This committee provides oversight of the process of migrating members to the behavioral health carve-out program. The SC will report concerns and recommendations to the Council. Issues to be addressed include assuring that providers receive payment for all services rendered to the date of the changeover as well as assuring no disruption of services to members during the transition. In addition to the transitional issues, the SC will:
Review implementation of BHP claims monitoring systems, denials of provider claims, implementation of authorization linkages to claims payment,
Implementation of authorization look-up technology, IVR and web technology for outpatient registrations, and improvements to efficiency of initial and concurrent reviews,
Review data on network adequacy, member access issues and member complaints,
Review ongoing member and provider education initiatives,
Review impact of Intensive Care Management (ICM) on emergency room utilization and discharge from inpatient levels of care,
Review ongoing operational issues.