KanCare Training for Providers - Ubhonline.com

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Pre-Specified Authorization Limits Substance Use Disorders Service Level Level 1 Outpatient Services Level 2 Intensive Outpatient Level 3.1 Reintegration Services Level 3.3/5 Residential Intermediate Services Level 3.7D Residential Acute Detox Initial Authorization Limits 60 hours over 6 months 45 days over 15 weeks 30 days 14 days Pending state guidelines • The KanCare program relies on the American Society of Addiction Medicine (ASAM) ) as the criteria used to make determinations for all Substance Use Disorder requests. • For services not included in this chart, you must obtain prior authorization by phone at 855-802-7095. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 12
Authorization Non-emergent situations • Prior authorization can be obtained by a member, family member, or a provider. When calling Optum be prepared to provide demographic information and a brief description of the presenting problem. Optum will explain the services available under their benefit plan. • Authorization phone number: 855-802-7095 Emergent situations • A medical professional, a member, or a lay person in an emergency situation can identify the need for behavioral health services. Conditions that warrant an emergency admission are situations in which there is a clear and immediate risk to the safety of the member or another person as a direct result of mental illness or substance abuse. • Optum must be contacted for a prior authorization of additional care. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 13
Page 1 and 2: KanCare Training for Providers Optu
Page 3 and 4: Introduction to Optum • United Be
Page 5 and 6: Behavioral Health Services
Page 7 and 8: Behavioral Services • Inpatient H
Page 9 and 10: Value Added Services - continued
Page 11: Pre-Specified Initial Authorization
Page 15 and 16: Eligibility and Benefit Review Proc
Page 17 and 18: Appeals and Grievances
Page 19 and 20: Services While In Appeal • You ma
Page 21 and 22: Treatment Record Documentation
Page 23 and 24: Discharge Planning • Effective di
Page 25 and 26: Billing and Claims
Page 27 and 28: Claims Tips To ensure clean claims
Page 29 and 30: Member Information
Page 31 and 32: Member Rights and Responsibilities
Page 33 and 34: Provider and Member Resources An ex
Page 35 and 36: Access to Care - Standards Routine
Page 37 and 38: Provider Responsibilities • Provi
Page 39 and 40: Optum Provider Website • Provider
Page 41 and 42: Network Participation
Page 43 and 44: Joining Our Network If you have rec

KanCare Training for Providers - Ubhonline.com

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