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UPMC Behavioral Health Care Management Update

July 28, 2009

Effective July 1, 2009 Community Care Behavioral Health Organization will be providing care management for the behavioral health services of UPMC Health Plan members under the age of 21 who have Autism Spectrum Disorders (ASD).  This will be done under the coordination of the UPMC Health Plan’s staff who are managing the physical health care needs of this population. 

Act 62 specifies that commercial insurance companies must cover ASD services up to $36,000 per benefit year.  Members become eligible for Act 62 mandated coverage based on their insurance plan and their benefit year start date.  Children who are covered under CHIP become Act 62 eligible on December 1, 2009.   The best way to determine if a UPMC Health Plan member is Act 62 eligible is to have the subscriber contact Member Services of the Health Plan to inquire about their status. 

Please note the following:

• Providers should use the treatment plan format for requesting authorizations under the members’ UPMC commercial benefit.  The treatment plan format can be found below.

• Prescribers requesting authorization for Best Practices Evaluations should complete and submit the Act 62 Best Practice Evaluation Authorization Request Form.  The Best Practices Evaluation Authorization Request Form can be found below.

• Providers should fax the Act 62 treatment plans and/or Act 62 Best Practice Evaluation Authorization Request Form to 1-888-251-0087 or mail them to Community Care Behavioral Health Organization, One Chatham Center, Suite 700, Pittsburgh, PA  15219, Attention Act 62.  However, if you have already faxed your treatment plan to the UPMC Health Plan, you do not have to resubmit since the UPMC Health Plan and Act 62 staff are in daily contact.

• Use the new dedicated Act 62 care management phone number if you have clinical or utilization questions 1-877-822-3167.  Commercial Act 62 authorization requests will be reviewed against the Appendix T Medical Necessity Criteria.

• If you have not yet received a contract from the network department for Act 62 services and you have a UPMC Health Plan member(s) who qualifies under Act 62 whose policy effective/renewal date is July 1, 2009, please contact Kristin Burns or Tonya Cann at 1-888-251-2224;

• Claims processing guidelines for UPMC members are available for these services at: http://www.upmchealthplan.com/providers/manual.html#TOC

Providers who also hold HealthChoices contracts should pay specific attention to the UPMC Health Plan’s claims guidelines as there are different addresses.

Please contact those individuals listed above for any questions you may have.  Thank you for your commitment to serving UPMC Health Plan’s members.

To view and edit these forms you will need the latest version of Adobe Reader, if you do not have it or are unsure what version you have, click here to go to Adobe for the free download.

Act 62 Treatment Plan for Autism Spectrum Disorders Services Request
Act 62 Best Practice Evaluation Authorization Request Form

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