2025 Carelon Maryland Medicaid PRP Set Up Best Practices

2025 Carelon Maryland Medicaid PRP Set Up Best Practices

If your organization provides both PRP services and OMHC/Therapy services, best practice is to maintain two separate ICANotes accounts—one dedicated to PRP clients and clinicians and another for your other services and providers. This approach helps ensure compliance with Maryland licensing and accreditation requirements while minimizing clinical, administrative, and reporting challenges. Please be sure to contact sales for assistance ICANotes Sales

Here are some other PRP Specific workflows you may find helpful 
2024/2025 Transition Optum Maryland Medicaid to Carelon

Initial PRP Intake/Assessment & Daily PRP Follow Up Notes

(see attachment - PRP Functional Assessment Custom Button Configured Templates for adults and minors included)

Lets start with Group Level Settings

(https://scribehow.com/shared/Setting_up_PRP_in_ICANotes__aoW5lPSLRw6W_hMY5KxB4A )

Edit Sites/Letterheads- Add your 3 sites PER LOCATION. One for each POS code, 49 Blended, 15 Off Site, 52 Onsite. If you have more than 1 location where services are provides, repeat this for each location being sure to use make each site name visually distinguishable for each site for easy visual filtering. For example, I used L1- for these sites name for "Location 1". Then you could do L2 for "Location 2"
Screenshot for 2025 Carelon Maryland Medicaid PRP Set Up Best Practices
Screenshot for 2025 Carelon Maryland Medicaid PRP Set Up Best Practices

Now lets add your service codes!!

I added each of the CPT codes I will be using and repeated the H2018 CPT codes and added the proper description and 

modifier per billable event for adults and minors. You can request that we enable the following group rule so that ICANotes recognizes and adds the prior authorization number specifically for that CPT code H2018

Set Authorizations by Service Code: With this rule enabled an additional field will be visible on the Managed Care Monitor layout where a user can optionally choose one service code (from the group-level service code shortlist) to link with the managed care authorization. When that linked service code is selected in service code line #1 of a note that supports managed care authorizations, the authorization will automatically populate for the note for that patient. As service codes are changed from Service Code line #1, qualifying service codes will have the authorization automatically update as well. 

Screenshot for 2025 Carelon Maryland Medicaid PRP Set Up Best Practices

Now lets add you insurance payers. Here I'm adding Carelon Medicaid. Feel free to add more payers in this format. I also recommend enabling these ANSI rules and clicking SAVE


Screenshot for 2025 Carelon Maryland Medicaid PRP Set Up Best PracticesNow lets go to Specific to Individual 
Make sure to add and supervising clinicians to the the appropriate supervisee
Assigning a Supervisor
Screenshot for 2025 Carelon Maryland Medicaid PRP Set Up Best Practices

Here is how we set up the CPT codes, modifier codes and rates. You can add them all to each PRP workers Billing Rates or add the Adult PRP ones to the ones that are providing adult services and the minor ones to those providing services to minors. 

Please be sure that the billable rates are correct! These are just for the demo!!!!!

00000 Cancellation/No Show $0.00
00000 non-billable $0.00
00000 Therapist Collaborative Note $0.00
H0002 HA Adult Rehabilitation Assessment $97.65

H0002 HB Minor Rehabilitation Assessment $97.65
H2016 PRP Encounter $1.00
H2018 PRP Monthly Adult U3 X2 U3 $386.32
H2018 PRP Monthly Adult U3 X3 U3 $676.72
H2018 PRP Monthly Adult U3 X4 U3 $709.55
H2018 PRP Monthly Adult U3 X5 U3 $794.82
H2018 PRP Monthly Adult U3 X6 U3 $1,205.88
H2018 PRP Monthly Summary U2 x2 U2 $386.32
H2018 PRP Monthly Summary U2 x3 U2 $676.72
Screenshot for 2025 Carelon Maryland Medicaid PRP Set Up Best Practices

Screenshot for 2025 Carelon Maryland Medicaid PRP Set Up Best Practices

Lastly, lets add our managed care auths! Group Rule: Set Authorizations by Service Code!

Screenshot for 2025 Carelon Maryland Medicaid PRP Set Up Best Practices

Screenshot for 2025 Carelon Maryland Medicaid PRP Set Up Best Practices

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