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State of Maryland Department of Health and Mental Hygiene & V ALUE O PTIONS ® . June 2009. G ETTING C ONNECTED. Welcome to ValueOptions ®. Presenters. Lissa Abrams – Deputy Director Mental Hygiene Administration

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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®

June 2009


  • Lissa Abrams – Deputy Director Mental Hygiene Administration
  • 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
valueoptions the best resource for the behavioral healthcare people need
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
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. 
recovery and resiliency
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 utilization management
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 management1
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
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
provider handbook
Provider Handbook
  • A guide to ValueOptions® policies and procedures forall providers
  • Available on the ValueOptions® Maryland website
valueoptions provider website www valueoptions com providers providers htm
ValueOptions® Provider
  • 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
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
  • 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
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
ProviderConnect Demonstration
  • Step
  • Step 2: Click on “Providers”
  • Step 3: Click on “Try the Demo”
edi claims set up
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
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 continued1
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
the valueoptions electronic funds transfer
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
    • Supports Internet Explorer 5.0 and above
next steps
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
  • ValueOptions® contract will be effective September 1, 2009