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Third Party Billing

Third Party Billing. California Human Development Outpatient Treatment Santa Rosa, CA. Change Team Members: Dana Alvarez Tina Millis Angie Tapia Start Date: 4/1/2012 End Date: 10/9/2012. AIM. Increase the number of insurance claims sent to Anthem Path2Health from 0-1.

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Third Party Billing

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  1. Third Party Billing California Human Development Outpatient Treatment Santa Rosa, CA Change Team Members: Dana AlvarezTina Millis Angie Tapia Start Date: 4/1/2012 End Date: 10/9/2012

  2. AIM Increase the number of insurance claims sent to Anthem Path2Health from 0-1 • Complete the Anthem Agreement application and submitted. • Called on a weekly basis to inquire on application status • Viewed the Webinar orientation • Finally learned CHD was an contracted drug and alcohol provider of Anthem (following Supreme Court ruling) Learned this through an email from the person taking the place of our Anthem contact while he was on vacation • Set up a group for CMSP clients on Thursday evening (capped at 8 participants) • Began enrolling CMSP participants (using the medi-cal site confirmed CMSP eligibility)

  3. AIM Increase the number of insurance claims sent to Anthem Path2Health from 0-1 • County SWITS administrator set up the CMSP payor group on SWITS; counselor created encounters but did not release given we had not received the authorization at this point • Completed and faxed two forms: 1 Data Sharing 2. The OTR (emailed our original contact with many questions – sometimes we would get a response and other times not) • Waited for responses – at least two weeks • Received an authorization on one person and then another • Dates and number of sessions differed on these authorizations (an Anthem representative adjusted dates and sessions while informing us how to input the data (codes) – Now had a Anthem contact!!! • Completed SWITS authorization record and released encounters. • Batched encounters, printed 1500 forms (six claims) and sent to address given for claims

  4. Results CHD increased the number of insurance claims sent to Anthem Path2Health From “0” To “6” (actual measurement achieved) by September 15, 2012. October 4, 2012 received a check in the amount of $125 for one claim.

  5. Next Steps Create a cross reference system (submitted forms to authorizations) Create a cross reference system (claims vs. actual payments) Assign staff the role of overseeing both above processes (resubmitting appropriate documents when needed and making corrections as they arise. Assign staff the role of checking eligibility on a monthly basis Report to fiscal department Create additional groups to accommodate the CMSP clientele (one group at a time) Update treatment flyers showing we now take CMSP in addition to Medi-Cal Notify and educate our community partners as to how CMSP has been implemented, what it covers, and who will benefit Keep data for future process improvements

  6. Impact Cut the cost of treatment for our lowest income clients by a minimum of 66% - ($290 to $100) Strengthen our corporate and treatment mission by having the ability to serve greater numbers of low income individuals Keep our group size small (8) – allowing more time for each individual to process etc. Possible increase in revenue (fee for service rate higher than sliding scale for our low income clients) Staff must be credentialed – recruitment and hiring will be changed to accommodate this contract (Higher salaries required for credentialed staff) A designated staff assigned for 3rd party billing duties

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