ATTENTION VHP PRIMARY CARE PROVIDERS
IMPORTANT INFORMATION ABOUT CHANGES IN THE WAY SOME BEHAVIORAL HEALTH SERVICES FOR TENNCARE MEMBERS WILL BE HANDLED
Effective
July 1st, 2002, behavioral health related services provided
to VHP enrollees by a VHP Primary Care Provider shall NOT be the responsibility
of the Behavioral Health Organization (BHO).
TennCare acknowledges that some Primary Care Providers may appropriately
treat or manage an enrollee’s behavioral health condition. In an
effort to minimize administrative complexities for those Primary Care
Providers that do, VHP CommunityCare will now be responsible
for all services provided to their enrollees by their Network Primary
Care Providers.
BEGINNING
JULY 1st, 2002
VHP PRIMARY CARE PROVIDERS SHOULD SUBMIT CLAIMS FOR
TENNCARE COVERED SERVICES WITH
PRIMARY BEHAVIORAL DIAGNOSIS CODES:
ICD-9-CM
290.xx
– 319.xx
TO VHP COMMUNITYCARE FOR PAYMENT
All other mental health related services provided to enrollees continue
to be the responsibility of the Behavioral Health Organization (BHO).
To assist you in this process, VHP CommunityCare and Advocare, the company that manages the care/services and claims for Premier Behavioral Systems, have each named an MCO/BHO Case Management Coordinator and an MCO/BHO Claims Coordinator, respectively. These staff will respond to your needs pertaining to prior authorization, care coordination and continuity and coordination of benefits. Please note these contacts for future reference:
| •VHP CommunityCare MCO/BHO Case Management Coordinator: |
| Lyn Lawarence, RN, CCM: (615) 782-7800, ext. 4011 |
| •VHP CommunityCare MCO/BHO Claims Coordinator: |
| Robin Bradley: (615) 782-7949 |
| • Advocare MCO/BHO Case Management Coordinator: |
| Susan Levy, RN, MSN, Care Manager: (615) 743-2153 |
| • Advocare MCO/BHO Claims Management Coordinator: |
| Rena Brooks: (615) 743-2171 |
WE
ENCOURAGE YOU TO CONTINUE TO CONTACT THE BHO FOR CONSULTATION AT YOUR
DISCRETION.
This “carve out” of mental health and substance abuse services
provided by PCP’s from the BHO benefit package does not relieve
the BHO from the responsibility to assist in the coordination of these
services for TennCare enrollees.
WE
ENCOURAGE YOU TO CONTINUE TO REFER YOUR PATIENTS TO BHO NETWORK PROVIDERSFOR
MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES.
This “carve out” of mental health and substance abuse services
provided by Primary Care Providers from the BHO does not
prohibit PCP’s from continuing to refer enrollees to mental health
or substance abuse providers in the BHO’s network, whenever you
determine it to be necessary.
