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1 Fee for Service Transition June 25, 2009 Santa Fe, New Mexico.

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Presentation on theme: "1 Fee for Service Transition June 25, 2009 Santa Fe, New Mexico."— Presentation transcript:

1 1 Fee for Service Transition June 25, 2009 Santa Fe, New Mexico

2 2 Transition features Fee-for-service begins July 1 OptumHealth New Mexico and the Human Services Department/Behavioral Health Services Division are committed to assisting each provider successfully complete this transition without disruption in services. A capped allocation has been set aside by provider, based on FY09 allocations Except for legislatively-driven cuts, no reductions to these allocations have occurred Services are also designated by provider

3 3 Transition features (cont.) Provider agencies have received training on:  How to enter service registration  How to obtain an authorization  How to file a claim  How to register for the OptumHealth New Mexico Provider Portal There are five programs with special legislative appropriations that have invoice deliverable components:  Native American Initiative  Sexual assault  Jail Diversion  Veterans and Family Support  Methamphetamine Initiative These represent less than 10 percent of the total non-entitlement budget for adults

4 4 Transition work in Progress Meetings are being held with providers for further definition of invoice deliverables to insure services are not disrupted Setting up reimbursement process to insure funding is not disrupted OptumHealth has designed a single form to be used for all invoice services

5 5 Technical Assistance for Providers OptumHealth New Mexico regional teams ready on Day One Each regional office has its own team, consisting of:  Two provider relations staff  An IT liaison  A claims funding specialist Providers can access these regional teams by calling the provider-relations toll-free number at 866-660-7182.

6 6 Monitoring and evaluation by BHSD/OptumHealth Monitoring will include evaluation of claims billed against allocation amounts OptumHealth is currently conducting fiscal viability assessments of provider agencies. Technical assistance will be provided to a select number of at- risk providers. Training will focus on improving access and retention rates If claims volume is significantly below expected billings after six months, funds may be re-allocated on a one- time basis to other providers for the Fourth Quarter (April-June 2010) to insure no reversion of funds. These providers will have further technical assistance available on fiscal viability.

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