Transcript State of Maryland Department of Health and Mental Hygiene

State of Maryland
Department of Health and
Mental Hygiene &
VALUEOPTIONS®
GETTING CONNECTED
June 2009
Welcome to ValueOptions®
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Presenters
•
Lissa Abrams – Deputy Director Mental Hygiene
Administration [email protected]
•
Mary Mastrandrea – ValueOptions® Maryland CEO
•
Clarence Jordan – ValueOptions® Director,
Recovery & Resiliency
•
Ray Coleman – ValueOptions® National Director,
Provider Relations
•
Mara Rapant – ValueOptions® National Director,
Clinical Services
•
Kathy Melia – ValueOptions® Vice President,
Operations
[email protected]
An Introduction to
ValueOptions®
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ValueOptions® − The Best Resource for the Behavioral
Healthcare People Need
• Singularly qualified – 30 years experience
providing behavioral health and wellness
services.
• Nation’s largest independent behavioral
health and wellness company – more than
23 million covered lives nationally.
• More than 50,000 providers nationwide
• More than 300 corporate clients, including
50% of the Fortune 10 companies.
• Technology used to drive down costs.
ValueOptions® − Recognized Public Sector Leader
• Currently manages more public sector
behavioral health contracts than any other
company
• More than 4.5 million covered lives across 14
states.
• Many of these contracts have Member
populations exceeding 400,000, and several
exceed 1 million covered lives.
ValueOptions® Public Sector Contracts
ValueOptions®
Recovery & Resiliency
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Recovery and Resiliency
• Philosophy consistent with 2006 SAMHSA
National Consensus Statement
• Respect and support of culturally sensitive
individual affirmations of self-efficacy
• Prevention Education and Outreach –
support staff and provide community
outreach
• Community Stakeholder Collaboration –
consumers, family members, providers and
other stakeholders
ValueOptions®
Clinical Services
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ValueOptions® Utilization Management
• Clinical transition will be seamless to
providers and consumers.
• 800-888-1965 will automatically connect to
ValueOptions® staff – September 1, 2009.
• Current authorizations transfer from current
ASO to the ValueOptions® system.
• Maryland medical necessity criteria will be
used.
• Telephonic reviews and Web based
applications will be used for authorization
requests.
ValueOptions® Utilization Management
Services that are currently authorized
by Core Service Agencies will
continue to be reviewed by CSA staff
and will be incorporated into
ValueOptions authorization system
ValueOptions® Care Management
• A dedicated team of local Maryland care
management staff
• Acceptance of referrals from medical,
behavioral, substance abuse, CSA, consumers
and family members
• Proactive identification of high risk consumers
• Referrals and reviews as needed
• Outreach to all involved in consumer’s care
• Treatment plan coordination
• Discharge planning
ValueOptions®
Provider Relations
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Provider Handbook
• A guide to ValueOptions® policies
and procedures for all providers
• Available on the ValueOptions®
Maryland website
ValueOptions® Provider Website
www.valueoptions.com/providers/Providers.htm
• Regulatory News: Changes in state and
federal laws affecting providers.
• The Valued Provider: Newsletter highlighting
service authorization and claims payment
improvements.
• Achieve Solutions®: A comprehensive library
of consumer behavioral health educational
articles.
ValueOptions®
ProviderConnect Overview
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ValueOptions® ProviderConnect
ProviderConnect is an online tool that increases
convenience & decreases administrative burden.
• Free, secure, online application
• Easy access 24 hours a day, 7 days a week
• Complete multiple transactions in a single sitting
ValueOptions® ProviderConnect Features
With ProviderConnect providers can:
• Verify Consumer eligibility
• Request Authorizations
• View Authorizations
• Submit Claims (Batch and Single claim)
• View Claim Status
• View and Print Provider Summary Voucher
• Submit inquiries to Customer Service
• Access and print forms
Accessing ProviderConnect
• Each provider has a secure login and online
registration, including a provider ID number via
the ProviderConnect Web site.
• Additional logins for other providers in the
same practice are available through
ProviderConnect. Contact:
ValueOptions® EDI Helpdesk
(888) 247-9311, Option 3
Monday through Friday
8 a.m. – 6 p.m. EST
Turn around time for additional logins is 48 hours.
ProviderConnect Demonstration
• Step 1:
www.valueoptions.com
• Step 2:
Click on “Providers”
• Step 3:
Click on “Try the Demo”
ProviderConnect Login Screen
User Agreement
Search/View Member Eligibility
Member Eligibility Results
Review an Authorization
Search Authorizations
Authorization Search Results
Authorization Summary
Authorization Detail
My Online Registration Profile
Updating My Online Profile
ProviderConnect Message Center (Personalized!)
Inquiry Details
View Provider Summary Voucher
Provider Summary Voucher Search
Provider Summary Voucher Results
EDI Claims Submission
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EDI Claims Set-up
•
ValueOptions® will accept any HIPAA
compliant 837p or 837i file
•
Claims are submitted through
www.valueoptions/providerconnect
•
Filing guidelines are the same, regardless of
the software used to submit a claim.
•
A completed Account Request Form must
accompany all claims.
•
Billing agents must also submit an
Intermediary Form.
•
ValueOptions® has Experience working
with multiple clearing houses
EDI Claims Set-up (continued)
• Account request and intermediary forms
can be faxed to 866-698-6032.
• Allow 2 days for account set-up in test
mode.
• An ID and Password will be sent via
email.
EDI Claims Set-up (continued)
• Once a file is successfully submitted in test
mode:
– Call ValueOptions® EDI Helpdesk at
888-247-9311 to be taken out of test
mode.
– Normal claims submission can begin
• During normal claims submission, eSupport
will send two e-mails:
– The1st email confirms receipt of file
– The 2nd email confirms pass/failure of file.
If file fails, the email will explain the reason
for failure
PaySpan Health and Electronic
Funds Transfer (EFT)
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The ValueOptions® Electronic Funds Transfer
• ValueOptions® partners with PaySpan to give
providers the ability to:
– Receive Electronic Funds Transfer (EFT)
– View and Print Provider Summary Voucher
• PaySpan Features
– Ability to control each user’s access to
specific customer applications
– Logs all user activity on the PaySpan
provider site
– Online Help on every screen
www.payspan.com
– Supports Internet Explorer 5.0 and above
www.payspanhealth.com
Next Steps
• Provider/Stakeholder Advisory Committee
• Provider/Stakeholder meetings coming soon
(July and August)
• Upcoming Provider trainings, multiple modalities
• Maryland Website development continues
• This presentation/updates will be posted on the
DHMH Website http://DHMH.state.md.us/mha
• ValueOptions® contract will be effective
September 1, 2009
Questions
[email protected]
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Thank You!
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