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State of Maryland Department of Health and Mental Hygiene & V ALUE O PTIONS ® . September 2009. Clinical Training for RTC Providers . Welcome to ValueOptions ®. Presenters. Nancy Calvert, Director, ValueOptions® Maryland Provider Relations

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state of maryland department of health and mental hygiene v alue o ptions

State of MarylandDepartment of Health and Mental Hygiene & VALUEOPTIONS®

September 2009

Clinical Training

for

RTC Providers

presenters
Presenters
  • Nancy Calvert, Director, ValueOptions® Maryland Provider Relations
  • Jennifer Lowther, Clinical Director, ValueOptions® Maryland
agenda
Agenda
  • Update
  • Overview of ProviderConnect
  • Requesting Authorizations
  • Questions
updates
Updates
  • ValueOptions® Maryland Website
  • 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
contact information
Main ValueOptions® Maryland Telephone Number:

1-800-888-1965

Secure Clinical Fax Number:

1-877-502-1044

Dedicated RTC Care Managers:

Janice Jenkins Moylan – 410-691-4027

Jenny Rowe – 410-691-4043 (PRTF Waiver)

DES 1000:

Dee Hrvat – 410-691-4046

ValueOptions® Maryland Mailing AddressPO Box 618

Hanover, MD 21076

Contact Information
medical necessity criteria
Medical Necessity Criteria
  • This has changed to incorporate implementation of RTC Waiver
  • Youth with severe psychiatric needs have the option of being treated in the community with RTC Waiver wraparound services
  • RTC Waiver enrollees and RTC admissions are required to follow the same CON process and are evaluated with the same Medical Necessity Criteria
certificate of need con process
Certificate of Need (CON) Process
  • The process remains the same:
    • Fax in 3 required Certificate of Need documents:
      • Psychiatric Evaluation
      • Psycho-social Evaluation
      • Physical Evaluation
    • All evaluations must be dated within 30 days of ASO’s review
    • CSA recommendation form is still required and CSA will fax to the ASO
    • Submit clinical pre-auth via ProviderConnect
valueoptions providerconnect
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
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
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.

september 25 th upgrade
September 25th Upgrade
  • 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.
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