The Holman Group - Provider Manual

Client Referrals

1. Initial call to Intake

The client calls the Holman Care Access Department to be assigned to a Holman Contracted Provider. A Care Access Specialist will obtain information from the client regarding the presenting problem and statistical information, (i.e., name, address, phone number, client account, etc.). Subsequent to verification of the client’s eligibility, the Care Access Specialist contacts a Holman Contracted Provider within 15 miles and/or 30 minutes from the client’s geographic area with expertise in the presenting problem(s).

2. Referral to Provider

When making a referral to a provider, the Care Access Specialist will:

A. Call the provider with a referral or leave a message for the provider to call The Holman Group within the same business day. If the Care Access Specialist identifies the case as emergent or urgent, a return call from the provider is expected as soon as the message is received.

B. Authorize depending on various factors including Client Company, benefit schedule, etc.

C. Provide the client’s benefit schedule, including copayment and applicable deductible information.

D. If applicable, specify a time frame in which to complete the authorized sessions (i.e., five weeks for five sessions).

E. Inform the provider whether to contact the client at home or at the place of employment.

F. Inform the provider of the appropriate procedures to follow (see 3A and 3B below) after the patient is seen for the first session.

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3. What To Do After Accepting A Referral:

A. For a routine referral, once the provider accepts the case from a Care Access Specialist, he/she must call the client within 24 business hours and make every effort to set up the initial session within five business days. If the client is identified by the Care Access Specialist as being in crisis (that is, needs to be seen on emergent [within six hours] basis or urgent [within 48 hours] basis), please call immediately. On- Call clinicians are available twenty-hour (24) hours per day to assist clients in crisis. The nationwide number is (800) 321-2843.

It is imperative to maintain Confidentiality. When leaving a message for a client, never indicate that you are calling from The Holman Group. The provider should give only his/her name and phone number. If the provider is unable to reach the client and/or schedule an acceptable appointment, he/she must notify the Care Access Department immediately. This allows The Holman Group to either attempt to reach the patient, and/or make a note in the patient's file that they were unreachable after requesting initial services.

B. If the provider is unable to accept a case, he/she must immediately inform the Care Access Department. Unavailability for a case will not adversely affect the provider’s status as a Contracted Provider.

C. Schedule an appointment at the earliest mutually convenient time. If the earliest mutually agreed upon time is more than five (5) business days, the provider must notify the Care Access Department. Additionally, it is the provider’s responsibility to inform the client of The Holman Group’s
24-HOUR CANCELLATION POLICY:

A client may cancel an appointment if 24 hours advanced notice is given. Late cancellations and/or no-shows may result in the client’s loss of an authorized session. The Provider may bill The Holman Group for no-shows or late cancellations that occur during authorized EAP or free HMO/ASO carve out sessions. This amount shall not exceed twenty-five dollars ($25.00). A late cancellation refers to a client who fails to cancel with at least 24 hours advanced notice. The Holman Group will pay for up to two (2) no-show/late cancellation occurrences per benefit year, per enrollee. For no-show/late cancellations after the maximum (2 per benefit year), the provider may charge the enrollee directly for such an event. If a copayment is required an enrollee may be charged the applicable copayment or the sum of twenty-five dollars ($25.00).

PLEASE NOTE: The no-show/late cancellation policy may differ for each client company. The Care Access Specialists can provide you with the applicable no-show/late cancellation policy.

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4. What To Do After Seeing The Client For The First Session:

Following the first date seen, the provider will forward (either by fax at [818] 704-4252 or mail) to Care Management a completed copy of the Clinical Assessment form . This form needs to be on file before applicable claims can be paid.

For those cases which allow for additional sessions and require additional treatment, the provider will complete a Request for Treatment Authorization Renewal (RTA) form and forward either by fax (818) 704-4252 or by mail to the Utilization Review Department ten days prior to the authorization expiration date. Health Care Advisors will review all RTA forms for completeness and clinical appropriateness. The provider will receive written notification of the treatment authorization outcome. Authorization decisions made by Health Care Advisors are based on Holman's Clinical Review Guidelines. Health Care Advisors disclose or provide for the disclosure to providers of the process used to authorize or deny services under the benefits provided by The Holman Group. Health Care Advisors will also disclose those processes to enrollees or persons designated by an enrollee upon request.

5. What About Management Referrals?

For a management referral, once the provider accepts the case from a Care Access Specialist, he/she will be transferred to a Senior Account Executive who will provide an orientation to the case and discuss the management referral policies and procedures. The Account Manager communicates with the client’s employer regarding treatment compliance information.

Following the first date seen, the provider will forward (either by fax at (818) 704-4252 or mail) to the Senior Account Executive completed copies of the Clinical Assessment form. This form needs to be on file before applicable claims can be paid.

If the provider feels that an additional assessment session is needed to further diagnose or recommends adjunctive, additional or a different form of therapy (i.e., medication evaluation), the provider should make those requests to the Outpatient Department. If the client is in a crisis, contact the Outpatient Department, immediately to discuss the case. The Outpatient Health Care Advisor may verbally authorize additional sessions within a specific period of time, if appropriate.

The provider will receive written authorization for all approved treatment sessions. The written authorizations will confirm your verbal authorization for treatment sessions. The Health Care Advisor will note the number of sessions authorized and the time frame to complete these sessions. An RTA form may also be sent to the provider. If additional sessions are needed, please complete and return this form to Holman ten days prior to the treatment authorization expiration date.

Note: IT IS ABSOLUTELY CRITICAL THAT CONFIDENTIALITY BE MAINTAINED AT ALL TIMES. DO NOT CONTACT, OR RELEASE ANY INFORMATION TO ANY REPRESENTATIVES OF THE CLIENT’S EMPLOYER, SUCH AS SUPERVISORS OR HUMAN RESOURCE PERSONNEL. THE HOLMAN ACCOUNT EXCUTIVE SHOULD BE CONTACTED IMMEDIATELY IF THE PROVIDER RECEIVES A CALL FROM A REPRESENTATIVE OF THE CLIENT’S EMPLOYER.

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6. What If The Client Has A Deductible:

There are certain clients who may have a deductible. All deductible and copayment information will be given to the provider at the time of referral. If a client disagrees with the deductible amount, then the provider should require the client to bring in an Explanation of Benefits form (EOB) from his/her insurance carrier to determine if any applicable deductible has been satisfied. It is the provider’s responsibility to collect any outstanding deductible for authorized insurance treatment sessions.*

In addition to the EOB, the client must bring a signed insurance claim form obtained from his/her benefit department. (Holman HMO clients have no deductibles or insurance claim forms for their mental health/chemical dependency services.)

All financial obligations, including applicable deductibles and copayments, must be discussed with the client during the first session.

If the client is unable or unwilling to meet the deductible or copayment, please call The Holman Group IMMEDIATELY after the initial session.

*The deductible amount must be collected by the provider and used towards payment. The Holman Group will deduct any deductibles due from provider reimbursement.

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Once You Have Received A Referral, Have You... ?

  • Contacted client within 24 hours to set an appointment to take place within five (5) business days.
  • Met with client within five (5) business days for first Holman referred session.
  • Notified Holman's Care Access Department by the next business day if client was a “no-show” or “late cancellation”.
  • Discussed with client his/her financial obligations, (i.e., applicable deductible and/or copayments).
  • Obtained client's signature on the Authorization for Release of Information form found on the reverse side of the EAP Billing form.
  • Obtained authorization for additional EAP/MAP and/or insurance treatment sessions from the Care Manager. ALL TREATMENT MUST BE PRE-AUTHORIZED.
  • Collected a signed claim form from the client's insurance carrier, if the client is NOT covered by The Holman Group HMO. Holman HMO referred clients have no deductibles.(what does this mean?)
  • If applicable, received copy of the Explanation of Benefits (EOB) as proof that the client's deductible has been fully or partially satisfied.
  • Collected any outstanding deductible from client.
  • PROVIDERS WILL NOT BE REIMBURSED IF CLIENT'S DEDUCTIBLE HAS NOT BEEN SATISFIED.
  • Collected applicable copayments from clients. Please Note: Copayments are kept by the provider and deducted from your contracted rate.
  • Requested additional authorized treatment sessions by completing and forwarding to Holman a Request For Treatment Authorization (RTA) ten (10) days prior to the expiration date of your current authorization.
  • Established the client's file with a copy of each form, including Clinical Assessment form, Progress Notes form, Client Information form, and Authorization for Release of Information form.

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Reporting Adverse or Sentinel Events

The provider must report immediately any Adverse or Sentinel Events to The Holman Group.

Adverse or Sentinel Events include:

  • Successful and attempted suicides
  • Behavior exhibiting danger to self (other than suicidal behavior)
  • Behavior exhibiting danger to others
  • Patient injury during the course of treatment
  • Tarasof Interventions
  • Ethical/ Legal misconduct

Call 1-800-321-2843, during business hours (7:30 a.m. — 6:30 p.m. P.S.T.) and speak to an Outpatient Care Manager, after hours speak to the On-Call therapist and report the incident.

NOTE: If the provider is unsure whether an incident can be considered an Adverse or Sentinel Event he/she should contact the Holman Group and confirm.

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