Applied Behavior Analysis (ABA) Provider Update 2015...1 Applied Behavior Analysis (ABA) Provider...
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1 Applied Behavior Analysis (ABA) Provider Update 2015 August 2015 ValueOptions, Inc. is a Beacon Health Options company.
Transcript of Applied Behavior Analysis (ABA) Provider Update 2015...1 Applied Behavior Analysis (ABA) Provider...
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Applied Behavior Analysis (ABA)
Provider Update 2015
August 2015
ValueOptions, Inc. is a Beacon Health Options company.
Objectives
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Overview of AMA CPT® Code Changes
Impacted CPT Codes
Authorization Procedures & Claim Submission
Accessing ProviderConnectSM
Contact Information
Questions
CPT® is a registered mark of the American Medical Association.
Overview of CPT Code Changes
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American Medical Association’s (AMA) CPT codes are meant
to reflect services as they are actually rendered
Two codes may now be used to provide a method for billing
supervision services
New services have been added for severe behavior
• Meaning child is at risk for hurting him or herself, others or
property
• These codes carry higher rates and are intended to have support
built into the service to protect the patient and provider
Indirect services (case management) will no longer be covered
Additional new services include parent training without the
child (single and multiple families)
Association of Professional Behavioral Analysts (APBA)
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Recently an agreement was reached for ABAI, APBA, the Behavior
Analyst Certification Board, and Autism Speaks to be co-applicants
on a proposal to modify the codes before they become permanent.
APBA will be represented on the Steering Committee that will guide
development of the code change proposal by Executive Director
Gina Green, with Board member Bryan Davey serving as the
alternate.
APBA has also nominated several providers and health plan
representatives to the workgroup that will develop the proposal, and
will make every effort to solicit input from others.
If you have suggestions for modifying the Category III CPT codes,
please send them to [email protected].
Impacted CPT
Codes
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ValueOptions, Inc. is a Beacon Health Options company.
AMA ABA Code Crosswalk – effective August 15, 2015
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This crosswalk is also posted on our ABA Network-Specific page
AMA ABA Code Crosswalk – Cont’d
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AMA ABA Code Crosswalk – Cont’d
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Additional information, included an updated FAQ, is posted on our ABA Network-
Specific page
Summary
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AMA CPT codes are meant to reflect services as they are
actually rendered
• Note new services added
Indirect services (case management) will no longer be covered
PLEASE NOTE: CPT code interpretations are meant for
applicable ValueOptions’ contracts ONLY
• New CPT codes may not apply to all ValueOptions’ contracts
• Other health plans may interpret codes differently
Begin billing using the new codes effective August 15, 2015
Authorization
Procedures &
Claim Submission
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ValueOptions, Inc. is a Beacon Health Options company.
Authorizations & Claims
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• Submit new or continued authorizations using the new AMA
ABA coding
• Billing using the new codes began effective August 15, 2015
• Note: All providers will move to the new coding structure
unless instructed differently based on contract requirements
or by a Clinical Care Manager related to a specific
authorization
• Providers are strongly encouraged to submit all claims and
authorization requests via our online portal, ProviderConnect
Submission Guidelines
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Efficiently submit requests electronically through ProviderConnect
Enter an Authorization Request
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Disclaimer
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Search a Member
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Member Demographics
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Select Servicing Address
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ABA Assessment
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ABA Assessment
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ABA Assessment Behavioral Diagnosis
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ABA Assessment Medical Diagnosis
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ABA Assessment Social Elements Impacting Diagnosis
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ABA Assessment Results
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ABA Services
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ABA Services
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ABA Services Behavioral Diagnosis
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ABA Services Medical Diagnosis
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ABA ServicesSocial Elements Impacting Diagnosis
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ABA ServicesCurrent Impairments and Skill Impairments
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ABA ServicesProgress
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ABA ServicesRequested Services
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ABA ServicesRequested Services
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ABA ServicesRequested Services
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ABA ServicesResults
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Concurrent Request
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Concurrent Request
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Concurrent Request
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Additional information requested from
ValueOptions Clinician
Things to keep in mind going through
Concurrent request
Paper ABA Forms
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For forms, visit www.ValueOptions.com
and click on “Providers” and “Forms,” and
then look for “Clinical Forms” on the right
side of the page
ABA forms are at the
bottom of the page on
the left
Direct Claim Submission
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Provides ability to enter a claim directly into ProviderConnect
portal without using special software
Expedites processing of the claim and payment
Available for professional services only, not higher levels of
care
Recommended for providers submitting a lower volume of
outpatient claims
Direct Claim Submission
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Direct Claim Submission
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Direct Claim Submission
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Direct Claim Submission
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Direct Claim Submission
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Must be
Capital
Letters
Direct Claim Submission
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Lowercase
Letter
creates error
Direct Claim Submission
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Summary Page
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Accessing
ProviderConnect
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ValueOptions, Inc. is a Beacon Health Options company.
Registering Option 1: Online
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On the right side select “Getting
Started,” then “Register”
Complete Registration page
**Note: The online registration process
includes e-signature for claims access
Registering Option 1: Online
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Registering Option 2: Account Request Form
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Go to www.ValueOptions.com, choose
“Providers”
Choose “Forms” under Overview on the
right side of the screen, then click
“Administrative Forms”
Under ProviderConnect Forms choose
“Online Services Account Request Form”
Complete the form and fax to the fax
number indicated on the form
Registering Option 2: Account Request Form
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Logging into ProviderConnect
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Access the ABA Network Specific page:
http://valueoptions.com/providers/
Network/Applied_Behavior_Analysts.htm
Click “Log In” under ProviderConnect on
the right side of the screen
Logging into ProviderConnect
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Additional Resources
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EDI Helpful Resources
• Provider Connect User and Getting Started Guides
Short Video Tutorials
• Viewing Member’s Eligibility
• Viewing and Submitting Authorizations
• Direct Claim Submission Process
• Batch Claim Submission Process
• Re-credentialing
Personalized Training
• Scheduled at your convenience
• Available to just one employee or your entire office
• Training topics customized based on needs
Contact Information
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ValueOptions EDI Helpdesk
(ProviderConnect Technical Questions)
Monday through Friday, 8:00 a.m. - 6:00 p.m. ET
Phone: (888) 247-9311
Email: [email protected]
Provider Service Line
(Training Requests)
Monday through Friday, 8:00 a.m. – 8:00 p.m. ET
Phone: (800) 397-1630
If you have suggestions for modifying the Category III CPT codes,
please email them to [email protected]
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Thank you!
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