Behavioral Health Office Administration Overview
Behavioral health providers: CDPHP welcomes you to our growing network of caring professionals. We have a proactive program to help you coordinate the care of our members. By understanding our expectations and guidelines, you can streamline the process and assure timely reimbursement for your efforts. We have assembled a presentation with the following resources to help you get started:
- Sample member ID card
- Information on participating labs and our drug formulary
- Contractual expectations and treatment reporting
- CPT coding and claim submission
- Mandated autism services
- Important CDPHP phone numbers
View the Behavioral Health Office Administration Overview presentation.
Communication is Key: Exchange of Information Consent Form
To help us coordinate your hospitalized patients’ care, the hospital will share discharge plans with CDPHP. Please remind your patient to fill out an Exchange of Information Consent Form so this information can also be shared with the primary care physician.
Level of Care for Alcohol and Drug Treatment Referral (LOCADTR) Manual
LOCADTR is a web-based tool that aids substance abuse treatment providers in determining the best level of care for a patient with a substance use disorder. This manual will explain the reasoning behind the LOCADTR, and the logic of the tool, which includes a step-by-step guide through the questions, and answers to Frequently Asked Questions.
CONTACT Lifeline: An After-Hours Hotline for CDPHP Members
Capital Counseling offers an after-hours telephone crisis hotline service.
Members calling the CDPHP Behavioral Health line at 1-888-320-9584 between the hours of 6 p.m. and 8 a.m. as well as weekends and holidays will be given the option to press “1” and be connected with a live voice.
- CONTACT Lifeline is staffed by licensed mental health professionals and nationally accredited as a crisis center.
- CONTACT Lifeline will offer referrals to community resources and services. CDPHP will provide follow-up case management.
- If the member does not currently have a behavioral health provider, CONTACT Lifeline professional staff will offer and schedule a counseling appointment with Capital Counseling staff the next weekday.
CDPHP Community Transition Program
As an added benefit to our members, CDPHP can arrange for an in-home follow-up visit after your patient is discharged from the hospital.
- The Community Transition Program works with the behavioral health provider and certain hospitals in the Capital District to offer our members an in-home visit. With the patient’s consent, this visit will be scheduled prior to leaving the hospital.
- The appointment can be scheduled between 24 to 48 hours of discharge, but no later than five days post-discharge.
- The patient should also see his/her behavioral health provider within one week of discharge.
If you feel your patient could benefit from a post-hospital home visit, please call the CDPHP Behavioral Health Access Line at (518) 641-3600 or toll-free at 1-888-320-9584, weekdays from 8 a.m. to 6 p.m.
Parsons Capital Region Children and Adolescent Mobile Crisis Team
CDPHP has a collaborative relationship with Parsons Child and Family Center to offer a mobile crisis diversion service for children up to age 20 in Albany, Rensselaer, and Schenectady counties. This no-cost intervention service can visit children at home, school, or anywhere else in the community. The crisis team is available 11 a.m. to 9:30 p.m. weekdays. To learn more, please call the CDPHP Behavioral Health Access Center during business hours at 1-888-320-9584.
Opiate Withdrawal Assistance Program
CDPHP is collaborating with Conifer Park Inc. on a treatment model to assist individuals seeking medical assistance with opiate withdrawal. The program involves a brief inpatient stay at Conifer Park. Each CDPHP member is individually assessed to determine a “medication assisted “ protocol that will provide comfort to the person as they go through the process of safely withdrawing from opiates. Substance abuse relapse prevention counseling is provided as well as referral to the next appropriate level of care.
For CDPHP members being referred to this program, please confirm eligibility first by calling the CDPHP Behavioral Health Access Center at 1-888-320-9584. The referral process can proceed by calling Conifer Park’s Intake Department at 1-800-989-6446.
LiveWell IOP for Eating Disorders
The Capital District's Only Intensive Outpatient Program for Eating Disorders
The LiveWell IOP for Eating Disorders is as an alternative to inpatient treatment and can be used as a transition from inpatient care, partial hospitalization, or a step up from outpatient treatment. This program will provide members an additional outpatient level of care to improve their treatment outcome, without interrupting their daily lives, and will help them avoid future hospitalizations.
- Patient must be age 13 or older
- Must have a diagnosis of anorexia nervosa, bulimia nervosa, and eating disorder NOS and in need of more intensive treatment
- Must be cognitively, psychically, and medically stable to participate
- Four hours of therapy are offered three afternoons per week to accommodate work and family schedules
- Patients will learn skills to manage eating disorder behaviors, thoughts, and emotions
- Each patient will attend a daily exposure meal group and will be encouraged to work toward individual nutrition goals
If you feel you have a patient who may benefit from IOP at LiveWell, please call the CDPHP Behavioral Health Access Center toll free at 1-888-320-9584 between 8 a.m. and 6 p.m., Monday through Friday. Or, contact LiveWell directly at (518) 218-1188.
HEDIS 101 For Providers
The Healthcare Effectiveness Data and Information Set (HEDIS®) is the health care industry’s most widely used set of performance measures. Our NCQA accreditation and provider incentive programs depend, in part, upon this annual evaluation. The New York State Department of Health also requires us to fulfill Quality Assurance Reporting Requirements (QARR). Learn how these data collection efforts may affect your practice.
For an in-depth look at the data collection process and tips on achieving higher HEDIS scores, please read the HEDIS Summary Tool for CDPHP Providers.
Behavioral Health Guidelines are Online
CDPHP utilizes both industry-standard and internally developed clinically based medical necessity criteria. The industry-standard behavioral health criteria are Milliman Care Guidelines and ASAM Patient Placement Criteria for the Treatment of Substance-Related Disorders. Internally developed criteria are determined based on current industry standards.
View the guidelines here:
Important Forms and Checklists
Behavioral health providers can learn more by downloading a tip sheet.
Documentation and communication are essential to quality of care. Please review our quick and easy Behavioral Health Medical Record Checklist to ensure completeness in your patients' charts.
Hixny Consent Form can help CDPHP collect medical records located in different places where they obtain health care, including your office or facility, making them available electronically to CDPHP.
If you have not yet joined the growing panel of CDPHP behavioral health providers and would like to do so now, please complete a data collection form and Practitioner CAQH Application or Adjunct Practitioner CAQH Application to begin the process. Download the application forms and send them to CDPHP. If you have any questions while completing the forms, please call CDPHP Credentialing Department at (518) 641-3321 for assistance.
Participating providers are also urged to register for secure access to the provider portal to view the Provider Office Administration Manual and full list of CDPHP policies. If you have not already done so, please click on “Register” in the login box to sign up.
Paper Claim and Trading Partner Testing for Medicaid Behavioral Health
Medicaid Behavioral Health (BH) testing with our trading partners began April 15, 2016. Please register with CDPHP when you are ready to begin testing and indicate if you are testing with a paper claim submission or using a trading partner. Please make sure you have submitted an operating certificate to your network contracting representative at least five business days prior to registering for testing.
E&M Coding Tips
CDPHP hosted a workshop entitled “E&M Coding for Behavioral Health Providers: Avoiding Common Documentation Mistakes.” The presentation and related handouts are provided here, by express permission of presenter Derek Jansen-Jones, PhD, cofounder of health care compliance consulting firm Diligence.pro.
Member Access to Care
Our behavioral health staff is available 24 hours a day, seven days a week to facilitate inpatient admissions. For non-life threatening behavioral health emergencies, CDPHP directs network practitioners to refer members to the emergency department.
CDPHP network providers are required to ensure that members have access to care within the following standards:
- Emergency—Immediate access (may be referred to the ER)
- Urgent appointment—within 48 hours
- Initial routine appointments—within 10 business days
- Follow-up routine appointment within 20 business days
- Ambulatory appointment post-inpatient discharge—within 7 days of discharge
The behavioral health utilization management (UM) process includes triage and referral as well as prospective, concurrent, and retrospective review of the services delivered to our members.
Call the Behavioral Health Access Center at 1-888-320-9584, Monday through Friday, 8 a.m. to 6 p.m. to verify eligibility and benefit information prior to rendering care for your patients.
Participating providers can log into the secure provider portal at any time to view the Provider Office Administration Manual and CDPHP policies.
Presentation: Behavioral Health Care-In and HARP
CDPHP presented "Behavioral Health Carve-In and HARP" on May 18, 2016 to the provider community in order to discuss the new HARP product which will go into effect on July 1.
View the presentation
Behavioral Health Engagement Strategy
View the video