Applied Behavior Analysis

(ABA) Provider Update

March 2015

Objectives

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Overview of Horizon Blue Cross Blue Shield of New

Jersey Behavioral Health Program AMA CPT®

Code Changes

Impacted CPT Codes with New Rates

Claim Submission and Authorization Procedures

ProviderConnectSM

Contact Information

Questions

CPT® is a registered mark of the American Medical Association.

Overview of Horizon Behavioral Health

CPT Code Changes

Horizon Behavioral Health is increasing the reimbursement rates on four

of the American Medical Association’s (AMA) CPT codes.

Two of the codes (0368T and 0369T) may now be used to provide a

method for billing for supervision services. We are taking this action

due to the lack of a distinct supervision code in the AMA’s CPT

temporary code set.

The increased rates and the billing method are intended to provide

appropriate compensation for both the technicians rendering ABA

services and the physicians or Board Certified Behavioral Analysts

(BCBAs) supervising the technician who actually provides the ABA

service.

Use of codes 0368T and 0369T for supervision services is temporary until such time as the AMA revises the code set to include distinct codes for that purpose.

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Impacted CPT Codes

with New Rates

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Updated Rates – Retroactive to 7/1/14

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New

AMA

Code

Description Rate

0364T

Adaptive behavior treatment by protocol, administered by

technician, face-to-face with one patient; first 30 minutes of

technician time.

$25.75

+0365T

Adaptive behavior treatment by protocol, administered by

technician, face-to-face with one patient; each additional 30

minutes of technician time (list separately in addition to code for

primary procedure).

$25.75

0368T

Adaptive behavior treatment with protocol modification

administered by physician or other qualified health care

professional with one patient; first 30 minutes of patient

face-to-face time.

$36.00

+0369T

Adaptive behavior treatment with protocol modification

administered by physician or other qualified health care

professional with one patient; each additional 30 minutes of

patient face-to-face time (list separately in addition to code for

primary procedure).

$36.00

A full listing of the new AMA codes, including definitions and fee schedules, can be viewed online at NaviNet.net.

Claim Submission &

Authorization

Procedures

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Claims & Authorizations

• Claims for directly rendered ABA services using these four codes

will be reprocessed with the new fee schedule retroactive to

7/1/14. You will not need to resubmit these claims.

• Any claims processed under the former H codes will not be

reprocessed.

• The Horizon Behavioral Health Clinical Team will provide a listing

to you with the number of direct hours provided for each

member along with the recommended number of supervision

hours.

• Once we receive confirmation from you that the number of

supervision hours is accurate, the authorization will be created

using the existing authorization number so you can submit claims

for the supervision component.

• Claims for supervision services will need to be submitted

as an initial claim.

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Claim Submission Guidelines

• Submit claims electronically to Horizon BCBSNJ.

• After logging into NaviNet.net, mouse over Claim

Management and select CMS 1500 Claim Submission

• If you are not able to submit electronically, you can send paper claims to our new address:

Horizon BCBSNJ

Horizon Behavioral Health

PO Box 10191

Newark, NJ 07101-3189

Reminder: Submit claims with the proper suffix based on tax ID

to ensure claim is properly adjudicated.

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ProviderConnect

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ProviderConnect and Navinet

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Transaction NaviNet ProviderConnect®

Claim Submission X

View Member BenefitInformation

X

Verify Member Eligibility X X

Access and Print Forms X X

Download and PrintAuthorization Letters

X

Request and ViewAuthorizations

X

Access to Message Center to Submit CustomerServices Inquiries

X

Submit RecredentialingApplications

X

INCREASED CONVENIENCE, DECREASED ADMINISTRATIVE PROCESSESDisclaimer: Please note that ProviderConnect may look different and have different functionalities based on individual contract needs, therefore some

functions may not be available or may look different for your specific contract.

ProviderConnect Registration Process

New and current ProviderConnect users need to fax a completed

Account Request form to 1-866-698-6032.

• Account Request form to register for ProviderConnect is located at

Valueoptions.com/providers/Forms/Administrative/Online_Services_A

ccount_Request_Form-Editable.pdf

• Providers who already have a ProviderConnect account need to

submit a new form to request an additional login ID to access Horizon

BCBSNJ member information

• Horizon BCBSNJ providers need to mark the box for Horizon Behavioral

Health Authorizations

• Providers who do not know their Provider ID can contact the Provider

Services Line at 1-800-397-1630, Monday through Friday, between 8 a.m. and 8 p.m., Eastern Time (ET)

• If there are any questions on the form, providers can contact the EDI

Helpdesk at 1-888-247-9311, Monday through Friday, between 8 a.m. and 6 p.m., Eastern Time (ET)

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ProviderConnect Resources

ValueOptions.com/Providers/Provider

Connect

Free demonstration:

Valueoptions.com/PMC_prototype/

ProviderConnect/pvd.html

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Quick Start Guide and Comprehensive User Guide

Short Video Tutorials:

Viewing Member’s Eligibility

Submitting Authorizations

Submitting an Inpatient or Higher Level of Care Request

Responding to Requests for Additional Clinical Information

Recredentialing

ProviderConnect - Horizon BCBSNJ Providers

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ProviderConnect - Horizon BCBSNJ Providers

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Contact Information

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Provider Contacts

• Authorizations and Care Management

• 1-800-626-2212

• ABA Treatment Request and Treatment Plan Report

Submission:

• Fax: 1-855-241-8895

• NaviNet

• 1-888-482-8057 or NaviNet.net

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Provider Contacts, continued

• Provider Relations, Credentialing and Contracting

Questions:

• 1-800-397-1630 Monday through Friday, between 8 a.m.

and 8 p.m., Eastern Time (ET)

• Complaints, appeals and/or general inquiries

• 1-800-626-2212 or

1-800-991-5579 (for NJ State Health Benefits Program)

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Helpful Links

• Network-specific Website:

• valueoptions.com/horizon

• valueoptions.com/horizon/aba

• NaviNet

• NaviNet.net

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Questions?

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Parking Lot

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Fee Schedule

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