The in-person UM and Billing presentations covered a review of Utilization Management and Billing rules and policies for all Adult Behavioral Health providers. Specifically, these trainings provided in-depth information concerning: state OMH and OASAS UM guidelines by program type, UM rules and policies by Managed Care Organizations, specific UM rules & policies for prior authorization and concurrent review by each Managed Care Organization, billing guidance review, and a review of Field by Field Requirements by Managed Care Organizations for the 837i/UB-04 billing form.
The UM presentation slides and behavioral health outpatient revenue codes can be downloaded below. For billing guidance, please consult the billing tool at billing.ctacny.org.
managed care, adult, billing, utilization management, um