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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 MarylandDepartment of Health and Mental Hygiene & VALUEOPTIONS®

September 2009

Clinical Training

for

RTC Providers


Welcome to ValueOptions®


Presenters

  • Nancy Calvert, Director, ValueOptions® Maryland Provider Relations

  • Jennifer Lowther, Clinical Director, ValueOptions® Maryland


Agenda

  • Update

  • Overview of ProviderConnect

  • Requesting Authorizations

  • Questions


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


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

  • 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

  • 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


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

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.


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.


Requesting an RTC Authorization

  • Live demonstration


Questions

[email protected]


THANK YOU!

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