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WELCOME
TO PROVIDERS
The Commonwealth's HealthChoices program and the creation of CBH in February
1997 provided all of us with the opportunity to improve and expand mental health
and substance abuse services for people in need. Achieving this aim requires a
partnership between those managing public resources and those whose clinical
expertise and compassion can make a real difference to the lives of
Philadelphia's most vulnerable citizens. In pursuing that goal, we remain
committed to playing a key role in your success, as you have played a key role
in ours. |
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Please contact a CBH
Provider Relations representative at
(215) 413-7660, if we can be of
any assistance.
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CLICK
HERE TO RECEIVE CBH E-MAIL UPDATES
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National Provider Identifier Q&A |
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Executive
Directors' Meeting |
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Provider
Notices |
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August 14, 2008 |
Executive Directors
Meeting Schedule REVISED (through June 2009) - Click Here - Please
note that the Oct. 1, 2008 meeting was rescheduled for Oct. 15, 2008
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August 7, 2008 |
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Reminder Notice to Current and Prospective Providers:
Please be
advised that unsolicited requests for new programs or program expansions
will no longer be accepted for Community Behavioral Health (CBH)
services. The Philadelphia Department of Behavioral Health and Mental
Retardation Services will utilize Requests for Proposals (RFP) and
Requests for Qualifications (RFQ) to acquire new services or add
providers to the CBH network. Requests for the relocation of existing
services may still be submitted for consideration.
Please
note that the CBH website will be the only
guaranteed
method of notice for CBH-related RFP's and RFQ's. RFP's
and RFQ's are issued under strict requirements and any responses to an
RFP that does not meet the specified requirements, including not
submitting responses within the timelines stated in the RFP, will be
cause for disqualification. We encourage all current and prospective
providers to monitor the CBH website regularly for new contracting
opportunities.
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June 25, 2008 |
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Reminder To All
Providers: Effective July 1, 2008, CBH has instituted a change in
the billing clock which applies to all services provided on July 1, 2008
and later. In order to be considered for payment a
provider must submit a Clean Claim no more than 90 days following the
date of service for all Covered Services. This 90-day
submission requirement includes services requiring an authorization and
services not requiring an authorization.
There is no change to the submission requirements
for Providers pursuing Coordination of Benefits. Providers must obtain
a final determination from the primary payor dated no more than one
hundred eighty (180) days following the date of service and submit a
Clean Claim to CBH within ninety (90) days after receipt of a final
determination from the primary payor.
If Providers have any concerns regarding specific authorizations, which
might affect the timely submission of claims, these concerns need to be
addressed to Nancy Lucas, Chief Executive Officer. |
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June 23, 2008 |
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Notice: - FBI
Fingerprint-based Clearance: Please be advised that beginning July
1, 2008, new and prospective child care service employees will be
required to obtain a FBI fingerprint-based clearance in addition to the
PA State Police Clearance and PA ChildLine Clearance as a condition of
employment.
Click here to view more information on the requirements, and who is
required to have these clearances. |
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June 17, 2008 |
Notice: On July 1st, all non-parent based
EDI Browser logins will be disabled. The only logins allowed to submit
and retrieve claims information will be the logins starting with
par_XXXX. Question and Answer sessions will be held on June 25, 2008
from 1:00 PM to 4:30 PM at CBH (small conference room) to discuss
any questions you may have about this change. Please Fax
(215-413-7552 ) all questions by June 24, 2008 to your
Provider Relations Representative prior to these sessions to
ensure ample discussion of all relevant information.
Providers A-G
1:00 PM to 2:00 PM
Providers H-P 2:15
PM to 3:15 PM
Providers Q-W 3:30
PM to 4:30 PM
Click
here to see the answers to provider-submitted questions. |
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June 2, 2008 |
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NPI/Claims Processing Notice:
A large
number of electronic claims are still being submitted without the NPI
number. If you are in doubt as to whether or not you are sending a NPI
within your claim file, it is recommended that you do the following:.
1) Open your
claim file within a text editor program.(Microsoft Notepad will suffice
for most files)
2) Search
for the pattern XX. You should find it on a line that starts with NM1
and in the NM108 segment. The NPI number will be the in the NM109
segment.
For Example:
NM1*85*2*Your Company Name*****24*123456789
This is the provider's TAX ID, not the provider's NPI.
NM1*85*2*John Doe INC*****XX*1234567890
This is an example of a provider's NPI.
For further reference, please
refer to the National Implementation Guides for the 837I and 837P |
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May 30, 2008 |
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Providers who previously used a “dummy” (CBH
created) Promise ID for billing, you must have a NPI number "crosswalked"
with that Promise ID. If your newest Schedule A does not reflect
both a Promise ID MAID and a NPI, please contact your provider
representative to discuss and determine what NPI number should be
associated with your dummy Promise ID. Without this
relationship/crosswalk in place, your claims will reject. |
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May 22, 2008 |
NPI Information: As with the current
Promise Provider # Logic, the Service Line NPI # is the NPI # used in
adjudication logic. Specifically, any authorization number verification
and contract verification in the claims logic will use the Service Line
NPI #.
Providers need to verify that the Service Line NPI # is associated with
the provider's contract and, if applicable, authorization numbers. |
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May 13, 2008 |
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Click here to complete the Provider Survey: Serving LGBT Communitites |
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May 13, 2008 |
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NPI Questions and Answers |
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May 8, 2008 |
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Special
Pharmacy Benefit Program For Mental Health |
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April 25, 2008 |
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NPI Update Regarding CBH Claims
Processing |
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April 10, 2008 |
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Psychological First Aid Training Document |
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Psychological First Aid Training Registration Form |
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March 25, 2008 |
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Effective May 1, 2008, CBH will require that all physicians have
National Practitioner Data Bank (NPDB) queries completed, at a minimum,
every two years. The current policy, as stated in the CBH credentialing
manual, indicates that these checks are to be completed every five
years. This change is being effected in order to bring this check in
line with the requirements for other background checks (child abuse and
criminal history) that currently stand at every other year.
Credentialing teams will be requesting that evidence of these completed
queries be provided to them for all physicians employed at a provider at
the time of their initial or re-credentialing audit. Copies of these
forms will be provided to the audit team to retain for the CBH provider
file as well.
In the coming days we anticipate release of the
first in the series of new scoring tools reflecting specific levels of
care and/or provider specialties. You will notice that the new standard
for NPDB queries is included in these tools, but will NOT be enforced
until the May 1, 2008 date. |
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March 24, 2008 |
AACO AMBULATORY/OUTPATIENT HIV MEDICAL CARE
SERVICES REQUEST FOR PROPOSALS
The AIDS Activities Coordinating Office (AACO), a Unit under the
Division of Disease Control within the Philadelphia Department of Public
Health, is seeking applications from HIV experienced non-profit agencies
in the 9-county Philadelphia eligible metropolitan area, to deliver
Ambulatory/Outpatient HIV Medical Care for Persons Living with HIV/AIDS.
Applicants should attend a technical assistance conference to be held on
March 28, 2008 at 1pm at 1101 Market Street,11th floor. Applicants must
submit a Letter of Intent no later than April 2, 2008. The Application
Deadline is no later than 12:00 o'clock Noon, Monday, April 21, 2008.
Late or incomplete proposals will not be accepted. Eligible applicants
are non-profit organizations that are currently funded by AACO for this
service with satisfactory past performance or new organizations who
serve a significant number of HIV patients and have demonstrated HIV
expertise as defined in the RFP (posted at www.phila.gov/RFP/Index.htm).
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AACO MEDICAL CASE MANAGEMENT SERVICES REQUEST
FOR PROPOSALS
The AIDS Activities Coordinating Office (AACO), a Unit under the
Division of Disease Control within the Philadelphia Department of Public
Health, is seeking proposals from HIV experienced non-profit agencies in
the 9-county Philadelphia eligible metropolitan area, to deliver Medical
Case Management services for Persons Living with HIV/AIDS. Applicants
should attend a technical assistance conference to be held on March 28,
2008 at 2pm at 1101 Market Street, 11th floor. Applicants must submit a
Letter of Intent no later than April 2, 2008. The Application Deadline
is no later than 12:00 o'clock Noon, Monday, April 21, 2008. Late or
incomplete proposals will not be accepted. Eligible applicants are
non-profit organizations currently funded by AACO for Medical Case
Management with satisfactory past performance, or new organizations who
serve a significant number of HIV clients and have providers with
demonstrated HIV expertise in Case management. (The RFP is posted at
www.phila.gov/RFP/Index.htm.) |
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February 22, 2008 |
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Individual Credentialing Certification Form
Policy Revision |
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February 21, 2008 |
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Practice Parameters - American Academy of Child & Adolescent Psychiatry |
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January 28, 2008 |
NATIONAL PROVIDER
IDENTIFIER (NPI) ALERT
Please note that it is absolutely necessary for all
providers to:
1) Acquire
National Provider Identifier (NPI), subpart, taxonomy;
2) Remember
to register your National Provider Identifier (NPI) with the
state;
3) Submit
verification of this information to your Provider Relations
Representative.
Please remember to register your National
Provider Identifier (NPI) with the state. If the National Provider
Identifier (NPI) is not registered, The Commonwealth of Pennsylvania and
Community Behavioral Health will not acknowledge an unregistered
National Provider Identifier (NPI). Payment will not be issued.
This information is mandatory for the
processing of all claims beginning on 5/23/2008. Understand that
no payment will be issued without the appropriate information.
For more information, please refer to
http://www.dpw.state.pa.us/PartnersProviders/MedicalAssistance/DoingBusiness/NPIinfo/ |
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September 6, 2007 |
DVHC is forwarding the attached information
as a follow up to the HealthChoices meeting regarding the Senior
Partners transition. Attached for your review please find:
Information on the Senior
Partners transition of members to Bravo Health
If you have any questions or comments, please contact Pam Clarke at
pclarke@dvhc.org or 215-575-3755. |
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August 1, 2007 |
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Change in Valid CPT Code For
Laboratory CPT Code
85031 Bllod Count Hemogram Manual, Complete (RBC, WBC, HGB, HCT,
Differential & Indices) is no longer valid and will be terminated as of
August 31, 2007. The replacement codes, effective, January 1,
2007 are listed below. We prefer that any billing prior to August
31, 2007 end date will be submitted with the new CPT codes. Claims
will not be accepted using CPT Code 85031 beginning September
1, 2007, please plan accordingly.
600-125 85014
Blood Count; Hematocrit (HCT)
600-127 85018
Blood Count; Hemoglobin (HGB)
600-126 85032
Blood Count; Manual Cell Count (Enthrocyte, Leukocyte, or Platelet)
If you have any questions regarding this
change please contract your Provider Relations Representative. |
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July 17, 2007 |
The following CME Course is being offered by
ASAM:
Best Practices: Clinical Drug Testing in Addiction Treatment V
September 22, 2007
Location: The Loews Philadelphia, Philadelphia, PA
Contact: (301)-656-3920 |
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June 29, 2007 |
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Performance Measure Development Phase I & II Draft Report |
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May 22, 2007 |
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New Paper Claim Form PROMISe Number Location |
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May 10, 2007 |
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Invitation
to Provider Agencies Regarding Performance Measure Development |
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April 30, 2007 |
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Department of Public Welfare NPI
Initiative Contingency Plan |
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April 10, 2007 |
Following the NPI Contingency Plan
announcement by CMS on Monday, April 2, 2007 and PA Department of Public
Welfare (DPW) announcement (See the links below), CBH has begun to
examine options for implementing a NPI Contingency Plan. Once DPW
announces a final decision regarding their plan (expected the week of
April 16, 2007), CBH's own contingency plan will shortly follow.
CBH's overall goal is to try ensure that the NPI process has minimum
impact upon the normal claims payment/adjudication cycle; therefore,
minimizing the financial impact upon CBH's provider community.
In the meantime, providers are expected to submit their legacy Promise
ID's on all 837 transactions as per the CBH implementation guide. In
addition, providers are encouraged to pursue the acquisition of an NPI
if they have not done so and to register said NPI with DPW. |
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http://www.dpw.state.pa.us/Business/NPIinfo
http://www.cms.hhs.gov/NationalProvIdentStand/01_Overview.asp#TopOfPage |
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IMPORTANT REMINDER
Have you obtained and registered your
National Provider Identifier (NPI)
number with the Department of Public Welfare? Don’t
delay! Register with Medical Assistance by
April 16, 2007 to
ensure smooth claims processing during the implementation of NPI.
Learn more about it at
http://www.dpw.state.pa.us/Business/NPIinfo/
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February 12, 2007 |
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See two new Provider Bulletins on the
Bulletins page. |
State Allowable
ICD-9-CM Codes
Claims Adjustment Procedure
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February 9, 2007 |
Change in Valid CPT Code
The state has notified CBH that CPT code
96100 is no longer valid and must be terminated. The replacement code
has been identified as 96101, and can be used effective immediately.
Claims will not be accepted using code 96100 beginning March 1, 2007,
please plan accordingly. The levels if care effected are:
300-7 Outpatient Psychiatric – Psychological Testing
350-7 Outpatient D&A – Psychological Testing
400-5 BHRS – Diagnosis Intellect Evaluation
400-6 BHRS – Diagnosis Personality Evaluation
400-9 BHRS – Children’s Diagnostic Psy. Eval. Evaluation
If you have any questions regarding this change please contact your
Provider Relations Representative. |
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January 19, 2006 |
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As indicated in a letter dated November 15,
2006 sent to our in-network providers, CBH is moving forward with the
elimination of the routine production of hard copy payment details.
January 31, 2007 will mark the first check distribution that will NOT
include hard copy payment details. Should you have questions or concerns
please contact your Provider Relations Representative. |
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December 15, 2006 |
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Payment Details |
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As stated in a letter sent to all providers,
we are pleased to announce the next step in the continued modernization
of Community Behavioral Health’s (CBH) information sharing with its
provider community. We have made strides in making claims submission to
CBH more streamlined and efficient through electronic submission of
claims. As we continue this process, the logical next step is that CBH
will no longer be sending hard copy payment details and rejection
reports effective January 1, 2007. Please begin to plan accordingly for
this change within your organization. We believe the use of electronic
reports via the FTP process will be more efficient than the current
paper report process. Should you have questions or concerns please
contact your Provider Relations Representative at (215) 413-7660. |
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December 8, 2006 |
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TPL Matrix Update Notice on Clozaril
Support |
CBH has made adjustments to its TPL Matrix
for level of care 300-26 Clozaril Monitor & Evaluation and 300-27
Clozapine Support Services. For the past five months, we CBH has
required Providers to coordinate benefits for Dual Eligible Members that
have primary coverage with Medicare or Medicare Advantage HMO Plans and
CBH. We have now adjusted our system to pay as the primary payor for
those Dual Eligible Members covered by Medicare, Keystone 65/Magellan
and Elder Health/CompCare. Providers must coordinate benefits with
Senior Partners/MH NET.
Claims exceeding the timely filing limit related to these changes must
be submitted to the attention of Eric K. Jones, Director of Claims
Management by 12/20/06 for appropriate handling. |
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August 21, 2006 |
Medicare and Medicare Advantage HMO
Provider Exceptions Notification
It has come to our attention that some providers within our network are
not aware of the changes made around dual eligible members
(Medicare/Medicaid).
The DPW Policy Clarification regarding dual eligibles has required CBH
to end date Medicare and Medicare Advantage HMO provider exceptions as
of 6/30/06. CBH will not cover as primary insurer a service which is
covered by Medicare or Medicare Advantage HMO plans. This includes
Medicare services where the provider is not enrolled in Medicare or
Medicare Advantage HMO plans. CBH is prohibited from paying for a
Medicare covered service simply because the provider is not enrolled in
Medicare or Medicare Advantage HMO plans. It is incumbent upon the
provider to either enroll in Medicare or Medicare Advantage HMO plans,
refer the member elsewhere, serve the member at no cost to them, share
the cost with the member, or the member may elect to pay out of pocket. |
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PHILADELPHIA DEPARTMENT OF BEHAVIORAL HEALTH
AND MENTAL RETARDATION SERVICES |
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APPLICATION FOR
NEW/EXPANDED
BEHAVIORAL HEALTH SERVICE PROGRAMS
March 2007
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PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE |
Mobile Mental Health Treatment
PA DPW Medical Assistance Bulletin
and DBH/MRS Summary |
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Behavioral Health Fee For Service
Transfer from OMAP to OMHSAS
PA DPW Bulletin
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