Residential Treatment FAQs

1. 1.  How frequently is the fee schedule updated?

   • The fee schedule is systemically updated weekly.  If you have questions, contact Provider Inquiry at (202) 906-8319 (inside DC metro area) or (866) 752-9233 (outside DC metro area) or via email at providerinquiry@conduent.com.

3. 2.  How does the Prior Authorization requirement impact services for youth enrolled in Managed Care Organizations?

   • Approval for DC Medicaid beneficiaries enrolled in Managed Care must be obtained from the beneficiary’s Managed Care Organization. However, youth enrolled in UnitedHealthcare Community Plan (formerly Unison Health Plan) and Chartered Health Plan are typically disenrolled from Managed Care and enrolled in Fee-for-Service (FFS) at the beginning of the month following thirty (30) consecutive days in a PRTF.  By contrast, those enrolled in Health Services for Children With Special Needs (HSCSN) must be recommended by a Psychiatrist who has a treatment history with the enrollee.   HSCSN coordinates placement and the continued stay admission and initiates discharge planning when warranted.  Conversely, beneficiaries are not disenrolled from HSCSN into FFS.

      

     To claim for services provided after that transition, the facility must obtain a letter approving a continued stay from DMH and submit a prior authorization request to DC Medicaid. Compliance with the requirement that your facility notify the Department of Mental Health within twenty-four (24) hours of any admission by a District of Columbia Medicaid beneficiary will ensure a smooth transition. Notification instructions are provided elsewhere in this document.

5. 3.  Is there a deadline for submitting electronic claims?

   • Electronically submitted claims (i.e., claims submitted using billing software or via a clearinghouse), must be transmitted by 3:00 pm on Fridays to ensure processing in weekly payment cycle. For assistance and questions regarding electronically submitted claims, please contact Conduent’s EDI Department at (866) 407-2005.

7. 4.  We are having trouble using the online web portal, who can help?

   • Registration and navigational instructions for the web portal can be found on the left-hand side of the web portal under the heading “Training Material/CBT”. Please review the Web Portal Quick Reference Guide for instructions.  

     If you need additional help, contact the Conduent Provider Inquiry line at (202) 906-8319 (inside DC metro area) or (866) 752-9233 (outside DC metro area) or via email at providerinquiry@conduent.com.

9. 5.  Why use the Web Portal?

   • Providers and their staff can conveniently and efficiently access health-related information for a 24 hours a day via the Web Portal. The web portal has many key features that is beneficial to its users. A few of the key features include the ability to verify recipient eligilibity, check claim status regardless of method of submission, obtain payment information and download Remittance Advices.

11. 6.  What are the notification requirements when admitting a youth to a facility?

    • Notification must be made to the Department of Behavioral Health whenever a District of Columbia resident is admitted to a PRTF, including Fee-for-Service and Managed Care DC Medicaid beneficiaries.  Notification must be made within twenty-four (24) hours of admission to: 

      James Ballard, PhD

      Clinical Program Manager, Residential Treatment Center Reinvestment Program

      Department of Behavioral Health

      Telephone: (202) 673-4424

      Email: James.Ballard2@dc.gov

13. 7.  How does our facility obtain a letter of medical necessity from the Department of Behavioral Health?

    • The representative of the District agency which placed the youth will be the point of contact for obtaining both the initial and continuing stay Level of Care Determination Letters. However, if your facility has questions regarding the determination process for medical necessity or need to obtain copies of letters approving medical necessity, questions may be emailed to PRTF.ReviewCommittee@dc.gov.

15. 8.  Who can we contact if we have questions about submitting prior authorization requests?

    • For questions about DC Medicaid policies related to PRTFs, contact Gwen Bell in the Division of Children's Health Services (DHCF) at gwen.bell@dc.gov or (202) 442-5988. 

17. 9.  For what length of time is the authorization valid?

    • Services must begin within sixty (60) days of the date of the medical necessity letter from DBH. The maximum amount of time that DHCF will approve services is the length of time indicated in the medical necessity letter. If services are still needed after the initial authorization period, the facility must obtain a certification for continued stay from DBH and submit an additional request for authorization.