety and
depression going on right now with the stresses going on at home, the loss of jobs, not being able to
participate in as many after-school activities,” she said. “That trickles down to the children through
absenteeism, dropping out, receiving poor grades, needing to get an after-school job. There are things we can do to assist the school and the community. If we’re treating the children, we’re treating the community.”

“We’re just so happy for a community like ours, an urban school, to be able to service our children,”
Dr. Shirley added. “I think it’s an ideal situation, especially in our schools where we don’t have fulltime nurses. Keeping children well will help improve attendance and help more kids stay in school.”

Download a PDF version of this article as it appeared in our 2009 Integration Issue Provider Report

In the Weeds was convened by Managed Health Services (MHS) and its sister company, Cenpatio, one of the Hoosier Healthwise healthcare plan providers in Indiana, and was co-sponsored by Council of Community Mental Health Centers, Indiana Primary Health Care Association and Mental Health America of Indiana. The keynote speaker was Dr. Dennis Freeman, CEO of Cherokee Healthcare Systems. Other session speakers included Steve McCaffrey, president and CEO of Mental Health America of Indiana, Beth Wrobel, CEO of HealthLinc, Inc. and Bob Franko, Vice President of Marketing and Development for Porter-Starke Services, Inc.

The two main sessions of the conference included a panel discussion about the state of integration in Indiana and an exploration about the best ways Indiana may refine and overcome its healthcare integration challenges.

Conference Presentations

Dr. Freeman’s Session PowerPoint Slides	Bob Franko’s and Beth Wrobel’s Session PowerPoint Slides

Grant Announcement
Learn more about the MHS Healthcare Integration Transition Grant, worth 10,000, and how your Indiana health clinic can apply: Grant Announcement (PDF)

Click on a thumbnail below to view the full-size image in a new window.
You can view more pictures from the conference on our event images page.

MHS & Cenpatico Web Updates
In further support of healthcare integration, MHS and Cenpatico have undertaken supplying quality education resources on the topic of healthcare integration for our providers. We have collected research articles that look at coordinating healthcare. These studies have been undertaken by experts to better understand the relationship between physical and behavioral health, and to evaluate the impact of coordinated care on the health of patients.

A new article abstract, and a link to read the full article will be featured periodically on the MHS and Cenpatico Web sites. We encourage our providers to use these articles and web resources as tools for further education on the integration of physical and behavioral healthcare.

Integration Web links
Several healthcare and academic bodies around our country have recognized the value of healthcare integration; several systems have already implemented integrated healthcare, and have the research and data to prove that it is effective. These links will direct you to their websites so that you may learn more about these other projects:

Collaborative Family Healthcare Association
Cherokee Health Systems
Community Care Services
Integrated Behavioral Health Project
Univeristy of Texas – Hogg Foundation for Mental Health
Health Management Associates
Open Minds
Mountain Area Health Education Center