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

1. State of MarylandDepartment of Health and Mental Hygiene & VALUEOPTIONS® September 2009 Clinical Training for RTC Providers

2. Welcome to ValueOptions®

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

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. 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

7. 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

8. 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

9. ProviderConnect

10. 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

11. 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

12. 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.

13. 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.

14. Requesting an RTC Authorization • Live demonstration

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

16. THANK YOU! Please complete the survey which will appear shortly.