Cenpatico Behavioral Health, LLC (CBH)

Georgia Service Area

General Fact Sheet

Introduction:

Centene Corporation was awarded Medicaid contracts in the Atlanta, Central, and Southwest regions on July 19, 2005. The Atlanta and Central regions will become effective June 1st, 2006 and represent two of the largest regions awarded, with approximately 500,000 eligibles in the Atlanta region and 150,000 eligibles in the Central region. The Southwest region will become effective September 1st, 2006.

Georgia Healthy Families (GHF) is a new managed care initiative in the State of Georgiafor members of Medicaid and PeachCare for Kids. The program is a partnership between the Department of Community Health and private care management organizations (CMOs). By providing a choice of health plans, GHF allows members to select a health care plan that fits their needs.

Centene’s Georgia subsidiary, Peach State Health Plan (PeachState), is a participant in Georgia Healthy Families and will manage a portion of the Medicaid recipients in the awarded regions.

Members in these regions have the option to enroll with one of the following CMO’s. After the enrollment deadline, members will be auto-assigned to a CMO.

Atlanta:

  • PeachState Health Plan
  • Amerigroup Community Care
  • WellCare of Georgia

Central:

  • PeachState Health Plan
  • WellCare of Georgia

Southwest:

  • PeachState Health Plan
  • WellCare of Georgia

Effective June 1, 2006, Cenpatico Behavioral Health (CBH) will begin managing the covered behavioral health services for members enrolled with PeachState in the Atlanta and Central Regions. The Southwest Region will be effective September 1st, 2006.

Previous Behavioral Health / ACS
Health Plan / PeachState Health Plan (PeachState)
Effective Date of Transition / June 1, 2006–Atlanta & Central
Sept. 1, 2006- Southwest Region
PeachState Membership / 112,423 as of 4/25/06
CBH is responsible for the following: /
  • Referral & triage
  • Utilization management
  • Provider & facility network management
  • Provider Relations
  • Intensive case management
  • Credentialing
  • Member grievances & administrative reviews
  • Provider complaints administrative reviews
  • Claims adjudication & payment

Excluded Populations: /
  • Recipients eligible for Medicare
  • Member of a Federally recognized Indian Tribe
  • Recipients eligible for Supplemental Security Income (SSI)
  • Under 19 yrs of age who are in foster care or other out-of-home placement, or are receiving other adoption assistance
  • Children enrolled in the Children’s Medical Services Program administered by the Georgia Division of Public Health
  • Children enrolled in the Georgia Pediatric Program (GAPP)
  • Children with severe emotional disturbance whose care is coordinated under the Multi-Agency Team for Children (MATCH) program

Important Information:

For questions regarding dates of service that occurred prior to June 1, 2006, a provider or a facility should call: / GHP- Provider Inquiry Number
Telephone: 800-766-4456
For claims submission for services that occurred prior to June 1, 2006, a provider or facility should submit claims to: / GHP Remote Mail Organization
P.O. Box 5000
McRae, GA31055
For Authorization of Services starting June1, 2006, a member, provider, or a facility should: / Call CBH-Georgia at:
800-947-0633
or visit:

CBH-GeorgiaServiceCenter Hours of Operation: / 7:30am-5:00pm (CST)
CBH- Georgia Claims for services on or after June 1, 2006 should be sent to: / CBH Claims Dept.
P.O. Box 6700
Farmington, MO 63640
Telephone: 866-324-3632
CBH- Georgia Claims Appeals for services on or after June 1, 2006 should be sent to: / CBH Claims Dept.
P.O. Box 6000
Farmington, MO 63640
Telephone: 866-324-3632
Fax:
Claims filing deadline for Georgia Providers / 120 days or 4 months
If a provider would like to join the CBH Network or would like someone from Network Development to visit them, the provider should call: / CBH Atlanta Region Network Development Manager:
Carla Menchion
Phone: 770-437-3001
Email:
CBH Central & Southwest Region Network
Development Manager
Clinton Shedd
Phone: 478-951-7199
Email:
For any other area outside of the Atlanta, Central, or SW regions, the provider should call the Manager closest to their region
CBH Provider Relations Specialist for Georgia: / Latisa Kidd
Telephone: 770-437-3007 or 1-800-947-0633 ext 73007
Email:
CBH’s Georgia Service Area Website: /
To Verify if a PeachState member eligibility, providers and facilities should: / Call CBH at 800-947-0633 or check via the on-line Provider Portal by visiting
PeachState Member Services Contact: / 1-800-704-1484
PeachState Provider Relations Contact: / 1-866-874-0633
CBH- Georgia Service Area Staff Location:
ICM- Intensive Case Management
UM- Utilization Management / Customer Service- Austin, TX
Care Coordination (UM): Austin, TX
Care Management (UM):Austin, TX
ICM- Case Management- Smyrna, GA
ICM- Care Coordination- Smyrna, GA

After-Hours Coverage:

NurseWise will be providing after hours coverage and after hours triage for Peach State Members. A CBH Case Manager will be “on-call” for after hours Behavioral Health crisis situations.

Covered Behavioral Health Services:

  • Traditional Outpatient Services
  • Medication Management
  • Group and Family Therapy
  • Inpatient Hospitalization
  • Detoxification
  • 23-Hour Observation
  • Electroconvulsive Therapy (ECT)
  • Partial Hospitalization Program (PHP)
  • Intensive Outpatient Program (IOP)
  • Specific Community-Based Services

Provider Network Includes the Following Types of Providers:

  • Licensed Psychiatrists
  • Licensed Psychologists
  • Licensed Clinical Nurse Specialists(Psychiatric Nurses)
  • Licensed Professional Counselors
  • Licensed Clinical Social Workers
  • Licensed Marriage & Family Therapists
  • Community Service Boards (CSB’s)
  • Free-Standing Psychiatric Hospitals (IMDs)(except for members between ages 22 and 64)
  • Psych Units within General Hospitals
  • Community-Based Service Specialists/Agencies
  • Behavioral Health and/or Substance Abuse Programs

Please Note: All providers must have a State of Georgia Medicaid Number for each service location.

Intensive Case Management Program (Overall Goals):

  • Identify members with complex or chronic behavioral health conditions that require coordination of services and periodic monitoring in order to achieve desired outcomes.
  • Work collaboratively with the member, physician, family/significant others, providers, and support services to implement an individualized plan of care.
  • Maximize efficiency in utilization of available resources and plan benefits

Components of the Intensive Case Management Program:

  • Early identification of high-risk cases
  • Screening and assessment of cases to identify those members who meet criteria for ICM
  • Referral to the appropriate providers and services
  • Provision of effective interventions in conjunction with providers to improve clinical outcomes
  • Coordination of support services
  • Member/Family Education
  • Measurement of the intervention outcomes and use of those measures to improve the program’s effectiveness

How to refer a member for the Intensive Case Management Program:

  • Complete the ICM referral form or call 800-947-0633

Atlanta, Central, and Southwest Regions Covered Counties

CBH manages the behavioral health benefits for PeachState in the following regions and counties:

NOTE: The “Go-Live” Date for the Southwest Region is 9/1/06

Region / Counties / Planned “Go-Live” Date for
Service Region
Atlanta / Barrow, Bartow, Butts, Carroll, Cherokee, Clayton, Cobb, Coweta, DeKalb, Douglas, Fayette, Forsyth, Fulton, Gwinnett, Haralson, Henry, Jasper, Newton, Paulding, Pickens, Rockdale, Spalding, Walton / 6/1/06
Central / Baldwin, Bibb, Bleckley, Chattahoochee, Crawford, Crisp, Dodge, Dooly, Harris, Heard, Houston, Johnson, Jones, Lamar, Laurens, Macon, Marion, Meriwether, Monroe, Muscogee, Peach, Pike, Pulaski, Talbot, Taylor, Telfair, Treutlen, Troup, Twiggs, Upson, Wheeler, Wilcox, Wilkinson / 6/1/06
Southwest / Atkinson, Baker, Ben Hill, Berrien, Brooks, Calhoun, Clay, Clinch, Coffee, Colquitt, Cook, Decatur, Dougherty, Early, Echols, Grady, Irwin, Lanier, Lee, Lowndes, Miller, Mitchell, Quitman, Randolph, Schley, Seminole, Stewart, Sumter, Terrell, Thomas, Tift, Turner, Webster, Worth / 9/1/06

CBH, LLC Fact Sheet - Page 1 of 9