Managed Care List Update 2011 and Strategy for Counselors to be Included as Managed Care and Insurance Providers

 

 

I have updated contact information for the major national insurance and managed care companies. Check with major employers and unions in your area to identify which ones to pursue. In order to bill a client’s insurance company, you need to apply to be credentialed or “paneled”.

 

The list has direct links to provider relations information on the web as well as details outlining the number of insured lives covered, necessary paperwork and reimbursement rates.. Information on the number of covered lives is taken from a study by Harvard University’s John F. Kennedy School of Government Mossavar-Rahmani Center for Business and Government. We compiled information regarding payment and paperwork requirements from insurance and managed care websites as well as surveys of licensed counselors.

 

This past year included many mergers among these companies. Counselors should note that these changes could offer opportunities as the companies expand into new areas. This is a good time to consider applying to become a provider to these companies. Remember, persistence will pay off when applying to become a provider or even when asking to be considered for an increase in reimbursement rates.

 

 

Top 11 insurance, managed care and employee assistance providers

 

 

• Blue Cross/Blue Shield (Various states)

 

AETNA

(covers 11 million)
UOP Station
P.O. Box 2907
Minneapolis, MN 55402
http://www.aetna.com/provider/credentialing.html
1-800-333-1232

 

AMERICAN PSYCH SYSTEMS/ APS Healthcare (Maryland)
(covers 20 million)
6705 Rockledge Drive Ste. #200
Bethesda, MD 20817
1-800-888-1965
http://www.apshealthcare.com/providers.aspx

 

BENEFIT ADMINISTRATIVE SYSTEMS, LTD various regions
17475 Jovanna Drive, Suite #1B
Homewood, IL 60430-4623
1-708-799-7400
http://benadmsys.com/
Note: administers PHCS, CCN, Beach Street, MultiPlan, ABCCompany
payment varies

 

BEHAVIORAL HEALTH SYSTEMS, INC. *National
Two Metroplex Drive, Ste. #500
Birmingham, AL 35209
1-800-245-1150
http://www.behavioralhealthcareoptions.com/body.cfm?id=8

 

BENESIGHT
P.O. Box 350
Pueblo, CO 81002
1-877-396-4834
www.benesight.com

 

BLUE CROSS/BLUE SHIELD
http://www.bcbs.com/about-the-companies (scroll down to find your state’s BC/BS company)

 

BSSI/ BENEFIT SYSTEM AND SERVICE INC. (Illinois)
760 Pasquinelli Dr
Suite 320
Westmont, IL, 60559
1-630-789-2082
http://www.benefit-sys.com

 

CERIDIAN (LIFEWORKS)
Minneapolis, MN
(covers 2.5 million)
800-367-3920

 

CIGNA
P.O. Box 46270
Eden Prairie, MN 55344
1-800-442-2353/ 1-888-800-8849 x7064
Michigan and New York 1-800274-7603
http://www.cigna.com/healthcare-professionals

 

COMMUNITY CARE NETWORK/CCN COMMONWEALTH ADMINISTRATORS/CHA HEALTH
PO Box 3079
Lexington, KY 40588
1-800-457-5683
1-800-937-6824 / 1-800-247-2898
http://www.firsthealth.com

 

COMPREHENSIVE BEHAVIORAL CARE/ COMP CARE
(FL,CA,CT,DC,GA,IN,MC,TX,PA,MD)
619 Oak Street
Tampa, FL 33607
1-813-288-4808 (press 6)
http://comprehensivecare.com

 

COMPSYCH BEHAVIORAL HEALTH CORP.
NBC Tower 24th Floor
455 N. City Front Plaza Drive
Chicago, IL 60611
1-800-557-1005
http://www.compsych.com/jsp/en_US/core/provider/credentialing.jsp?cid=46
60% of usual and customary, $10 co-pay/ EAP $30, $0 co-pay, extensive paperwork and utilization review.

 

CORPHEALTH, INC.
LifeSync
1300 Summit Avenue Ste #600
Forth Worth, TX 76102
1-800-890-8288
http://corphealth.com/providers

 

EMPLOYEE ASSISTANCE PROGRAMS AND CONTACT INFORMATION LIST (*important national comprehensive list of EAP’s)
http://www.eaplist.com

 

FIRST HEALTH SERVICES, INC.
501 Great Circle Road #300
Nashville, TN 37228
1-800-598-6462
http://www.firsthealth.com

 

GEN AM BENEFITS/ GREAT WEST (Midwest States Only)
P.O.Box 190018
North Charleston, SC 29419-9018
1-888-663-8081,
https://www5.greatwesthealthcare.com/Providers/home.aspx
MD referral necessary. 100% usual and customary. W/o MD ref 50% u+c

 

• Ceridian /Lifeworks (National)

 

GUARDIAN (affiliated with CORPHEALTH)
P.O. Box 8007
Appleton, WI 54913
1-800-873-4542

 

THE HOLMAN GROUP
21050 Vanowe Street
Cahoga Park, CA 91303
1-800-824-2932
www.holmangroup.com

 

HORIZON BEHAVIORAL HEALTHCARE MANAGEMENT CORP.
Acorn Building
134 N. Narbeth Ave
Narberth, PA 19072
1-800-223-7050 (press o for operator)
http://www.horizonhealth.com

 

HUMANA EMPLOYERS HEALTH
1100 Employers Blvd.
Green Bay, WI 54344
https://www.humana.com/provider

 

INTEGRA
(see MHN)
1060 First Avenue Ste. #400
King of Prussia, PA 19406
1-800-232-1540

 

MAGELLAN BEHAVIORAL HEALTH
(covers 24 million)
5565 Sterret Place Ste #500
Columbia, MD 21044-2611
1-800-788-4005
www.magellanprovider.com

 

MANAGED HEALTH NETWORK
(covers 10 million)
1600 Los Gamos Drive Ste. # 300
San Rafael, CA 94903
1-800-541-3353
https://www.mhn.com/provider/content.do?mainResource=workManual&category=ww
http://www.multiplan.com/providers

 

PACIFICARE BEHAVIORAL HEALTH *National
(covers 4 million)
23046 Avenida de la Corlota Ste. #700
Laguna Hills, CA 92653
http://www.pbhi.com/Providers_public/MyHomePage/MyHomePage.asp
$60-75
1-800-357-5850

 

PLANNED BEHAVIORAL HEALTHCARE, INC. (affiliated w/MHN)*National
(covers 10 million)
9535 Forest Lane Ste.#110
Dallas, TX 75243
http://www.mhneteap.com/docs/provintro.aspx
1-800-866-7242 x2452
5 years clinical experience required

 

PPO NEXT
1-800-334-5646
http://www.pponext.com/v5/provider/index.asp

 

PRINCIPAL LIFE
PO Box39710
Colorado Springs, CO 80949
1-800-233-8030

 

TRICARE *National
(through Value Options w/physician supervision for now)
http://www.mytricare.com/internet/tric/tri/tricare.nsf/HomePage/Prov?OpenDocument

 

UNITED BEHAVIORAL HEALTH, INC.
(covers 22 million)
One Piere Place, Ste.#550w
Itasca, IL 60143
1-800-333-8724/ 1-800-250-6176/
http://www.ubhonline.com/cred/credIndex.html

 

UNITED HEALTHCARE INSURANCE CO.
P. O. Box 30555
Salt Lake City, UT 84130-0555
1-800-638-8075
1-877-842-3210 provider relations
https://www.unitedhealthcareonline.com/b2c/frameIndex.html

 

VALUE OPTIONS
(covers 24 million)
P.O. Box 141927
Irving, TX 75014-1927
1-800-228-1286
1-800-535-0108
1-800-247-6070 (IL, MI, WS, OH)
http://www.valueoptions.com/providers/Providers.htm

 

WELLPOINT Anthem
(covers 13.7 million)
San Diego, CA
1-800-728-9493
Call for provider application
http://wellpointbehavioral.com/pro/pro_index.html

 

 

Response to Managed Care Denials

 

 

The following strategy has been used to respond to denials by an insurance claim or
refusal to allow a clinician to be a member of a managed care panel. For the most
effective response, a letter should be sent by the client and the counselor.
A letter is sent from the client to the managed care or insurance company explaining why
they wish to see this particular licensed counselor. A copy (cc) is sent to the client’s company
benefits manager.
The counselor sends an appeal to both the client’s employer benefits manager and
managed care or insurance company outlining the counselor’s credentials and giving the
reason the client was referred to him/her. Always have the client sign a release so this letter can be sent.

 

A more detailed description with examples about how to utilize these letters in working with managed care is also available in our book: “The Complete Guide to Private Practice”.

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