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Value Behavioral Health of Pennsylvania, Inc. Auto Approvals for Outpatient and Clozapine Supports Services via ProviderConnect. The webinar will begin at 10:00 AM We are waiting for the other participants to join . Value Behavioral Health of Pennsylvania. Presenters.

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value behavioral health of pennsylvania inc

Value Behavioral Health of Pennsylvania, Inc.

Auto Approvals for Outpatient and Clozapine Supports Services via ProviderConnect

The webinar will begin at 10:00 AM

We are waiting for the other participants to join

presenters

Value Behavioral Health of Pennsylvania

Presenters

Shar Whitmire, Director of Provider and Member Services

Jim Friend, Special Projects Manager

Gary Kordes, VBH-PA Clinical Manager

Kim Keller, OTR Authorization Specialist

Lori Raling, OTR Authorization Specialist

Tracy Phelps, OTR Authorization Specialist

Pennsylvania Service Center

webinar rules
Webinar Rules
  • All lines are open so we ask that all attendees place there phones on mute at this time by pressing *6 or the mute button on your phone. Again, please mute your phone by pressing *6 or we will be able to hear any background noise. We appreciate you keeping your line muted.
  • If you have to take a call please disconnect from this call. DO NOT use HOLD. We will have to talk over the music.
  • If you happen to get disconnected from the audio portion please call back into the same number you just dialed.
  • The visual portion of this presentation is web based. Of course you can choose the audio portion only but if you would like to join/login to see the webinar presentation/PowerPoint,the login information is located on the invite you received after you registered. If you are experiencing any problems with that particular link to join you can also go to www.joinwebinar.com and enter the web ID:233933123
  • There will be a designated question and answer portion at the end of today’s presentation. We ask attendees to hold their questions for this designated question/answer period.

Value Behavioral Health of Pennsylvania

audio component of the webinar
Audio Component of the Webinar

For the audio component the call in number is 1-877-329-0172 and the participant code is 9429776

Value Behavioral Health of Pennsylvania

agenda
Agenda
  • Outpatient Authorizations
  • Evaluations Authorizations
  • Medication Management Authorizations
  • Clozapine Support Services Authorizations
  • ProviderConnect Demonstration
  • Questions and Answers
  • Contact Information

Value Behavioral Health of Pennsylvania

slide6
Auto Approvals for Outpatient and Clozapine Supports Services via ProviderConnect

Value Behavioral Health of Pennsylvania

outpatient registration orf1 form
Outpatient Registration ORF1 Form

Value Behavioral Health of Pennsylvania

auto authorized services
Auto Authorized Services
  • Outpatient individual psychotherapy
  • Outpatient group therapy
  • Outpatient family psychotherapy
  • Psychiatric Evaluation / Examination
  • Medication Management
  • Clozapine Support

Value Behavioral Health of Pennsylvania

value behavioral health of pa homepage
Value Behavioral Health of PA Homepage

For Providers Only

  • Go to: www.vbh-pa.com
  • Click on: For Providers
  • Click on: ProviderConnect
  • Enter: User ID
  • Enter Password

Value Behavioral Health of Pennsylvania

value behavioral health of pa web site
Value Behavioral Health of PA Web-Site

Value Behavioral Health of Pennsylvania

providerconnect logon homepage
ProviderConnect Logon Homepage

Value Behavioral Health of Pennsylvania

slide12

After logging in, providers will initially view their home page. Authorization Requests are started by utilizing the Enter an Authorization Request

Value Behavioral Health of Pennsylvania

slide13

After selecting Enter an Authorization Request providers will be directed to a disclaimer page and then to a Search a Member page where Member ID and Date of Birth are required elements. The system defaults to the current date for “As of Date” but can be changed as needed. The Member ID is the nine digit Medicaid ID number.Providers will be offered a page to confirm the consumer information.

Value Behavioral Health of Pennsylvania

slide14

Next, the provider must select the correct service address on the Select a Service Address page. This address needs to be a match to the primary location where the consumer will receive services, and is the key to successful navigation through the request process. Funding streams, program codes and provider types are linked to this selection.

Value Behavioral Health of Pennsylvania

submitting outpatient out authorization requests
Submitting Outpatient (OUT) Authorization Requests
  • There are two options for providers requesting authorizations for OUT services. The provider must select either Mental Health or Substance Abuse (Type of Service field)
  • On the Requested Services Header screen the provider must provide the following information to successfully enter the Outpatient (OUT) authorization.
  • Requested Start Date– the date the provider wishes to begin this authorization request.
  • Level of Service – select Outpatient
  • Type of Service –select Mental Health or Substance Abuse
  • Type of Care – for Mental Health select “Psychiatric” and for Substance Abuse leave blank “Select”

Value Behavioral Health of Pennsylvania

level of service
Level of Service

Select Outpatient or Medication Management

Value Behavioral Health of Pennsylvania

type of service select mental health or substance abuse
Type of Service: Select Mental Health or Substance Abuse

Select Mental Health or Substance Abuse

Value Behavioral Health of Pennsylvania

below is an example of a mental health request
Below is an example of a Mental Health request

For Mental Health select the Type of Care field Psychiatric

Value Behavioral Health of Pennsylvania

below is an example of a substance abuse outpatient service request
Below is an example of a Substance Abuse Outpatient Service request

For Substance Abuse the Type of Care field is left blank (Select)

Value Behavioral Health of Pennsylvania

click ok to proceed with auth approval
Click OK to proceed with Auth Approval

Value Behavioral Health of Pennsylvania

enter contact name and telephone number
Enter Contact Name and Telephone Number

Value Behavioral Health of Pennsylvania

slide22

Use of hyperlinks to search with pop ups – entering partial information in a field may assist in narrowing search for desired information. However, if the information is known and the field allows free text, the information can data entered.If Mental Health is selected (TOS), a Mental Health diagnosis code must be entered. If Substance Abuse is selected (TOS), a Substance Abuse diagnosis code must be entered.

Value Behavioral Health of Pennsylvania

slide23

The provider requesting Outpatient services will be offered the Accept/Reject option for 72 units. These requests may approve or pend depending on the type of services being requested and if the member has exceeded the 72 units within a 12 month period, or there has been previous outpatient requests during the course of the year. Accepting these units will allow the process to move forward.

Accept 72 units of Outpatient Services

Value Behavioral Health of Pennsylvania

requested service screen
Requested Service Screen
  • The provider will be asked to enter the specific Place of Service, Service Class and Units.Place of service must always be “Office”.
  • Leave CPT and Modifier blank
  • Options for Outpatient Services are as follows:
  • Service Class-options are as follows: (1) Outpatient Services, (2) Examinations, (3) Medication Management. Total units can not exceed 72 units for all three Outpatient services combined.
  • Please Note: The Place of Service (POS), Service Class and Units selections will result in an authorization request for the service class. This service class allows providers to bill any of the service codes and modifiers for that class on the VBH-PA service class grid. However, in order to be paid for that service you must first be contracted for that service. This allows for flexibility in providing services to the consumer.

Value Behavioral Health of Pennsylvania

requested service screen25
Requested Service Screen

Note: OUT, EXM, and RXM can be combined

Outpatient=OUT

Examinations / Evaluations= EXM

Medication Management= RXM

Can not exceed 72 units

Value Behavioral Health of Pennsylvania

approved authorizations will span 12 months
Approved authorizations will span 12 months.

Authorization will span 12 months

Value Behavioral Health of Pennsylvania

pended confirmation for further review
Pended Confirmation for Further Review

Value Behavioral Health of Pennsylvania

printing and saving options on confirmation page
Printing and Saving Options on Confirmation Page

Value Behavioral Health of Pennsylvania

submitting clozapine cme cs1 cs2 prc authorization requests
Submitting Clozapine (CME, CS1,CS2, PRC) Authorization Requests
  • On the Requested Services Header screen the provider must provide the following information to successfully submit a Clozapine authorization.
  • Requested Start Date– the date the provider wishes to begin this authorization request.
  • Level of Service – select Outpatient
  • Type of Service –select Mental Health
  • Type of Care –select Clozapine Support
  • An example of a Clozapine request is displayed below:
  • Must select Clozapine in the Type of Care drop down to get the 104 maximum number of units

Value Behavioral Health of Pennsylvania

clozapine cme cs1 cs2 prc requests
Clozapine (CME, CS1,CS2, PRC) Requests

Must select ClozapineSupport

Value Behavioral Health of Pennsylvania

enter contact name telephone number and diagnosis code 1
Enter Contact Name, Telephone Number and Diagnosis Code 1

Axis 1 Diagnosis Code 1 needs completed

Value Behavioral Health of Pennsylvania

clozapine cme cs1 cs2 prc requests32
Clozapine (CME, CS1,CS2, PRC) Requests
  • The provider will be asked to enter the specific Place of Service, Service Class and Units.Place of service must always be “Office”.
  • Please Note: The Place of Service (POS), Service Class (Clozapine Services) and Units selection will result in an authorization request for the service class. This service class allows providers to bill any of the service codes and modifiers for that class on the service class grid. However, in order to be paid for that service you must first be contracted for that service. This allows for flexibility in providing services to the consumer.

Value Behavioral Health of Pennsylvania

clozapine cme cs1 cs2 prc requests33
Clozapine (CME, CS1,CS2, PRC) Requests

Can choose CME, CS1, CS2 or PRC in any combination

CME = Clozaril Monitoring and Support

CS1 = Clozaril Support Services-CS1

CS2 = Clozaril Support Services –CS2

PRC = Clozaril Support -PHP

104 units will be offered for Clozapine Support services

Value Behavioral Health of Pennsylvania

slide34

Clozapine Support level of care is programmed to offer a maximum of 104 units, in any combination of CME, CS1, CS2, or PRC service classes. Select “Accept” to continue with the rest of the authorization process.

104 units will be offered for Clozapine Support services

Value Behavioral Health of Pennsylvania

clozapine support approval
Clozapine Support approval

Value Behavioral Health of Pennsylvania

submitting medication management rxm authorization requests
Submitting Medication Management (RXM) Authorization Requests
  • There are two options for providers requesting authorizations for Medication Management services (RXM).
  • The provider can combine RXM with the 72 units as described in the Outpatient (OUT) example. However, if the member only needs medication management and no other services, RXM can be authorized separately. The provider must follow the work-flows below for either Mental Health or Substance Abuse (Type of Care field)
  • On the Requested Services Header screen the provider must provide the following information to successfully enter the Medication Management (RXM) authorization.
  • Requested Start Date– the date the provider wishes to begin this authorization request.
  • Level of Service – select Medication Management
  • Type of Care –select “Psychiatric” for Mental Health and for Substance Abuse select “SWPA Substance Abuse Drug and Alcohol”

Value Behavioral Health of Pennsylvania

submitting medication management rxm authorization requests mh
Submitting Medication Management (RXM) Authorization Requests (MH)

Select Medication Management

Select Psychiatric for Mental Health

Value Behavioral Health of Pennsylvania

medication management rxm request sa
Medication Management (RXM) Request-(SA)

Select Medication Management

Select SWPA Substance Abuse Drug and Alcohol for SA services

Value Behavioral Health of Pennsylvania

enter contact name and telephone number and diagnosis code 1
Enter Contact Name and Telephone Number and Diagnosis Code 1

Axis 1 Diagnosis Code 1 needs completed

Value Behavioral Health of Pennsylvania

medication management rxm request continued
Medication Management (RXM) Request-continued

24 units will be auto authorized for Medication Management for a 12 month period

Value Behavioral Health of Pennsylvania

medication management rxm request continued41
Medication Management (RXM) Request-continued
  • Select Place of Service (Office), Service Class (Medication Management), and Units (24), and click Submit.
  • The provider will be asked to enter the specific Place of Service, Service Class and Units.Place of service must always be “Office”.
  • Please Note: The Place of Service (POS), Service Class and Units selection results in an authorization request for the service class. This service class allows providers to bill any of the service codes and modifiers for that class on the service class grid. However, in order to be paid for that service you must be contracted for that service. This allows for flexibility in providing services to the consumer.

Value Behavioral Health of Pennsylvania

medication management rxm request continued42
Medication Management (RXM) Request-continued

Select Place of Service (Office), Service Class (Medication Management), and Units (24), and click Submit.

Value Behavioral Health of Pennsylvania

slide43

The confirmation page has the Level of Service (Medication Management), authorization effective and expiration dates, authorization reason code A71, and the number of units (24).

Approved

Value Behavioral Health of Pennsylvania

continuing authorizations
Continuing authorizations

If the member needs additional Outpatient services (more than the 72 that were auto approved) you will have to complete the ORF1 form and / or answer the risk assessment questions on-line via ProviderConnect.

Value Behavioral Health of Pennsylvania

rfs form required
RFS Form required
  • Services that need reviewed
  • Non-Acute Partial Hospitalization
  • Intensive Case Management / Resource Coordination (ICM/RC)Intensive
  • Intensive Outpatient (IOP )
  • Methadone Maintenance-use form**

Value Behavioral Health of Pennsylvania

enter an authorization using the request for service rfs form
Enter an Authorization using the Request for Service (RFS) form
  • The Authorization Request function shown below in the screen shot enables users to electronically submit requests for services (RFS) for all the services listed above.
  • Please use the ProviderConnect RFS form found on the VBH-PA website, on the Provider Forms page. Select “Outpatient Request Form” from the drop down list. Click “Yes” if it contains clinical information on the member. Click “Upload file” to attach your request for authorization.

Value Behavioral Health of Pennsylvania

to request additional services a rfs form must be attached
To request additional services a RFS form must be attached.

Browse and find, then upload the RFS form

Value Behavioral Health of Pennsylvania

request for service rfs
Request for Service (RFS)

Value Behavioral Health of Pennsylvania

tips for successful submission navigating screens include
Tips for successful submission/navigating screens include
  • ProviderConnect works best with Internet Explorer 6 or IE7 for your browser – if you are having issues with the screens not displaying or pop ups, etc. not working correctly you may be using a newer version of IE or using Fire Fox. If you are using IE8, you can follow the below steps to help with the issue:
    • Click on the Tools menu at the top of your browser
    • Click on Compatibility View Settings
    • Type in: valueoptions.com, and click the Add button
    • Click the Close button
  • Do not use the browser Back button – use the Back button on the screen itself – using the Back on your browser can result in errors and loss of data.
  • Required fields are indicated by “*”. These fields must be completed each time an authorization is requested. Some fields are dependent on other fields – a positive or negative response to a question may result in other fields being required

Value Behavioral Health of Pennsylvania

pass through units
Pass Through Units

Value Behavioral Health of Pennsylvania

slide51

Starting on March 1, 2010 Providers will be able to view their recent authorization letters with a simple click. All authorization letters within the last 30 days will be accessible on the Provider homepage. See the hyperlink below entitled “View My Recent Authorization Letters

Value Behavioral Health of Pennsylvania

slide52
The second enhancement enables providers to run their own weekly authorization reports via ProviderConnect.

Value Behavioral Health of Pennsylvania

providerconnect demonstration
ProviderConnect Demonstration

Value Behavioral Health of Pennsylvania

frequently asked questions
Frequently Asked Questions
  • Q: Can I request Outpatient (OUT), Medication Management (RXM) and Examinations/Evaluations (EXM) in the same request?
  • A: Yes. VBH-PA has programmed it so that a combined 72 units will be auto authorized. You can use all 72 units for Outpatient, or break it out into 48 OUT, 22 RXM, and 2 EXM, or any combination of the above. However, the units can not exceed 72.
  • Q: Can I auto auth Clozaril, and Outpatient at the same time on the same request.
  • A: No. Since they are in two different Service Classes, two different requests need to be submitted, but the member can receive services at the same time.
  • Q: If I have an auth for Medication Management that overlaps to the next year can I Auto Auth just OUT?
  • A: Yes, OUT will Auto Auth 72 units

Value Behavioral Health of Pennsylvania

frequently asked questions55
Frequently Asked Questions
  • Q: What will happen if I choose one of the other selections in the “Type of Care” drop down list.
  • A: You have only two choices for Outpatient Service for Mental Health , Clozapine Support and Psychiatric. The other selections will pend.
  • Q: I noticed there is no Psychiatric “Type of Care” selection for Substance Abuse. What “Type of Care” do I choose?
  • A: Leave the “Type of Care” field at the default which is Select.
  • Q: The member already was authorized 72 units for Mental Health Outpatient. Can the member now get Substance Abuse Outpatient?
  • A: Yes, 72 units will be offered, the same as Mental Health.
  • Q: If I have an auth for Methadone Maintenance that overlaps to the next year, can I Auto Auth OUT?
  • A: Yes, OUT will Auto Auth 72 units.

Value Behavioral Health of Pennsylvania

question and answer period for providers
Question and Answer Period for Providers

Value Behavioral Health of Pennsylvania

contact information jim friend special projects manager 724 744 6372 james friend@valueoptions com

Contact InformationJim Friend - Special Projects Manager724-744-6372 James.Friend@ValueOptions.com

contacts
Contacts

VBH-PA Provider Line

Toll Free

1-877-615-8503

Hours: 8:00 a.m. – 5:00 p.m. EST

Monday – Friday

Value Behavioral Health of Pennsylvania