Dbhdd publishes its expectations, requirements, and standards for community providers via policies and the respective behavioral health or developmental disabilities provider manuals. The manuals include allprovider and providerspecific pages. Your plan includes online health tools, awardwinning customer service, health and wellness programs, travel coverage, and many more benefits and services. Youll find most of the information you need in the provider manual.
Health information programs provide general health information and are not a substitute for diagnosis or treatment by. Our health plan and its subcontractors provide medical, behavioral health, dental. Please refer to the covid19 alerts and updates page for specific changes and updates. Optum behavioral health uses clinical criteria based on sound clinical evidence to make coverage determinations, as well as to inform discussions about evidencebased practices and discharge planning. Aarp health insurance plans pdf download medicare replacement pdf download aarp medicarerx plans united healthcare pdf download. As an aetna better health of california provider, there are certain procedures and protocols you need to know. Call us if you have questions about which provider manual you should use. We created this health care professional office manual for our participating physicians. Aarp health insurance plans pdf download medicare replacement pdf download aarp medicarerx plans united healthcare pdf. This provider handbook services as a resource and outlines operations for aetna better healths integrated care program and our aetna better health premier plan program. Inform enrollees how and where to obtain behavioral health services. Community provider manuals georgia department of behavioral. Evening appointment availability, family therapy, group therapy, home visits, play therapy, urgent appointment availability, weekend appointment availability gender. Dec 3, 2014 as of january 1, 2015, mhnet will adopt aetna medicaid policies of using level of care utilization.
Provider and billing manual 20152016 ambetter prov15flc00008. Providers who meet aetna s eligibility requirements should watch for a caqh registration package via u. Behavioral health services quick facts and phone guide. If you do not have medicare coverage in addition to health net access, your behavioral health service provider will still be mercy maricopa integrated care. Aetna has a variety of mental health insurance options to fit employer needs, from standalone behavioral health plans to coverage that integrates with aetna health benefits. Community mercy health partners, catholic health partners, mercy health. And it can help ease your administrative burdens all in one easytoread document. Provider manual for all providers except ca 687 mb download pdf. Fall 2015 volume 10, issue 2 aetna behavioral update your.
If the provider does not have web access, they may contact cigna behavioral health cbh provider services at 1. Calendar year cy 2014 hedis 2015 medicaid rates pdf cy 2016 health and quality of life. Your guide to doing business with us our recently updated behavioral health provider manual gives you what you need to work with us. Providers also must comply with the policies and procedures contained in any applicable handbook supplements, including the magellan. Provider newsletter aetna better health of missouri. This behavioral health provider manual, the eap manual and other related. Aetna and its affiliates provide certain management services for innovation health. Provider and billing manual florida sunshine health. The combination of kepro and aps healthcare in 2015 created an organization with unequaled experience with utilization management and prior authorization across. Optumhealth care solutions, llc provider operations manual.
Dallas service area for medicaidchipchip perinate dallas, collin, rockwall, kaufman, navarro, hunt and ellis counties. Parkland community health plan provider manual september 2015 2777 stemmons freeway, suite 1750 dallas, tx 75207. Fall 2015 volume 10, issue 2 aetna behavioral update. The manuals include all provider and provider specific pages. Amerihealth caritas louisiana staff will work with the appropriate primary care provider and behavioral health providers to develop an integrated treatment plan for members in need of physical and behavioral health care coordination. The sbirt app is available as a free download and is. English link opens in new window provider manual for california providers 4 mb download pdf.
All medicaid members now get their behavioral health services through a health plan. Screen, evaluate, treat andor refer as medically appropriate any behavioral health problemdisorder. The manual is divided into two major components, a general information and administration chapter. Aetna officelink updates all regions katz brunner healthcare.
The mental health plan point of authorization directory lists california county mental health office plan names, addresses and telephone numbers. Behavioral health provider prior authorization requests on mhnet portal. Aetna medicaid administrators, llc administers mc for dignity. In using its clinical criteria, optum behavioral health takes individual circumstances and the local delivery system into account when. Ste b jeferson city, mo 65109 10991 nw airworld dr. Our behavioral health programs focus on the important role of mental health on a persons overall wellbeing.
Beginning october 1, 2015 if you have medicare coverage in addition to health net access dual coverage, your behavioral health service provider will be health net access. If services are not available through an innetwork ohio state provider, students will use the aetna network. Aetna is the brand name used for products and services provided by one or more of the aetna group of subsidiary companies, including aetna life insurance company and its affiliates aetna. Provider manuals for fy 2020 fy 2020 provider manual for community behavioral. Optum is a national leader in providing physical medicine solutions to the health care market. Aetna behavioral health medical necessity pdf download. Behavioral health appointment waiting times behavioral health providers are required to adhere to standard appointment wait times, regardless of provider type. The total health care provider manual is a resource to assist providers and staff in understanding the network structure, products and the policies and procedures of the plan. Behavioral health provider manual april 2016 page 2 introduction our company kepro is a qiolike entity designated by the centers for medicare and medicaid services. Please contact the department of health care services, mental health services division, county support unit if the county contact information needs to be. The 2017 provider manual is effective immediately for providers with executed agreements dated sept. Fy 20 th 4 quarter provider manual for community behavioral health providers april 1, 2020 page 5 of 409 summary of changes table updated for april 1, 2020 effective date posted march 1, 2020. Based on provisions in the affordable care act and effective january 1, 2015, arizona has. Aetna officelink updates nevada preferred healthcare providers.
Oct 26, 2017 services and behavioral health services to long term care members agreements, schn and mercy maricopa pay a monthly fee to aetna, as defined in the. Due to the world health organization declaring coronavirus disease covid19 a pandemic, the west virginia bureau for medical services bms has expanded certain services and waived certain requirements that may be listed in the medicaid provider manual. To see a complete list of behavioral health services requiring precertification, view our list online. Provider manual for california providers 686 mb download pdf. Spring 2015 volume 10, issue 1 aetna behavioral health. English link opens in new window the 2011 provider manual will remain in effect until dec. Aetna better health medicaid and chipchip perinate. The electronic medicaid provider manual contains coverage, billing, and reimbursement policies for medicaid, healthy michigan plan, childrens special health care services, maternity outpatient medical services moms, and other healthcare programs administered by the michigan department of health and human services mdhhs. If you have questions about coverage decisions for one of your aetna behavioral health patients, please call 18886323862. With aetna providing certain management services for innovation health plan, your innovation health patients now have access to the following aetna programs.
The intent of the service provider manual is to present useful information and guidance to providers participating in the louisiana medicaid program. Aetna behavioral health refers to an internal business unit. Aetna behavioral health behavioral health providers by town test provider type. Aetnas office manual for health care professionals is available on our public website. Sep 21, 2015 comprehensive behavioral health provider manual. Chipas clinical practice guidelines help ensure quality care for our members. Unitedhealthcares home for care provider information with 247 access to link selfservice tools, medical policies, news bulletins, and great resources to support administrative tasks including eligibility, claims and prior authorizations. We want to work with you to provide timely, safe and effective health care to our members. Plans and programs for aetna medicare advantage plans participating physicians, hospitals and other health care providers are independent contractors. We are currently finalizing an updated version for the current calendar year. The medicare access and chip reauthorization act of 2015.
Behavioral health care providers can contact staff during normal business hours 8 a. Youll learn which services are covered for our members. This manual details our referral process, quality standards, credentialing and reimbursement process. Providers must ensure services are delivered in accordance with the medicaid service provider manual and. Mercy care provider manual chapter 100 mc general terms. Aetna cook county member countycare transition notice pdf. Ncqa has added an additional standard, which is the care for nonlife threatening emergency appointment, which is within six 6 hours of the request. The policies and procedures referenced herein are subject to change as federal or state. The manuals are updated quarterly throughout each fiscal year july june, and are posted one month prior to the effective date. This manual is an extension of your contract with us. Coordination between behavioral health and physical health services. Ncqa has added an additional standard, which is the care for nonlife threatening emergency appointment, which is. The manual is divided into two major components, a general information and administration chapter and individual program chapters. Aetna offers health insurance, as well as dental, vision and other plans, to meet the needs of individuals and families, employers, health care providers and insurance agentsbrokers.
Provider manual for health care providers upmc health plan. Provider manual health plan contra costa health services. Through the provider handbook, providers should be able to identify information on the majority of issues that may affect working with aetna better health. It has policies, procedures and contact information. View, download and save as a pdf file or print eobs. If a member elects to use amwell for virtual behavioral health services, the members benefit plan must have both the. We hope you find this information and the enclosed documents useful to your office operation and in serving your patients our members. Aetna better health of louisiana 2400 veterans memorial blvd. If you are a licensed behavioral health professional and are interested in joining our provider network, please contact provider relations at 8007793825, then follow the prompts to the appropriate department.
Health plan provider manual september 2015 2777 stemmons freeway, suite 1750 dallas, tx 75207. Learn more about our plans and programs designed to help employees to feel their best, both mentally and physically. The magellan national provider handbook outlines the policies and procedures with which providers are required to comply when serving members whose care is managed by magellan andor its affiliated companies. Aetna behavioral health behavioral health providers by town.
Provider manual this behavioral health provider manual, the eap manual of care residential treatment, partial hospital and intensive. Youll also find information about a wide variety of topics, ranging from how to file a claim to. Virtual behavioral health services are subject to member cost sharing in accordance with their. Aetna behavioral health behavioral health providers by town services provider type. As a upmc health plan member, you have access to much more than topranked care. Aetna behavioral health medical directors are available 24 hours a day, 7 days a week, to discuss specific concerns and provide additional information. Treat mental health andor substance abuse disorders within the primary care providers scope of practice. Care managers will also assure that communication between physical and behavioral health providers occurs. Services mdhhs common formulary that is required under section 1806 of public act 84 of 2015. Policy manual west virginia department of health and. Publications and resources humana behavioral health. Aetna is the brand name used for products and services provided by one or more of the aetna group of companies, including aetna life insurance company and its affiliates aetna. This guide is intended to be used for quick reference and may not contain all of the necessary information.
See more information designed specifically for health care providers. View, download and save as a pdf or print eobs, as needed. Top sites aetna aba provider application 2019 latest. Behavioral health provider resources department of. The hpp provider manual reflects current policies, procedures and applicable changes to our medicaid health partners, chip kidzpartners, and health partners medicare product lines, and is considered an extension of your participating provider agreement. Provider manual for all providers except ca 3 mb download pdf. Provider responsibilities to aetna better health of michigan. Teladoc and teladoc physicians are independent contractors and are not agents of aetna. Providers must ensure services are delivered in accordance with the medicaid service provider manual and any other authorities in effect on the date of service. Well give you valuable tools to help you work with us and provide highquality service to our members.
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