Became operational November 1, 1979Chartered in West Virginia and domiciled inOhio as a 501-C-4 Non-Profit CorporationLice...
HANCOCK                                                                          BROOKE                                   ...
24 additional West Virginia Counties  Over 2100 New Providers  27 New HospitalsTertiary Facilities Include:
All contracting and service items (newproviders, claims inquiries, questions, etc.)serviced by Health Plan directlyNo Prog...
Coverage of Autism Spectrum           DisorderWV Legislative mandate for coverage effectiveJanuary 2012Large employer grou...
Establishing the Diagnosis of Autism         Spectrum Disorder Primary Care Physician (PCP) completes ASD screenings as pe...
Establishing the Diagnosis of Autism         Spectrum Disorder Once diagnosis is confirmed, coverage for autism treatment ...
Covered services: Applied Behavior Analysis provided and/or supervised by a Board Certified Behavior Analyst (BCBA) Inform...
Coverage of ABA Initial authorization:    Results of screening and scaling    Functional Behavioral Assessment    Goals   ...
Continuation of ABA Behaviors and interventions identified on initial authorization form Improvements and achievements Sup...
Billing for ABA Evaluation and Management Codes from Current Procedural Terminology have been assigned to various levels o...
Autism stakeholders meeting presentation (1)
Autism stakeholders meeting presentation (1)
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Autism stakeholders meeting presentation (1)

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Autism stakeholders meeting presentation (1)

  1. 1. Became operational November 1, 1979Chartered in West Virginia and domiciled inOhio as a 501-C-4 Non-Profit CorporationLicensed to do business in Ohio & West VirginiaExpanded into North Central WV in 1994Expanded Statewide 2010 / 2011
  2. 2. HANCOCK BROOKE OHIO PENNSYLVANIA MARSHALL WETZEL MONONGALIA MARYLAND MORGAN MARION BERKELEY OHIO TYLER PRESTON MINERAL HARRISON HAMPSHIRE PLEASANTS TAYLOR JEFFERSON DODDRIDGE WOOD RITCHIE BARBOUR GRANT TUCKER HARDY WIRT GILMER LEWIS JACKSON CALHOUN UPSHUR MASON RANDOLPH ROANE BRAXTON PENDLETON PUTNAM WEBSTER CLAY VIRGINIA CABELL KANAWHA NICHOLAS POCAHONTAS WAYNE LINCOLN BOONE FAYETTE GREENBRIER LOGAN MINGO RALEIGH SUMMERS WYOMING MONROEKENTUCKY MERCER MCDOWELL
  3. 3. 24 additional West Virginia Counties Over 2100 New Providers 27 New HospitalsTertiary Facilities Include:
  4. 4. All contracting and service items (newproviders, claims inquiries, questions, etc.)serviced by Health Plan directlyNo Programs or Services Carved OutHealth Plan requires credentialing of allproviders including extendersContact Provider Relations (800) 624-6961Ext. 7633 for contracting information
  5. 5. Coverage of Autism Spectrum DisorderWV Legislative mandate for coverage effectiveJanuary 2012Large employer groups required to cover: inpreceding year averaged over 25 eligibleemployeesCoverage effective upon reenrollment of largegroups throughout the yearDiagnosis of ASD prior to age 8Coverage applies to children age 18 months to18 years.
  6. 6. Establishing the Diagnosis of Autism Spectrum Disorder Primary Care Physician (PCP) completes ASD screenings as per AAP and AAN guidelines as part of the preventive health visits Multidisciplinary approach to establishing diagnosis Referrals to specialists, ancillary support, and testing are directed by the PCP Diagnosis of ASD based on DSM-IV-TR
  7. 7. Establishing the Diagnosis of Autism Spectrum Disorder Once diagnosis is confirmed, coverage for autism treatment is initiated as per the member’s insurance benefit plan. To assure payment of treatment and therapy under the benefit, services related to ASD require preauthorization
  8. 8. Covered services: Applied Behavior Analysis provided and/or supervised by a Board Certified Behavior Analyst (BCBA) Information found at www.healthplan.org > provider services > additional BHU resources > Initial Authorization for ABA and Concurrent Authorization for ABA Medically necessary treatments, such as OT, ST, PT
  9. 9. Coverage of ABA Initial authorization: Results of screening and scaling Functional Behavioral Assessment Goals Risk Assessment Targeted interventions aimed at specific behaviors Parental training
  10. 10. Continuation of ABA Behaviors and interventions identified on initial authorization form Improvements and achievements Supporting documentation
  11. 11. Billing for ABA Evaluation and Management Codes from Current Procedural Terminology have been assigned to various levels of treatment Billing details will be in your contract

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