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State of Maryland Department of Health and Mental Hygiene & V ALUE O PTIONS ®

State of Maryland Department of Health and Mental Hygiene & V ALUE O PTIONS ® . September 2009. Clinical Training For Non-OMS 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 ®

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  1. State of MarylandDepartment of Health and Mental Hygiene & VALUEOPTIONS® September 2009 Clinical Training For Non-OMS Providers

  2. Welcome to ValueOptions®

  3. Presenters • Nancy Calvert, Director, ValueOptions® Maryland Provider Relations • Jennifer Lowther, ValueOptions® Maryland Clinical Director

  4. Agenda • Update • Overview of ProviderConnect • Requesting Authorizations • Questions

  5. 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

  6. Important Information • Initial Authorization Requests • A diagnosis is not required. You may enter ICD-9 Code 799.9 “unspecified diagnosis” for the initial request. • Initial requests will auto-authorize for 12 visits/6 months. Providers do not need to call to request an additional 6 months. This will be automatically updated by ValueOptions® Maryland to 12 visits/12 months. • Concurrent Authorization Requests • Treatment plans should be attached via the attachment option. • Concurrent authorization requests will default to 24 visits. If more are required, please indicate the number requested in the treatment plan and include the clinical justification for the request. • Occupational Therapy/Psychological Testing/ECT: • Authorization requests must be called in to ValueOptions® Maryland: 1-800-888-1965

  7. Services Authorized for Outpatient Therapy • 90801: Initial Evaluation • 90804: Individual Psychotherapy (20-30 minutes) • 90805: Individual Psychotherapy with Med Eval/Mgmt • 90806: Individual Psychotherapy (40-50 minutes) • 90807: Individual Psychotherapy with Med Eval/Mgmt • 90846: Family Psychotherapy without Patient Present • 90847: Family Psychotherapy with Patient Present • 90849: Multiple Family Group • 90853: Group Therapy • 90862: Medication Management • 90875: Individual Psychotherapy with Biofeedback • 90876: Individual Psychotherapy with Biofeedback • T1015: FQHC Clinic Visit

  8. ProviderConnect

  9. 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

  10. 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

  11. 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.

  12. 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.

  13. Requesting an Authorization Non-OMS Outpatient Therapy

  14. Questions valueoptionstransition@dhmh.state.md.us

  15. Thank You!Please complete the survey which will appear shortly.

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