Frequently Asked Questions - Ubhonline.com

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and Human Services has adopted a standard) use NPIs in standard transactions. Please use the National Plan and Provider Enumeration System (NPPES) link below to obtain an NPI: https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.npistart Q3. How do I verify a member’s benefits, copay, or coinsurance? A3. To inquire about member benefits, copay or coinsurance, please call the number on the member’s insurance card listed for providers or for benefits and eligibility information. Q4. What services are covered for Autism ABA services? A4. Coverage is dependent upon the member’s certificate of coverage. Services that are typically covered for ABA treatment include: • Skills or Behavior Assessment by BCBA or qualified licensed clinician • Conjoint Treatment Planning and Supervision of Paraprofessionals by BCBA (or qualified licensed clinician) with clients present • Direct ABA services by a BCBA or licensed clinician • Direct ABA services by a paraprofessional or BCaBA (if appropriately supervised) Q5. How is supervision by a BCBA defined? A5. Supervision of a BCaBA or a paraprofessional by a BCBA or licensed clinician is defined as services rendered jointly, in-person, during directly supervised fieldwork of the paraprofessional or BCaBA by the supervisor. Q6. How do I obtain an authorization/notification for ABA services? A6. After verification of benefits is received for ABA services, the intake coordinator refers the request to an Autism Care Advocate, who will contact you to coordinate the review process for appropriate treatment. Q7. I faxed in my authorization/notification request packet, how long does it take to get a determination? A7. You should receive a phone call about your authorization/notification within 10 calendar days of sending in your completed packet. You will also receive a paper copy in the mail. Your submitted packet includes; diagnostic assessment, treatment plan, release of information, and the behavioral benefit assessment form. Where mandated by state law, the packet must include a physician prescription for services. You will also receive a paper copy in the mail or by fax. Once the packet is received, if we determine that additional information is needed before an authorization/notification can be generated, you will receive a phone call from the Autism Care Advocate requesting the necessary information. You will also receive a letter in this regard, and will have 45 days in which to provide the requested information in order to complete the authorization/notification review process. Q8. When do I submit my request for continued services? A8. You should submit the information needed for the next review within one week of the current authorization/notification expiring. Please submit an updated treatment plan, quantitatively detailing the member’s progress. 2 Oct 2013 United Behavioral Health operating under the brand Optum U.S. Behavioral Health Plan, California doing business as OptumHealth Behavioral Solutions of California
Q9. How do I request hours for supervision of BCaBAs and paraprofessionals, and how many are allowed? A9. Please request hours for supervision and treatment planning on the Behavioral Benefit Assessment form. A minimum of one hour of supervision per month is expected for each case. The maximum hours approved are based on the member’s direct hours, (i.e., one hour supervision for every ten hours direct service not to exceed eight hours per month). All services must be authorized by an Autism Care Advocate. If you have a need for more than this, please include your rationale in the request and it will be reviewed for clinical necessity. Q10. Do you cover treatment planning? A10. Treatment planning is an expected part of member care. A minimum of one hour of treatment planning per month is required. You may request up to one hour for every ten hours of direct service, not to exceed eight hours per month. If you have a need for more than this, please include your rationale in the request and it will be reviewed for clinical necessity. Q11. What should be in the treatment plan? A11. Required elements are included in the Treatment Plan template. This template is housed on the Autism Corner page of Provider Express. Q12. How do I request hours for an ABA assessment? A12. You will need to fill out an ABA Assessment Request Form. You can obtain this form on Provider Express, in the Autism/Applied Behavioral Analysis Corner. You can fax the completed form to your assigned Autism Care Advocate. Q13. Should I include a request for my next assessment? A13. If you are requesting less than six hours for a re-evaluation, please include this on the Behavioral Benefit Assessment form (list the assessments you will be using). If you are requesting more than six hours of testing, you will need to complete the ABA testing request form. Q14. What forms do I use to submit claims? A14. Participating ABA agencies and individual BCBAs should bill on the standard CMS-1500 claim form with the billing codes indicated on your contracted fee schedule. Please see our website Provider Express and go to Quick Links > Claim Tips >Outpatient Claims > CMS-1500 claim form to see a sample CMS-1500 claim form and view Required Fields. If you are out-of-network and have the capacity to generate a CMS-1500 form, please do. If you are interested in using CMS-1500 forms, you may get more information at www.cms.gov. Q15. I am a contracted provider. What procedure codes should I use to bill services? A15. If you are a participating provider, you should bill your contracted billing codes and customary charges after receiving appropriate authorization. You will be reimbursed based on your contracted rate. 3 Oct 2013 United Behavioral Health operating under the brand Optum U.S. Behavioral Health Plan, California doing business as OptumHealth Behavioral Solutions of California
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Frequently Asked Questions - Ubhonline.com

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