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Health Plan of Michigan Behavioral Health Transition FAQ Q: What
are the advantages of Health Plan of Michigan? Health Plan of Michigan provides a wide range of both preventive and therapeutic health care services to its Medicaid population. HPM takes great pride achieving high standards regarding HEDIS measures and implements technically advanced actions to ensure its success. Q: What is MCS? A: Health Plan of Michigan has implemented an innovative Managed Care System (MCS), which allows online authorizations to be viewed, created and authorized by our PCPs, Specialists and Hospitals. In addition to referrals and authorizations, providers may view specific preventive health care services needed for their own patients, verify eligibility and status claims online. The MCS is a real time information system that all contracted providers have access to free of charge. Q:
How can I apply to HPM? To receive information on becoming a contracted Provider with Health Plan of Michigan, please contact our Provider Services Department at (888) 773-2647 or email kwalker@hpmich.com. Q:
What are my contract options as
a health care provider in the HPM network? Hospital Providers: Communication is the key to all mutually beneficial relationships. In this regard, HPM makes every effort to partner with each contracted Hospital in coordinating the care of its beneficiaries. Hospital Providers can count on Health Plan of Michigan to help serve the members of their community with as little interference as possible. For more information see the links below. Thank you for your participation as a Health Plan of Michigan (HPM) Behavioral Health Provider. We are committed to ensuring a seamless transition from CompCare to HPM. Effective January 1, 2010, you will no longer need to contact CompCare to arrange for behavioral health services. Instead, Health Plan of Michigan will be your primary contact. The toll free phone number to arrange these services remains the same. It is 1-888-222-8041. What is the behavioral health benefit for HPM members? Twenty (20) outpatient visits per calendar year. Do I need to obtain an initial authorization? No. HPM provides up to ten (10) outpatient visits without prior notification. How do I request additional visits after the 10th visit? HPM requires notification if you anticipate the member will require greater than 10 visits for treatment. The notification must include the DSM –IV diagnosis, reason for continued treatment, and status of PCP notification. Refer to “HPM Continued Outpatient Treatment Notification form,” the form may be faxed to: 313-202-1268. Do I need to obtain authorization for psychological testing? No. Up to 5 hours of testing is permitted using either CPT code: 96101 or 96102. The tests and measures must be rendered by full, limited-licensed, or temporary-limited-licensed psychologists. Who do I contact if I have questions regarding a Member’s eligibility? HPM Member Services Department at: 1-888-437-0606 Who do I contact if I have questions regarding my Provider affiliation status or general question related to HPM? HPM Provider Services Department at: 1-888-773-2647. Can both the Psychiatrist and the Therapist who are engaged in the same episode of care each bill for a 90801? No, HPM reimburses for one “Psychiatric diagnostic interview examination” (CPT Code 90801) per year per provider group. If a member appears to be suffering from a Severe Mental Illness (SMI) how do I connect the member to Community Mental Health (CMH)? Call the HPM Behavioral Care Department at: 1-888-222-8041 to notify us of your evaluation. Our staff will coordinate the referral services with the member’s CMH center. When do I need to coordinate care with the PCP via written notification? After the initial assessment. Send claims for dates of service after January 1, 2010 electronically or mail to: Health Plan of Michigan Claims for dates of services in 2009 should be sent electronically or mail to: Comprehensive Behavioral Care, Inc. |
