In an effort to support behavioral health integration, Managed Health Services (MHS) and our behavioral health partner Cenpatico, have simplified billing for initial behavioral health assessments obtained in a primary care setting.

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.

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To increase satisfaction related to the timeliness and consistency of claim payment, MHS is changing our check run schedule. Beginning September 1, 2010, MHS’s check run date will change to Wednesday of each week. To support your continued cash flow schedules, MHS will provide two check runs the last week in July. The week of August 29, the check run will occur on Wednesday and thereafter on a weekly basis. Payment will be released from our bank on Thursday for immediate EFT deposit (EFT availability is subject to specific banking institution timeframes). Hard copy checks will be mailed on Friday.

An enhanced electronic payment software called Payformance will be implemented in July which will further compliment timely payment, specifically electronic payment capabilities.

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An Evansville pediatrics physician has received a national award for providing quality care and clinical excellence to Hoosier children and adults enrolled in Managed Health Services’ statewide health plan.

Dr. W. Michael Crecelius has received a 2010 Summit Award for Excellence in Care from MHS and parent company Centene Corp.

The award honors Crecelius, a board-certified pediatrician with Deaconess Clinic in downtown Evansville, for demonstrating exemplary performance when following up with examinations and consultations after patients’ emergency room visits, providing routine preventive and well-care services for children and adults and establishing a medical home for new enrollees in the MHS healthcare plan.

“MHS is proud to recognize Dr. Crecelius for the outstanding service and quality of care he provides to Managed Health Services members in the greater Evansville community,” said Dr. Robert Baker, vice president of medical affairs at MHS. “Our primary focus is on delivering the best possible care to our members and we could not do that without strong relationships with our plan’s physicians. The Summit Award is one way we can thank Dr. Crecelius for his ongoing dedication to helping children live healthy lives.”

Crecelius graduated Indiana University’s School of Medicine and completed his pediatric internship and residency at Riley Hospital for Children in Indianapolis. He is a Fellow, American Academy of Pediatrics, and a member of the Indiana State Medical Association and the Vanderburgh County Medical Society.

A total of 16 physicians from around the country were awarded a 2010 Summit Award by Centene Corp.

“These honors underscore Centene’s distinction as a physician-driven company that provides quality care to our healthcare plan members,” said Centene Corp. Chairman and CEO Michael Neidorff. “Physicians are selected for exemplary performance in several areas.”

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An Indianapolis pediatrics physician has received a national award for providing quality care and clinical excellence to Hoosier children and adults enrolled in Managed Health Services’ statewide health plan.

Dr. Sharon Gilliland has received a 2010 Summit Award for Excellence in Care from MHS and parent company Centene Corp.

The award honors Gilliland, a board-certified pediatrician who runs Rainbow Pediatrics in Indianapolis, for demonstrating exemplary performance when following up with examinations and consultations after patients’ emergency room visits, providing routine preventive and well-care services for children and adults and establishing a medical home for new enrollees in the MHS healthcare plan.

“MHS is proud to recognize Dr. Gilliland for the outstanding service and quality of care she provides to Managed Health Services members in the greater Indianapolis community,” said Dr. Robert Baker, Vice President of Medical Affairs at MHS. “Our primary focus is on delivering the best possible care to our members and we could not do that without strong relationships with our plan’s physicians. The Summit Award is one way we can thank Dr. Gilliland for her ongoing dedication to helping children live healthy lives.”

Gilliland opened Rainbow Pediatrics in 1996 and also maintains a solo practice supported by call partners. After earning an undergraduate degree from Northwestern University, she graduated Indiana University’s School of Medicine and completed her pediatric residency at Methodist Hospital in Indianapolis. From 1989 to 1996, Gilliland provided community pediatric care at HealthNet, a Federally Qualified Health Center located in Indianapolis before opening Rainbow Pediatrics.

Rainbow Pediatrics is located at 5711 N. Michigan Road in Indianapolis and online at www.rainbow-pediatrics.net. The center is open 9 a.m. to 4 p.m. Mondays, 9 a.m. to 5 p.m. Tuesdays, 1-7 p.m. Wednesdays, 9 a.m. to 3 p.m. Thursdays and 10 a.m. to 4 p.m. Fridays.

A total of 16 physicians from around the country were awarded a 2010 Summit Award by Centene Corp.

“These honors underscore Centene’s distinction as a physician-driven company that provides quality care to our healthcare plan members,” said Centene Corp. Chairman and CEO Michael Neidorff. “Physicians are selected for exemplary performance in several areas.”

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A South Bend physician has received a national award for providing quality care and clinical excellence to Hoosier children and adults enrolled in Managed Health Services’ statewide health plan.

Dr. Binod Balakrishnan has received the 2010 Summit Award for Excellence in Care from MHS and parent company Centene Corp.

The award honors Balakrishnan, a primary care physician in the MHS healthcare plan who specializes in pediatric medicine at the Navarre Pediatric Group, located at 100 Navarre Place, Suite 4440 in South Bend, for demonstrating exemplary performance when following up with examinations and consultations after patients’ emergency room visits, providing routine preventive and well-care services for children and adults and establishing a medical home for new enrollees in the MHS healthcare plan.

“MHS is proud to recognize Dr. Balakrishnan for the outstanding service and quality of care he provides to Managed Health Services members in his South Bend community,” said Dr. Robert Baker, vice president of medical affairs at MHS. “Our primary focus is on delivering the best possible care to our members and we could not do that without strong relationships with our plan’s physicians. The Summit Award is one way we can thank Dr. Balakrishnan for his ongoing dedication to helping people live healthy lives.”

Balakrishnan received his medical degree from the All India Institute of Medical Sciences in New Delhi, India. He completed his pediatric residencies at the All India Institute of Medical Sciences and at Women’s and Children’s Hospital of Buffalo, N.Y. He is board-certified by the American Board of Pediatrics and his interests include acute care, infectious diseases and asthma.

A total of 16 awards were awarded by Centene health plans throughout the nation.

“These honors underscore Centene’s distinction as a physician-driven company that provides quality care to our healthcare plan members,” said Centene Chairman and CEO Michael Neidorff. “Physicians are selected for exemplary performance in several areas.”

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Present on Admission (POA) Requirements
In compliance with Indiana Health Coverage Programs Provider Bulletin BT200928, Managed Health Services (MHS) will follow The Centers for Medicare & Medicaid Services guidelines requiring Present on Admission indicators on all qualifying inpatient claims. As outlined within the banner, some hospitals are exempt from this requirement. MHS is required to comply with this requirement for all dates of service October 1, 2009 and following. Services provided for qualifying hospital acquired conditions are not reimbursable per State direction. Your Explanation of Payment (EOP) will provide detail should certain services not quality for reimbursement. Please remember to include POA indicators for each diagnosis code placed on the claim. Non-compliant claims will be denied. Providers are encouraged to follow the MHS 60 calendar day resubmission timeline.

NPI Requirements
MHS continues to adhere closely to NPI requirements and has recently strengthened claim acceptance criteria to ensure compliance. Some providers may experience claim rejects for practices which were previously accepted. Professional claims billed by a provider who is part of a group, must place the group “BILLING” NPI ID in box 33A on the claim form when providing services for the group (box 33A is for billing provider information). This is the most common error on recent claim submissions. Should you have questions regarding a rejection, please contact Provider Services at (877)-647-4848.

Previous EDI Issue
MHS experienced a problem with EDI rejection notifications providing incorrect reject reasons starting March 14 through April 1, 2010. The error primarily affected professional claims submitted through Emdeon during this timeframe. The rejection or acceptance logic was applied correctly, however, the incorrect reject reason was provided. We do apologize for this confusion and the issue has now been resolved. Emdeon and MHS have regenerated correct error reports dating back to March 14. Again, please contact Provider Services at (877) 647-4848 if you have any questions regarding this issue.

Facility Radiology Rate and Home Health Rate changes effective April 1, 2010 per Bulletins BT201005 and BT201007 issued on March 9, 2010 by OMPP
The Indiana Office of Medicaid Policy and Planning (OMPP) is promulgating regulations on an emergency basis to avoid an anticipated budgetary shortfall and to remain within the available Medicaid appropriation. MHS has updated our programs to be in compliance with the State’s directive as follows:
• A permanent change in reimbursement for certain radiology services reported on the UB-04 claim form. For more details, view bulletin 201005: www.indianamedicaid.com/ihcp/Bulletins/BT201005.pdf
• Reimbursement for home health services with a “from” date of service on or after April 1, 2010, through June 30, 2011, will be reduced by 5 percent. For more details, view bulletin 201007: www.indianamedicaid.com/ihcp/Bulletins/BT201007.pdf

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The first of an entire year of community events throughout the state offering free health screenings will be hosted this weekend in Indianapolis by Managed Health Services (MHS).

From noon to 3 p.m. Sunday at Emmanuel Missionary Baptist Church, located at 4958 Ribble Road, MHS’ Healthy Lifestyles event will offer blood pressure, glucose and cholesterol screenings. All screenings, in addition to an array of health- and wellness-related educational information, will be offered at no cost to those who attend.

“The screenings we will be offering are critically important as part of taking charge of overall healthcare maintenance and routine,” said MHS CEO Patrick Rooney. “MHS encourages everyone to have these screenings performed annually and take the necessary steps with their primary healthcare provider to treat any conditions needing attention or management.”

MHS staff will be available Sunday to provide information about the Hoosier Healthwise program, a healthcare program available to Indiana residents throughout the state. MHS will also be coordinating health-related giveaways for attendees of all ages throughout the event.

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Managed Health Services (MHS) will offer no-charge mammograms Saturday for members of its plan who live in and around Lake County.

From 9 a.m. to noon at Methodist Hospital Southlake, located at 101 E. 87th Ave. in Merrillville, MHS plan members ages 40-69 who have not received a mammogram in the last 12 months can undergo a free screening by hospital staff.

Appointments are required as no walk-ins are accepted. MHS is also offering complimentary transportation for members if needed.

Eligible MHS members who complete a mammogram screening Saturday will receive $20 in credits on their CentAccount debit card to use on approved health-related items and at www.diapers.com for diapers, bottles and other approved baby-care items. If members follow-up with their primary care physician to get the results of their mammogram and undergo an annual cervical cancer and Chlamydia screening, they can earn additional CentAccount credits worth up to $40.

MHS will also be providing general women’s health information, smoking cessation materials, a breast exam shower hanger with information in both English and Spanish about how to conduct a self exam and complimentary health consultations. Light snacks will be provided.

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Beginning January 2010, members identified as high utilizers in need of specialized intervention will be enrolled into the Right Choices Program (RCP), formerly the Restricted Card Program. As RCP participants, members will be assigned to one (1) primary medical provider (PMP), one (1) pharmacy and one (1) hospital. Based on thresholds established by the State, some members will be reviewed by a clinical team at MHS and possibly placed in the RCP. The PMP will serve as the member’s primary lock-in physician and will be able to manage his or her care and coordinate service delivery. More detailed information about the RCP will be coming from your county’s designated Provider Relations Specialist.

MHS Letter to PMPs (PDF)
IHCP Provider Monthly News – RCP Article (PDF)
MHS RCP Frequently Asked Questions (FAQ) for Providers

You can also find information about the RCP in our most recent Provider Newsletters:
Provider Watch January 2010
The Communicator Winter 2010

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Updated 12/22/09

Effective December 31, 2009 the Office of Medicaid Policy and Planning will assume responsibility for the administration of the Hoosier Healthwise managed care organizations and Healthy Indiana Plan pharmacy benefits. Hewlett Packard (HP – formerly EDS) will process all outpatient pharmacy claims and manage pharmaceutical services for drugs and some drug-related medical supplies and medical devices provided by enrolled Indiana Health Coverage Programs pharmacy or durable medical equipment providers.

IHCP Provider Bulletin BT200948
MHS Pharmacy Benefit Changes Fax Blast (PDF)

Provider Manual and Quick Reference Guide
New versions of the MHS Provider Manual and Quick Reference Guide (QRG) effective 12/31/09, have been uploaded.
MHS Provider Manual
Chapter 8: Pharmacy has been replaced with Chapter 9 from the IHCP Provider Manual.
MHS Provider Quick Reference Guide

Pharmacy Preferred Drug List and Forms
Pharmacy manuals and forms are now located at the Indiana Medicaid and Indiana Pharmacy Benefits management Web sites.
Indiana Medicaid Preferred Drug List
Indiana Medicaid Pharmacy Forms

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