Who can join the Evergreen Behavioral Health Association?
EBHA members are licensed social workers, counselors, family therapists, psychologists, psychiatric nurses, and psychiatrists who practice independently in Linn, Benton and Lincoln counties, in the State of Oregon.
What are the benefits of joining EBHA?
Connection
EBHA provides private practice behavioral health providers a way to connect with each other.
- Greater opportunity for collegial community
- On-line bulletin board for professional communication
- Specialty interest groups (child therapy, ADHD, EMDR, etc.)
- Continuing education opportunities locally and at group rates
Opportunities to share expertise and contribute to a thriving professional association (e.g. join Board, join subcommittee, etc.)
- Security in being part of a group that can ride the tides of change in behavioral health care.
Enhanced Business Practices
- Easier access by potential clients and referring professionals
- Potential for streamlined coordination of care with other providers
- Website presence–your own professional profile on the EBHA website.
Market exposure
- Access to updates on billing questions, practitioner standards, and local, state and national trends
- Tools for outcome-informed care
- Potential group discounts (e.g. health insurance, cell phone packages, etc.)
- Current information about electronic health record technology
Contracting
EBHA will engage in the negotiation of contracts with insurance companies for fair reimbursement.
How will contracting with insurance companies work?
- EBHA will work specialists who are familiar with mental health contract negotiation, and who can facilitate communication between insurance companies and Members.
- Contracts will predominantly be between each individual Member and insurers, through agreements EBHA facilitates. As a Member of EBHA you will be able to select which contracts you wish to participate in and which ones you wish to opt out of..
- All Members who choose to participate in a contract are included regardless of location or degree. There will be no blackout areas or closed panels for EBHA Members.
- Included in the contract will be clear and defined reimbursement schedules.
What if I am not currently on any insurance panels?
All EBHA Members will have access to all EBHA contracts. If you are not credentialed with a particular insurance company and wish to be part of a contract EBHA sets up, you will be sent credentialing information when EBHA executes the agreement with that insurance provider.
How does contracting work?
Once EBHA has contracts to offer its Members, you as an approved Member will be able to access to our provider portal. There you will be able to review our current contracts (with the exception of reimbursement terms). Reimbursement negotiations are developed individually with each Member for each agreement. You will be able to review the ones in which you are interested and choose which ones you would like to join. Your choices about what you do or do not join and any reimbursement rates to which you agree are not accessible to other providers, and can only seen by personnel working directly with the insurance companies.
What if I want to contract directly with an insurance company EBHA is also working with?
EBHA will never discourage providers from working with payers directly. If you like the contract you have, you can keep it. You decide which EBHA contracts you wish to sign.
If I decide not to renew my Membership in the future, what happens to my EBHA contracts?
If you decide to discontinue your Membership with EBHA, your name would be removed from all EBHA contracts at the end of your Membership term. You would need to renegotiate your individual contracts with those insurance companies.
How is my confidential information protected?
All information given to EBHA is strictly confidential and will not be shared with other Members, or other outside companies. Member information will only be shared with Insurance Companies with whom Members choose to participate.
How will my current practice change?
Since we are a Membership organization, joining the IPA does not change the way you run your practice. You will continue to operate your business as usual, using your current staff and billing personnel, tax ID, etc. You will pay an enrollment fee and yearly dues, which allow you to access all Member benefits.
Does EBHA have any legislative power?
EBHA is strictly for contracting, networking, and educational purposes. If there is enough Member interest, we may develop a legislative committee in the future to address the issues which affect our Members; however, those issues would be carefully defined and approved by the Board of Directors.
What are antitrust laws and how do they impact me?
Federal antitrust laws generally apply to all Health Care Providers. They prohibit
Providers from collectively negotiating, hindering or boycotting a Health Plan or Insurer in any given area in any way that prevents competition or restricts fair trade.
This means that Providers cannot discuss or share reimbursement rates nor collectively set rates or restrictions on any given Health Plan. The antitrust alerts increase when a community IPA has a large majority of providers participating since this would potentially increase the antitrust possibilities.
Example: a group of independent behavioral health professionals cannot get together and discuss contract rates or preferred rates as a group, or exchange information on their billed charges. They also cannot collectively discuss and agree to sign or not sign contracts with a health plan. This includes informal discussions between two or more practices.
Providers can meet and discuss contracts, Health Plans and management issues such as Plan functions, claims, referrals and authorizations, so long as they do not discuss reimbursement terms or individual dispositions concerning a proposed contract.
The laws are complicated, and there are exceptions related to risk pool contracts. For now, EBHA does not plan to engage in risk pool contracting.
How can I become more involved?
As a membership organization, there are also many opportunities to become involved: Member volunteers can contribute time and expertise to the Board of Directors and the various committees, such as Membership, Technology, Networking, Insurance Liaison, Continuing Education, and Website.