Transcript State of Maryland Department of Health and Mental Hygiene

State of Maryland
Department of Health and
Mental Hygiene &
VALUEOPTIONS®
Clinical Training
for
OMS Providers
September 2009
Presenters
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Nancy Calvert, Director, Provider Relations, ValueOptions®
Maryland
•
Jennifer Lowther, Clinical Director, ValueOptions® Maryland
Agenda
• Update
• Outcomes Measurement System
• Overview of ProviderConnect
• Requesting Authorizations
• Questions
Updates
• ValueOptions® Maryland Website
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http://maryland.valueoptions.com
– Provider Alerts
• MHA Policy Clarification Memos and Announcements
• ValueOptions® Maryland Updates and Announcements
– Training Schedule
– ProviderConnect “tips”
– Maryland Specific ProviderConnect “demo”
– Provider Forms – including a hard copy concurrent review form
– Coming Soon:
• Provider Manual
• Diagnostic Crosswalk
• Fee Schedule
• Service Grid
– Consumer Information
OMS Information on Website
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http://maryland.valueoptions.com
• “For Providers”
• “Provider Forms”
OMS Tools
Discharge Information Sheet
Adult Questionnaire
Definitions for Adult OMS Interview
Adult Questionnaire Response Cards
Adult Discharge Form – Consumer Not Participating
Child and Adolescent Questionnaire
Child and Adolescent Response Cards
Child and Adolescent Discharge Form – Consumer not Participating
• The OMS Interview Guide will be included in the Provider Manual
September 25th System Upgrades
• Online Uninsured Eligibility Registration (request
function) is now available to providers.
• Axis 1-V diagnoses are now required on concurrent
reviews
• The “Individual Care Plan”
– The Plan tab has been added to the Mobile Treatment
authorization request screen.
– The Service Code Field has been removed
– Providers now have the option to print the Plan separately.
• “MCO” is no longer a required field.
• “Education Level” has been deleted from the federally
required questions.
• “N/A” is no longer an option to the “Race” question.
Outcome Measurements System
(OMS)
• Measures consumer outcomes regarding the
management of their illness and the quality of their lives.
• Supports recovery and resiliency
• An important measure of the benefit provided by
services in the PMHS
OMS
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In effect since September 2006
Collaboration between
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Only for outpatient services provided by
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Mental Hygiene Administration (MHA)
University of Maryland Systems Evaluation Center (SEC)
MHA Administrative Service Organization (ASO)
In-state providers
• Hospital outpatient clinics
• Federally Qualified Health Centers (FQHC)
• Outpatient Mental Health Clinics (OMHC)
• Local Health Departments
Consumers:
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Ages 6-17 and 18-64
Regardless of age, Dually eligible Medicare/Medicaid consumers are
excluded from OMS
OMS Questionnaires
• Separate questionnaires for adults and youth
– Adult questionnaire contains the BASIS-24 questions
• Cover several life domains:
– Living situation, Employment, School attendance, Substance use,
Legal system involvement, Symptoms, Functioning, etc
• Administered every six months
• Documentation of completion should be included in the
consumer’s clinical contact/progress notes.
OMS Service Bundle
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150 Unit Service Bundle Includes:
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2 outpatient evaluations (90801)
2 family therapy sessions without consumer present (90846)
Medication management
Individual Therapy
Group Therapy
Excluded:
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All extended therapy codes
Additional sessions of 90801 or 90846
Services associated with crisis bed stays
Intensive Outpatient Services (IOP)
Partial Hospitalization Programs (PHP)
Initial and subsequent inpatient care
• Combination of service rules apply
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http://maryland.valueoptions.com/provider/announcements/2005_Announcement_Archive.
pdf
Services Included in the OMS Authorization
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90801: Initial Evaluation*
90804: Individual Psychotherapy (20-30 minutes)
90805: Individual Psychotherapy with Med Eval/Mgmt
90806: Individual Psychotherapy (40-50 minutes)
90807: Individual Psychotherapy with Med Eval/Mgmt
90846: Family Psychotherapy without Patient Present*
90847: Family Psychotherapy with Patient Present
90849: Multiple Family Group
90853: Group Therapy
90862: Medication Management
90875: Individual Psychotherapy with Biofeedback
90876: Individual Psychotherapy with Biofeedback
T1015: FQHC Clinic Visit
Rev Codes: 0510, 0513, 0910, 0914, 0915, 0916, 0917, 0918,
0919
OMS Services, continued
• Discharge Codes (included in the authorization bundle)
• 90889
• 0929
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Not included:*
Extended visit codes (90808, 90809)
More than two initial evaluations (90801)
More than two family psychotherapy without patient
present services (90846)
*Separate pre-authorization required
OMS Registration/Authorization
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Initial Registration:
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Continuing Registration (150 bundle)
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2 visits/3 months
2 additional visits may be requested telephonically under special
circumstances
May be requested with the initial registration
The start date of the continuing registration will always the day after the
date of the OMS interview
End of Authorization/Discharge
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May be performed up to 10 days after the authorization is closed
After 100 days neither a continuing OMS nor a discharge OMS will be
accepted.
With consumer present:
• Discharge Information Sheet
• OMS Questionnaire
Without Consumer Present:
• Discharge Information Sheet
• Discharge OMS Form
End Users License Agreement
(EULA)
• Required for all OMS Providers of service to adults
– OMHC, FQHC, Hospital Based Clinics
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Allows inclusion of the BASIS-24 questions
Return a signed copy to ValueOptions® Maryland
Maintain individually signed copies in staff personnel files
Failure to sign:
– Questionnaire must still be completed (minus the BASIS 24 questions)
– Providers will only receive 12 visits per authorization period.
• Available on both the MHA and ValueOptions® Websites
• Contact: Teana Jones
– 410-691- 4015 Fax: 410 691-4001
– [email protected]
ProviderConnect
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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
• Register Uninsured Consumers
• Request Authorizations
• View Authorizations
• Submit Claims (Batch and Direct/On-line 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.
OMS Authorization Requests
• Live Demonstration
Questions
[email protected]
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