New Update - Notification of Transition of Behavioral Health Services
Submitted by sdunn on Fri, 08/15/2014 - 13:47
August 15, 2014
Dear Provider:
RightCare from Scott & White Health Plan (“RightCare”) values your commitment to serving our members. Effective September 1, 2014, RightCare will be transitioning management of behavioral health services from Beacon Health Strategies to RightCare. This letter provides you with important information related to medical management, contracting, claims, and appeals.
Behavioral Health Case Management, Disease Management and Utilization Management
Telephone: 1-855-395-9652
Facsimile: 1-844-436-8779
Member Crisis Hotline (24/7): 1-844-436-8781
All behavioral health service requests for RightCare members initiated September 1, 2014 and after must be directed to RightCare at the numbers provided above. Beacon Health Strategies will continue to review and authorize inpatient and outpatient service requests for RightCare members through August 31, 2014, as follows:
- Inpatient Services initiated by August 31, 2014. Beacon will continue to be responsible for all inpatient admissions begun by August 31, 2014 until discharge.
Outpatient service requests received by August 31, 2014. Beacon may authorize outpatient services received by August 31, 2014 through dates of services September 30, 2014, as needed.
- RightCare will accept authorizations provided by Beacon, as specified above. RightCare will be responsible for all behavioral health service authorization requests received September 1, 2014 and after; including outpatient and inpatient services, retro-notifications, and retro-requests.
As a reminder, behavioral health providers are required to send a member’s primary care provider reports of the member’s behavioral health status to ensure continuity of care. These updates must be initially, and thereafter not less than quarterly. More frequent updates should be sent if clinically indicated.
RightCare will transition all out of network care into network, where possible. Providers and facilities that were in network via a contract with Beacon Health Strategies but do not have a contract with RightCare, will be out of network and subject to this transition of care.
If you would like to continue providing services to RightCare members after September 1, 2014, you will need to be participating as a contracted and credentialed provider in the RightCare network. If you have not already been contacted by a RightCare Provider Relations Representative and would like to contract with RightCare, please contact the Medicaid Network Manager, Bobbie Weakly, at (254)298-3483 or bweakly@sw.org.
Claims Filing:
There has been no change to claims filing. Participating providers can file claims electronically through Emdeon, RightCare’s clearinghouse. The claims must be submitted using Emdeon’s Payer ID #74205.
Paper claims and corrected claims can be mailed to the following address:
RightCare from Scott & White Health Plan
c/o Valence Health
PO Box 3757
Corpus Christi, TX 78463-3757
Claims Appeals:
Providers who are filing an appeal on a claim decision will need to submit a copy of the Explanation of Benefits (EOB) page showing the claim in question, a claim form, and other supporting documentation including the reason for the appeal to the following address:
RightCare from Scott & White Health Plan
Attn: Claims Appeals
MS-A4-144
1206 West Campus Drive
Temple, TX 76502
Medical Appeals:
Providers have the right to appeal any of the utilization review decisions made by RightCare. The appeals process affords the provider the opportunity to refute a denial, explain, or justify the original request. A denial is used when a pre-certification, authorization, or extension of stay cannot be approved. Adverse determination appeals must be made in writing and mailed to:
RightCare from Scott & White Health Plan
Attn: Dispute Resolution
MS-A4-144
1206 West Campus Drive
Temple, TX 76502
RightCare will continue to provide educational information throughout this transition to make it as seamless as possible. Please check the RightCare website for additional information at
www.rightcare.swhp.org.
Please let us know if you have any additional questions or concerns by contacting Bobbie Weakly at (254)298-3483 for contracting issues and 1-855-TX-RIGHT (1-855-897-4448) for all other issues.
Sincerely,
Joe Kotlarczyk
Associate Vice President, Medicaid Operations