Our initial blog brought up the question of what insurance companies you are enrolled in, and which you are currently seeking enrollment. We were also looking to answer any questions you may have, so that we could collectively answer them. One question that could use further clarification is based on Medicaid reimbursing BCBAs and their hours structure. Through our personal experience, The Public Health Trust (UMBH) will cover ABA therapy if the recipient is under CMS Title 21. If you have any further information, please feel free to post a comment below.
Also, a company was discussed during a meeting with Gina Green that does credentialing work at the rate of $3,500 for agency and $2,500 for individual providers. This covers 8 major insurers such as Humana, BCBS, Aetna, etc. We are looking for the name of this company. If you have any information on the company, how to reach them, and/or which providers they work on credentials for, your input would be appreciated.
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I'm not familiar with UMBH. Is it authorized through CMS?
ReplyDeleteThis may be the company you are looking for for credentialing. I have spoken to them, but decided to do the work ourselve as we are already in the process. They can be helpful to others. Lisa Scott: (727) 492-9592 (cell), lscott383@msn.com.
UMBH is University of Miami Behavioral Health. They handle the mental health patients for Medicaid (as does Magellan) and are covering ABA services under CMS Title 21 at this time. So far we only have one single case agreement as they are still working on their credentialing process.
ReplyDeleteThank you Jing for the information on the credentialling people, I think we might continue on our own as we too are in the process.
I hope the above information helps.
I am not very familiar with most of the information discussed here so any help you all can provide would be greatly appreciated. I work in Bay County for the Florida State University and have several clients that receive Medicaid. I am so happy to see that medicaid is approving case by case basis and providing services und Title 21 but I have no idea what that is. Can someone please tell me how to find out more information about this so that we can see if our clients can start to receive funding? Thank you so much
ReplyDeleteThe CMS Network is one of four Florida Kid Care options. Family's who meet the financial eligibility requirements for Title XXI KidCare and whose child has a special health care need qualify for the CMS Network.
ReplyDeleteInformation can be found at the following website:
http://cms-kids.com/cmsnetwork/eligibility.html
I wanted to touch base with everyone regarding Medicaid coverage for ABA therapy. I am Cary the Office Administrator for New Way Day Services. Our office was receiving at least 20+ or so calls weekly from parents requesting ABA therapy through Medicaid. After one such call, I stepped out of the office and went to my local Medicaid Program Office to inquire if Medicaid was covering or going to cover ABA Therapy and if so how it would be covered. I basically wanted to let the parents know what they needed to do so their children could receive the therapy.
ReplyDeleteI spoke with someone who explained that for children with Autism who have Medicaid it would be covered under Magellan or UMBH. I again asked to be sure they were talking about ABA Therapy and they stated it would be covered under Magellan or UMBH. I took that and ran with it back to my office. I was excited to have an answer to give the parents.
We had been contacted by UMBH and we sent in a request for application from Magellan. Some of the children already had UMBH and they contacted UMBH to request services. This is where we found out how it was it being covered with UMBH. We were told that it will be covered under CMS Title XI only. We are not sure how Magellan is covering the service because we were not granted an application. We will resubmit another request for application from Magellan and see what happens.
With that said, we are giving the parents the links to CMS and Florida Medicaid so they can call and see if they qualify for CMS Title X1.
Now as far as codes go, UMBH is using Appendix P from the Florida Medicaid Handbook for Community Behavioral Health. They are HCPC codes I believe because they are the same as the waiver codes with different modifiers.
If you should have any questions, please feel free to contact us at 305-597-3861.
A few things have been going on in the last week or so. I have the contact information for Lisa Scott who is assisting BCBA's with their credentialling for insurance companies. Her number is 727-492-9592, her email address is lscott383@msn.com.
ReplyDeleteAlso with regards to credentialling I have found that some of the bigger insurance companies use Council for Affordable Quality Healthcare (CAQH) which is a service used by the insurance companies to find credentialed providers. We have been able to register one of our BCBA-D's and we are awaiting confirmation that her registration is complete. You might want to find out which insurance companies use CAQH and see if they have issued you a number so that you can register. You can find their information on our website http://www.newwaydayservices.org
Thanks for sharing this recommendation.......
ReplyDeleteMedical Credentialing Services