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Residential Treatment Information - FAQ

Residential Treatment FAQs

  1. 1.  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

  2. 2.  What is the Prior Authorization process?
    • Effective June 1, 2011, DHCF shall require all PRTF Providers to obtain prior authorization for PRTF services provided to District of Columbia Fee-for-Service Medicaid beneficiaries.  This applies to beneficiaries currently receiving services in your facility and awaiting admission. The prior authorization number must be included on all claims submitted for Medicaid reimbursement for services provided on or after June 1, 2011.

      To receive prior authorization for PRTF services, a PRTF Provider must have a letter approving medical necessity for PRTF from the District of Columbia Department of Behavioral Health (DBH).  The letter approving medical necessity will indicate a specific time period during which PRTF services will be authorized (i.e., three (3) months, six (6) months, etc).

      Upon receipt of the letter approving medical necessity from DMH, PRTF Providers must request prior authorization online to DHCF for services to be rendered within the specified time-frame provided in the medical necessity letter.  The first date of service must be no more than sixty (60) days following the date of the letter from DMH. A copy of the letter must be attached to the prior authorization request to complete the online process. If, for some reason, the letter won't upload in the web portal, then include the date of the letter from DMH in the justification section of the request.

      If the Medicaid beneficiary requires a longer stay than initially authorized, the PRTF Provider must have a letter approving a continued stay from DMH and then submit an additional prior authorization request through the web portal. 

  3. 3.  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) 752-9231 (outside DC metro area) or via email at providerinquiry@conduent.com.

  4. 4.  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. 

  5. 5.  How does our facility submit an online prior authorization request?
    • To submit a prior authorization request online, the PRTF Provider must be an active Medicaid provider with a valid Medicaid provider ID. The Provider must also register on the web portal to obtain a username and password. To register, simply go to www.dc-medicaid.com, click on the “Web Registration” found on the left hand panel and follow the on-screen directions to obtain a username and password. Once the Provider has logged into the web portal, a prior authorization may be requested.

      Registration instructions for the web portal can be found on the left-hand side of the web portal under the heading “Training Material/CBT.” There is also an instruction manual titled “Submitting Prior Authorization Requests Online for PRTF Providers.” Please review these materials to ensure a successful submission.

  6. 6.  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.

      In order 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.

  7. 7.  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.

  8. 8.  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.

  9. 9.  How frequently is the fee schedule updated?
    • The fee schedule is systemically updated the last Friday of each month.  If you have questions, contact Provider Inquiry at (202) 906-8319 (inside DC metro area) or (866) 752-9231 (outside DC metro area) or via email at providerinquiry@conduent.com.

  10. 10.  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.