RAVI’S PROVIDER UPDATES
Dear Summit County Mental Providers,
Thank you to those of you who attended our Provider Insurance Webinar. This email is a recap and also contains resources shared in this event.
1. Zoom event recording link:
- Must get credentialed with CO State Medicaid first (Health First CO) and then contract with Rocky Mtn Health Plans as they are the administrator and payer of Medicaid for our region.
- Pre-authorization is needed to extend therapy beyond 12 sessions on Medicaid for the 60 min psychotherapy CPT Code (90837).
- The form is available here: https://www.rmhp.org/i-am-a-
provider/provider-resources/ commonly-used-forms-for- providers
- The exact form for RMHP pre-auths is here: https://www.rmhp.org/-/media/
RMHPdotOrg/Files/PDF/Provider/ Prior-Authorization/CM95_ PreauthRequest_Pyschotherapy_ 90837_Form.ashx
- Make sure you verify benefits. Very important as last minute changes could have occurred or issues on the insurance company’s end can be uncovered.
- Benefits Verification is a quote and not finalized, and Explanation of Benefits is the final receipt of service.
- Denny will handle all phone calls to insurance companies except issues around credentialing (service location, rates, in-network status).
- Get set up with Direct Deposit! This is not something TheraThink can help with, you will have to go through your credentialing contact.
- Electronic payments are much faster than receiving a check.
- Billing time frames can be severely impacted by “unclean” claims (up to 75 days). 30 days on avg for “clean” claims.
- Reference attached PDF for what TheraThink does and does not do in terms of scope and boundaries.
- Reach out to TheraThink as first contact over email in order to troubleshoot problems.
- Check attached PDF for best practices when taking insurance: “Dos and Don’ts”
- Input client appointments once every few weeks – use “add multiple appts”
Peak Health Alliance:
- Peak is a “health insurance purchasing alliance” – negotiate rates directly with hospitals and insurance companies in order to reduce premiums, increase benefits, and increase reimbursement rates to providers.
- The majority of Bright plans have a $0 copay except for the HSA and catastrophic plans.
- Bright’s reimbursement will increase to $170 for a 60 min session starting in April 2021.
- Availity is a provider portal that is a helpful resource (in case you decide on to use TheraThink)
- There are different payment methods available. If you DO NOTHING, you will get paid through the credit card. If you want to set up something else, call Vpay.
Provides an overview of TheraThink’s roles and responsibilities and tips and tools for billing insurance.
Provides simple details of Peak’s insurance offering for 2021
Quick Reference Guide
Claims and Payments