Partnering with a New Partnering with a New PayerPayer

Catholic Charities ServicesCatholic Charities ServicesDiocese of Cleveland, OhioDiocese of Cleveland, Ohio

Change Team Members:

Maureen Dee, Ruth Abel, Keith Johnson, Catherine Bixenstine, Vikki Chinchar,

Lois Calderwood, Roszella McCoy

To become a network provider for Medical Mutual of Ohio by 12/31/12.

Our intent is to increase our private insurance contracts from 0 to 1. We had only been billing Medicaid, and pursued Federal, State, County grants. We had invoiced private insurance as out-of-network on a limited basis.

We now require all licensed staff to apply for an NPI number and to become providers under our new contract.

A Steering Committee was created to develop change in infrastructure to centralize behavioral health billing depts.

Learned to track success in reimbursements and started to roll out procedures to our sites – our goal is to have a standard approach at 12 sites.

Met Goal before deadline. Now have contract with Medical Mutual.

Fee Scale for services higher than Medicaid.

In some cases, receive 20% above fee scale if services provided within 30 days.

Attracted secondary contract with Medical Mutual for State Medicaid Waiver program. Referrals come from County Hospital.

Have a Steering Committee which will continue to meet to assist with reaching out and supporting new contracts

Build infrastructure to manage authorizations and reauthorizations.

Track the success. Refine tracking form through Billing User Group

Continue to reach out to new Managed Care Orgs.

Learn from other parts of our system (nursing homes) which do business with Mgd Care.

Now accept clients with Medical Mutual and are paid at higher rate than public dollars.

Number of referrals from County Hospital for Behavioral Health Services has potential to increase by hundreds.

Project has educated/impacted large social service agency that helps many. Thank you!!