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121085 1 New York State Empire Plan Frequently Asked Questions

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					New York State Empire Plan Frequently Asked Questions for Providers Q. What is OptumHealth Behavioral Solutions? A. OptumHealth Behavioral Solutions (OptumHealth), also known as United Behavioral Health (UBH), is a behavioral health specialty company and is part of OptumHealth. Q. When will OptumHealth begin administering the New York State Empire Plan MHSA Program? A. January 1, 2009. Q. How do I identify Empire Plan enrollees and their covered dependents? A. The enrollees of New York State Empire Plan, Excelsior Plan and Student Employee Health Plan. Below are images of the benefit cards to assist you in identifying enrollees and their covered dependents. Sample Empire Plan Benefit Card:

Sample Excelsior Plan Benefit Card:

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Sample Student Employee Health Plan Benefit Card:

Sample Student Employee Health Plan Benefit Card:

PARTICIPATING PROVIDERS Q. I am a participating provider with OptumHealth; does that mean I am a network provider for The Empire Plan? A. Yes, if you are an MD/DO, PhD/PsyD, LCSW-R or RN, and are an OptumHealth participating provider, then you are a participating provider for the New York State Empire Plan enrollees and their covered dependents. Please note LMFTs, LCSWs without the R designation and LMHCs are not currently eligible for participation in The Empire Plan. Q. What fee schedule will be used for the New York State Empire Plan? A. You will be reimbursed at your current fee schedule with OptumHealth which is included in your contract. Q. Can the rates be negotiated? A. The fee schedule is non-negotiable.

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Q. I am currently a participating provider with OptumHealth and submit Wellness Assessments as part of the ALERT program. Do I need to submit a Wellness Assessment for Empire Plan enrollees? A. Yes, we ask that you continue to submit the Wellness Assessment for New York State Empire Plan enrollees and their covered dependents. Q. I have never treated an Empire Plan enrollee before, what is the benefit plan? A. There are multiple benefit designs under the New York State Empire Plan’s mental health and substance abuse program. As an OptumHealth participating provider, you will need to contact us at 1-877-7-NYSHIP (1-877-769-7447) and press Option 3 and select the 2009 MHSA option for OptumHealth or go to www.ubhonline.com to determine eligibility and benefit information prior to rendering treatment. Q. I am already seeing a New York State Empire Plan enrollee, what do I need to do? A. As a network provider with OptumHealth, no authorization will be required for the first 10 visits of treatment you provide in 2009. The initial 10 pass through visits given per provider, per member, per treatment episode will automatically renew on 1/1/09 because of this vendor change. If treatment will be needed beyond the 10 pass through visits, an Outpatient Treatment Report (OTR) will be required to certify additional visits. Q. How do I obtain a copy of the OTR? R. An OTR will be attached to the certification letter that is sent to you. The OTR form will also be available online at www.ubhonline.com

Q. How is a treatment episode defined by OptumHealth? A. A treatment episode is the period of time required to provide mental health and substance abuse care for the resolution or stabilization of specific symptoms or a particular disorder. Q. As an OptumHealth provider, how can I stay informed and up-to-date? A. As an OptumHealth provider, you can stay informed by frequently checking www.ubhonline.com. You will find provider trainings, administrative resources, and technical resources as well as receive current news and alerts.

NON PARTICIPATING PROVIDERS Q. I am a participating provider with the current vendor (ValueOptions) but not with OptumHealth. How can I join the network?

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A. If you are actively treating an Empire Plan enrollee and have not been contacted yet by OptumHealth, we encourage you to call Clinical Network Services at 1877-499-4237. Q. What are the minimum credentialing requirements for practitioners to join the network? A. LCWS-R’s, PhD’s and RN’s will need to have two years of independent postlicensure clinical experience and professional liability coverage of $1 million/$1 million. Physicians need professional liability coverage of $ 1 million/$3 million. Q. I am a participating provider with the current vendor (ValueOptions) but not with OptumHealth. How are my current New York State Empire Plan enrollees going to be handled? A. Empire Plan enrollees are eligible to receive a transition benefit until March 31, 2009 which will allow you to continue treatment at the network level of benefit. If you are not an OptumHealth provider by March 31, 2009 and you continue to see Empire Plan enrollees, they will receive non-network benefits.

INPATIENT AND ALTERNATE LEVELS OF CARE Q. On 1/1/09, if I have a New York State Empire Plan enrollee confined in an Inpatient or Residential Treatment Center what do I need to do? A. ValueOptions will continue to manage enrollees and their covered dependents who are confined for behavioral health services before midnight on December 31, 2008. These cases will be transferred to OptumHeath when the level of care is stepped down. Q. Do I have to pre-certify Inpatient and Alternate Levels of Care after 1/1/09? A. Preauthorization is required for all inpatient and alternate levels of care. To precertify care, providers should contact OptumHealth at 1-877-7-NYSHIP (1-877769-7447) and press Option 3 and select the 2009 MHSA option for OptumHealth. ADMINISTRATIVE Q. What is the mailing address for Outpatient Treatment Reports (OTR)? A. OTR’s for dates of service 1/1/09 and after can be submitted via fax or mail to: OptumHealth Behavioral Solutions The Empire Plan PO Box 5190 Kingston, NY 12402-5190 Or Fax to: 1-888-495-0145 12/1/085 4

Q. What is the claims address for MHSA Empire Plan claims for dates of service 1/1/09 and after? A. For fastest processing of claims, please submit your claim electronically through your existing EDI vendor using Payer ID 87726. If you are already an OptumHealth/UBH provider, you may also submit your claims to us electronically at no cost to you by logging onto www.ubhonline.com. If you choose to submit your claims by mail, please send a completed, typed, CMS 1500 claim form to: OptumHealth Behavioral Solutions The Empire Plan PO Box 5190 Kingston, NY 12402-5190 Q. I need to appeal a claim determination for a date of service prior to 1/1/09; do I send that to OptumHealth? A. No, dates of service prior to 1/1/09 are considered by ValueOptions.

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Description: 121085 1 New York State Empire Plan Frequently Asked Questions