As your organization continues to adapt to the various changes implemented in the Ohio Community Behavioral Health Medicaid system, it is imperative that you take an internal assessment to continually assess your organization’s readiness for managed care. It makes no sense to have a contract with Managed Care Organizations when your Agency is not prepared to meet the various administrative (including billing) and clinical requirements set forth in your MCO Agreements.  This Ready, Fire, Aim Approach will be very frustrating and expensive!
As you conduct your  internal assessment, you will need to develop a punch list of questions that need to be answered to ensure your organization is positioned properly for these upcoming changes.  You need to assess your administrative, financial and clinical processes for our new reality.  I refer to this as the “three legged stool” of managed care readiness.  If one of these legs is wobbly, then the whole stool is wobbly.  In the next three blogs, we will focus on examining what items need to be on your punch list.  The following administrative questions should be part of your organization’s overall administrative punch list:
  1. Are your administrative systems in place to assist and support the clinician in working with the MCOs (Intake, benefit verification, utilization management systems)?
  2. What systems are in place to credential and contract with a MCO and then communicate the key operational and clinical provisions of that agreement internally to staff?
  3. What systems are in place to track managed care clinical authorizations (required authorization forms, managed care clinical criteria)?
  4. What systems are in place to make sure your organization is paid properly (and timely!) for services rendered?
  5. What internal systems are in place to communicate the various contractual provisions to the various affected departments?

It is our hope that these questions will jumpstart your review process and provide food for thought as you develop your game plan to become managed care friendly.

 At Pinnacle Partners, we have over thirty plus years of managed care credentialing and contracting experience.  In addition, we also specialize in developing administrative systems to assist behavioral health organizations in working with MCOs.
Please let us know how we can be of assistance to your organization!