State of Maryland Department of Health and Mental Hygiene

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State of Maryland Department of Health and
Mental Hygiene VALUEOPTIONS
GETTING CONNECTED

• June 2009

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Welcome to ValueOptions
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Presenters

• Lissa Abrams Deputy Director Mental Hygiene
  Administration abramsl_at_dhmh.state.md.us
• Mary Mastrandrea ValueOptions Maryland CEO
  mary.mastrandrea_at_valueoptions.com
• 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

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An Introduction to ValueOptions
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ValueOptions - The Best Resource for the
Behavioral Healthcare People Need

• Singularly qualified 30 years experience
  providing behavioral health and wellness
  services.
• Nations 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.

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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. 

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ValueOptions Public Sector Contracts
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ValueOptions Recovery Resiliency
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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

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ValueOptions Clinical Services
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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.

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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

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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 consumers care
• Treatment plan coordination
• Discharge planning

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ValueOptions Provider Relations
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Provider Handbook

• A guide to ValueOptions policies and procedures
  for all providers
• Available on the ValueOptions Maryland website

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ValueOptions Provider Websitewww.valueoptions.co
m/providers/Providers.htm

• 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.

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ValueOptions ProviderConnect Overview
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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

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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

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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 [phone],
Option 3 Monday through Friday 8 a.m. 6 p.m.
EST
Turn around time for additional logins is 48
hours.
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ProviderConnect Demonstration

• Step 1 www.valueoptions.com
• Step 2 Click on Providers
• Step 3 Click on Try the Demo

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ProviderConnect Login Screen
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User Agreement
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Search/View Member Eligibility
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Member Eligibility Results
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Review an Authorization
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Search Authorizations
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Authorization Search Results
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Authorization Summary
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Authorization Detail
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My Online Registration Profile
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Updating My Online Profile
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ProviderConnect Message Center (Personalized!)
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Inquiry Details
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View Provider Summary Voucher
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Provider Summary Voucher Search
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Provider Summary Voucher Results
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EDI Claims Submission
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EDI Claims Set-up

• ValueOptions will accept any HIPAA compliant
  837p or 837i file
• Claims are submitted through www.valueoptions/prov
  iderconnect
• 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

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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.

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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

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PaySpan Health and Electronic Funds Transfer (EFT)
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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 users access to specific
  customer applications
• Logs all user activity on the PaySpan provider
  site
• Online Help on every screen www.payspan.com
• Supports Internet Explorer 5.0 and above

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www.payspanhealth.com
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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 http//DHMH.state.md.us/mha
• ValueOptions contract will be effective
  September 1, 2009

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Questions
valueoptionstransition_at_dhmh.state.md.us
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Thank You!