Concordia’s values and expectations for coordination between the healthcare services and behavioral healthcare delivery systems and across the continuum of the behavioral healthcare services delivery system.
Continuity and Coordination among all levels and practitioners of behavioral health care and primary care physicians (PCPs) is monitored and expected by Concordia. For inpatient admissions, coordination starts with the notification of the admission to the patient’s PCP and then at discharge by providing the PCP with the discharge summary. Should the discharge plan include a referral to Partial Hospital Program, IOP (intensive outpatient program), or outpatient counseling or treatment, the PCP needs to be informed by progress reports or summaries at each level of care by the practitioner(s) at that level of care. Continuity and coordination with the PCP is also essential if the enrollee accesses outpatient visits and does not require more intensive levels of behavioral healthcare. The frequency required for outpatient practitioner’s coordination is dependent on the diagnosis and treatment. Coordination with the PCP is essential when medication is prescribed and/or modified. Another area of continuity and coordination between behavioral health and PCPs is in reporting the results of psychiatric consultations performed at hospitals and nursing homes. The attending physician requesting the consult benefits from the timely receipt of the report of the psychiatric consultation and may need or wish to discuss the consult with the Psychiatrist.
Continuity and coordination across the continuum between all levels of behavioral healthcare is considered a reasonable standard of practice. If the inpatient attending is not the outpatient practitioner, notification at the point of admission, and again at discharge, is essential to maintain continuity of care. Coordination between outpatient practitioners with a shared client (split treatment) is essential in providing quality care. Concordia monitors and expects coordination between all levels of behavioral healthcare.
Concordia is aware of the need for a release of information in order to coordinate with both the PCP and other behavioral healthcare practitioners, and that some individuals are reluctant to sign the release. Concordia expects the reluctant individual to be educated by the behavioral healthcare practitioner regarding the importance of sharing information among those practitioners who are providing care and services.
60-Day Transition of Care
In the event of a change in plan, vendor, or subcontractor, the following will apply:
- Behavioral Health Services will not be interrupted during the 60 day transition for network and out-of-network (OON) providers.
- Concordia Care Managers will reach out to the enrollees’ providers, actively in treatment, in order to discuss their current treatment plan and assist with the transition of care.
- Concordia Care Managers will assist new enrollees in referrals to new providers as needed.
- Concordia Care Managers and Member Service Representatives will educate enrollees and provide clarification about the new plan as needed.
- Non-contracted providers will be invited to join the network.
- For those enrollees who are currently hospitalized at the time of transition, Concordia will collaborate with the discharge planners to ensure follow up services are in place with network providers.
- Concordia Claim Business Rules for the first 60 days will be followed:
- No Claim will be Denied Due to Provider being Out of Network
- No Claim will be Denied due to No Prior Authorization
- No Claim will be Denied for ongoing course of treatment
- No Claim will be Denied for prior covered benefit(s)
- Concordia will honor any written documentation of prior authorization of ongoing covered services for period of sixty (60) calendar days after the effective date of enrollment,
- or until the enrollee’s behavioral health provider reviews the enrollee’s treatment plan
- Concordia will honor providers’ rates for a minimum of 30 days and may negotiate services rendered afterwards