February 2023: ROC Monthly Mastermind Call

Increasing Your Profitability in 2023

It's a new year, which means new insurance rules!

While the hope is for these rules to serve as collectively beneficial, some changes just might make things more difficult. We're in this together, right?  

Whether you desire to join our live meetings (please do), or you’re in the market for an aesthetically pleasing refresher on the latest industry updates, we’ve got you covered. 

A glimpse into our first discussion:

• Network Changes - Cigna IFPs

• Geographic Limitations - Aetna QHPs

• MHN updates detox/seizure protocols

• Needs & Leads

Add the monthly Mastermind Meetings to your calendar! 

11:00 AM PST on the second Tuesday of every month

In the meantime, we want to hear from YOU! What are you interested in hearing about? What are you sick of? What are your current challenges?

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Alright, you ready?  Let’s get into the recap -  

Cigna IFPs

As of January 1, 2023, Cigna IFPs (non-sponsored Marketplace and Individual Family Plans) have new restrictions.  

Network: IFPs are part of the CIGNA CONNECT network, which have regional coverage limitations. Your Cigna contract will show whether you are eligible to accept IFP patients.

More helpful information here: https://adcare.com/insurance/cigna/ 

All Eyes on Admissions & Verifications
Aetna QHPs 

What is an Aetna QHP? 

QHP plans to meet specific requirements under the Affordable Care Act, as well they have been certified by the Centers for Medicare and Medicaid Services (CMS). QHP plans often have access to unique networks with fewer participating providers than our traditional networks.

Aetna QHPs typically begin with number ‘101’ (no prefix or preceding “W”)
*Availity will show the policy as a QHP/IFP 

Example: 

Aetna QHP/IFPs have both GEOGRAPHIC and NETWORK restrictions. 

GEOGRAPHICALLY, they are limited to the member’s service area, which you can find by looking up their county (using the address from Availity) and checking against the maps below. 

The NETWORK is restricted to facilities whose contract has been amended to include QHPs. Facilities that are INN with Aetna are not necessarily INN with QHPs. For now, safest path is a call to Aetna, to confirm coverage.

Additional Resources: https://www.aetna.com/health-care-reform/public-exchanges-health-care-professionals.html 

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Let’s end with some good news, shall we? 

For our Arizona, California, and Oregon providers – we have positive MHN news to share -

As you know, previously, MHN has denied detox to anyone treatment with a history of seizures, pushing them into the hospital system. However, as of January 1, 2023, MHN has reversed that mandate. 

For those admitted with a history of seizures, MHN will allow detoxification at your facility ONLY IF:

· The treatment team of providers are willing to attest to offering a safe detox environment.

AND

· The Attending Provider is willing to assume responsibility for the client’s care.

Next Steps here. 

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Needs & Leads

We end every Masterminds discussion by sharing our ‘Needs & Leads,’ where we offer an open dialogue to approaching obstacles (like hiring needs), or, Leads and references (like referrals, introductions). 

NEEDS

Hiring Expansion

• Hiring: Chief Technology Officer (Hansei Solutions)

• Hiring: Clinical Director (Asana Recovery)

LEADS

Hiring Expansion

• Suggested Recruiter for Behavioral Health: Heather Lipman, Recruiter: 818-310-0769 

Marketing & Operations

• Thnks App: Set up for your sales team to send out digital gift cards to referral sources. 

• HiBob: A customizable HR platform that helps improve internal communications, org charts, and overall team/company growth and development. 

• Hatch Compliance: Healthcare compliance consulting. 

Additional Resources:

• Book Suggestion: Traction

• Team Growth: EOS (we hope to add a speaker to join us from the EOS platform soon).