FAQs
This section helps guide hospitals and community
health plans with short answers to frequently asked questions.
Frequently Asked Questions
What part of the Concurrent Review process will Acentra Health cover?
The Concurrent Review process begins when the hospital enters a Medi-Cal beneficiary into the Atrezzo system. Acentra Health will provide the clinical review for medical necessity criteria authorization and submission of the TAR, quality review, and appeals representation.
Will Acentra Health conduct a concurrent review if a private insurance company is paying for the hospitalization?
No, Acentra Health will only conduct a Concurrent Review for beneficiaries where Medi-Cal is the responsible payor and/or uninsured for Participating Contracted Counties.
Do I need to submit a request for a beneficiary that is not Medi-Cal eligible?
Acentra Health will be reviewing all inpatient psychiatric hospital admissions for beneficiary's with Medi-Cal or Uninsured/Short-Doyle for Participating Contracted Counties. Acentra Health will not review requests for beneficiaries if their primary insurance is private insurance, military insurance, or Medicare.
Will Acentra Health clinically review my request over the weekend?
Yes, Acentra Health is required to clinically review all concurrent requests within 24 hours, including weekends.
How can I contact a Acentra Health clinical reviewer?
Acentra Health's Atrezzo portal allows for two way communication between you and the clinical reviewer. For instructions on how to send Acentra Health a message, view page 12 of our Atrezzo Portal Guide.
Occasionally the stay is split between 2 counties, can Acentra Health's process accommodate that?
Yes, admission would likely have to be split in the system to reflect proper county of responsibility. Each county will need to submit separate TARs.
Does Acentra Health also submit the TAR to the State Fiscal Intermediary?
Yes, Acentra Health will submit the TAR to the State Fiscal Intermediary. If the TAR is from an Institute for Mental Disease (IMD), Psychiatric Hospital Facility (PHF), or for an indigent or uninsured patient, Acentra Health will send the TAR to the County responsible.
Are NOABDs available in the threshold languages?
Yes, they will be available in threshold languages. Acentra Health sends them out via fax at the time a determination is made.
How do the counties contact Acentra Health is there is a problem that needs to be addressed?
Acentra Health is actively engaged and communicating with the counties on a routine basis. There are several options for communication including phone, email, fax, and through the Atrezzo portal. Our Customer Service Representatives are available during normal business hours to answer questions and to provide technical assistance. Acentra Health will provide the counties and hospitals with an escalation tree for use shall a problem arise. If there is an issue that cannot be properly handled between the counties and Acentra Health, we will escalate the issue to CalMHSA for support. Acentra Health conducts either biweekly, monthly, or quarterly meetings with counties and providers to check in, troubleshoot any areas of concern, and maintain collaboration in our work. Acentra Health also has a Stakeholder Advisory Council with representation from multiple disciplines to discuss the ongoing issues and concerns. During these meetings, information on what is working well and what needs to be improved are among topics discussed.
Will Acentra Health communicate with our Hospital Liaison/county staff in charge of supporting and tracking hospital discharges?
Yes, Acentra Health staff will outreach to the hospital liaison/county staff members if there are questions about tracking discharges or things such as administrative days.
Will counties be receiving notification of admission from the hospital and will/how will that notification be communicated?
Acentra Health will receive notification via the Atrezzo system. Counties will have access to Atrezzo and can generate reports through the Atrezzo system. Reports can be distributed daily, weekly, or monthly or generated by the county on an as needed basis.
How will our county know what days were approved vs. not?
All outcomes are documented within the Atrezzo portal. Acentra Health can develop a report within the Atrezzo platform that provide the outcome of all case submissions. This can be scheduled to be sent securely to county contacts. Reports can be distributed daily, weekly, or monthly. All Notices of Adverse Benefit Determination (NOABDs) are uploaded into Atrezzo and faxed out at the time a denial determination is made.
How do we view the client’s hospital documents (progress notes, admit/discharge notes, treatment plan, etc.)?
Acentra Health, Counties and Hospitals will all have access to login to the Atrezzo system to view all uploaded documents and clinical information from the hospitals. Hospitals must upload documents into the Atrezzo system for review.
How will Acentra Health manage out of state hospitalizations (more common for counties that border other states)?
The providers for California beneficiaries who are hospitalized out of state are not to submit cases for review to Acentra health. All information about the hospitalization, patient, facility, and medical billing are to go directly to the state.
Are there any statistics on the level of compliance/approval rates?
Acentra Health will receive all state/CalMHSA polices and ensure the system will match those policies. Acentra Health uses InterQual on our reviews and will make sure differences for each county will be accounted for.
A couple times a year, we get a TAR for individuals who are Medi-Cal beneficiaries of other counties. Will Acentra Health be checking Medi-Cal eligibility and ensuring the proper county is billed?
Yes, Acentra Health will ensure Medi-Cal eligibility by checking monthly MMEF files and insurance information uploaded to a case to ensure the proper county is billed. Counties will need to upload their MMEF file to a drop box at CalMHSA.
Will there be an opportunity for counties to provide feedback on the determination of county of responsibility?
Yes. If Acentra Health is ever unsure of county of responsibility, outreach to the county will occur immediately. However, Acentra Health will follow the guidance outlined in the DHCS Information Notice 21-072, County of Responsibility for Specialty Mental Health Services and Arbitration between Mental Health Plans.
What does the Acentra Health's discharge planning and coordination look like?
Questionnaires, anything uploaded, and notes will be available to counties to use for discharge planning.
Can a county initiate the need for review by entering into your system?
Yes, the county could enter a request. Access for county could be set similarly to hospital.
I'm curious about Acentra Health's knowledge of Presumptive Transfer/county of responsibility.
Acentra Health is working with CalMHSA to get a clear understanding of the process and will make sure access to the state eligibility system. Acentra Health is still working through the details
We have a county owned PHF that is contracted to a vendor to operate. We do concurrent review with them, but they don't bill us through TARs but rather via a monthly invoice based on the number of beds in the facility. Will that be a county-specific process you discuss with the county since the process may not match other counties? (the bed days are paid regardless)
If a PHF doesn’t use TARs, then Acentra Health will process the specific hospitalization request form or treatment authorization form used by the county the PHF is located in.