FAQ for Behavioral Health Private Practice, non-agency, Private Practice Providers: Psychologists, LBHPs and Insure OK Providers

July 15, 2010

**The following information does not apply to Outpatient Behavioral Health Agencies** 

• What is the CDC? 
  
  The Customer Data Core (CDC) is a multi-purpose form which records admissions, changes in treatment, level of care, and discharges. The CDC collects socio-demographic information about the customer in addition to diagnostic information.  The CDC is designed to collect National Outcome Measures (NOMs), an initiative by SAMHSA, and will provide valuable information for all providers as well as our entire mental health system. For questions, you can call the ODMHSAS Helpdesk at (405)522-0318 or 1-877-522-0318 or you may send an email to the helpdesk@odmhsas.org.  You can also call APS at 1-800 522-0114, option 9 or option 4, and they can assist you.

• How does the CDC affect my ability to see SoonerCare members? 
  
  In order to be authorized to see SoonerCare members you must fill out a CDC 23 on CareConnection or upload via EDI if you have that capability.  You have 30 days from the first date of service to submit the CDC 23 on APS’ CareConnection.  In order to get an authorization number allowing you to bill for your services you must fill out a one page document (click here for the document) and fax it to APS.  This document alerts APS that you have submitted a CDC 23 on CareConnection and your five sessions of treatment per month for six months or eight units of testing for a year will be authorized.  When you do an update after six months or sooner if treatment is suspended, you will fill out a CDC 42 on CareConnection and fax the one page document.  When you are ready to discharge the client, there are several types of CDCs in the numerical 60 - 72 (e.g., discharge because of treatment goals fulfilled, client ended services, etc.).  You just pick the correct reason for discharge and submit that CDC on APS’ CareConnection. The CDC manual can be found on the SoonerPro website under Resources, then Manuals.

• Why do I have to fill out the income fields on the CDC? 
  
  It is important for the collection of the NOMS data.

• What is the CAR?
  
  The CAR is the Client Assessment Record which you will fill out on the CDC 23.  It provides a numerical level of functioning.  If you have done an assessment on the client it will be very easy to fill out on the CDC form.  In order to learn how to make your calculations, you can find the CAR manual in the Outpatient Provider Manual, (click here to view the manual), starting on page 36.

• How can I, or my group, be personally trained on the CDC and the CAR?
  
  APS and ODMHSAS have planned webinar trainings, the dates for which are on the SoonerPro website under the News tab.  You may also use the ODMHSAS Helpdesk and numbers listed above in question number one.

• What if I have a client who is Medicare and Medicaid dual eligible? 
  
  These clients are considered “crossovers” where Medicaid pays the deductible and copays for Medicare clients.  If you suspect that Medicare may deny a behavioral health claim, proceed with all of the administrative requirements for payment by OHCA.  You would probably want to do the CDC 23 and the one-page form ahead of time while you are waiting to see if Medicare is going to deny a claim, so that you can proceed with services quickly.

• What do I do if I have clients who still have an existing PA for the therapies with an agency and wants to come to the private provider for those services? 
  
  Have the client sign a letter of termination, (click here to view the letter), terminating services with the other agency.    Then in the Comments section on the Notification of CDC submitted form, document that a letter of termination has been signed and the date it was signed by the member/guardian. APS will end date the authorization with the agency.  That way the provider does not have to wait to provide services.

• What do I do if I want the three extra sessions added to my five authorization sessions for the therapies? 
  
  You will need to complete and submit the LBHP request on CareConnection.

• What if I want more than the eight hours allowed for testing? 
  
  You will need to complete and submit the LBHP request on CareConnection.  Any request for testing beyond the eight hours allowed are automatically referred by the reviewer to an APS Clinical Consultant for medical necessity review.

• How will I know if I have an authorization number? 
  
  There are two ways you can determine authorization:  1) On Care Connection go to the Download Notification Link on the left side of the navigation bar, or 2) On OHCA’s Medicaid secure website.

• How will I know if testing has already been authorized to be done by someone else? 
  
  You can call APS to see if the client has an authorization for testing by another provider.  You can also contact OHCA Provider Services to see if another provider has already filed a claim for testing on the client for reimbursement.

• What are H & B codes?
  
  These are medical codes which allow psychologists only to serve chronically and terminally ill children.

• Do Psychologists, Licensed Behavioral Health Providers, and Insure Oklahoma Providers use the same processes? 
  
  Yes, they all use exactly the same process.

Joni Jones