“ Administratively Yours ” 2008 Provider Forum

1. “Administratively Yours”2008 Provider Forum

2. Agenda • Welcome and Introductions • Overview of ValueOptions® • Overview of New York State Plans • Clinical Operations and Quality Management • Claims and Customer Service • Local and National Provider Relations • ProviderConnect Demonstration • Network Operations • Questions and Answers

3. A National Presence Indicates multiple offices Serving: 1 to 3 Million Lives 500,000 to 1 Million Lives 250,000 to 500,000 Lives Under 250,000 Lives Satellite/Regional Office EAP Model Office Corporate Headquarters Corporate Support Centers Regional Service Centers

4. Annual 2007 Provider Satisfaction Survey • Highlights of the Survey: • 95.4% of Empire Providers are satisfied with ValueOptions® • 88.5% of all ValueOptions® providers are satisfied • 86.4% of ValueOptions® providers have read the newsletter • 84.4% of ValueOptions® providers found what they were looking for in the provider handbook

5. New York State Empire Plan Service Center

6. New York City Service Center

7. Clinical Operations & Quality ManagementHelping meet members’ care needs…..

8. Clinical Operations(continued)

9. Clinical Operations (continued)

10. Clinical Operations(continued) • Outpatient Mental Health Authorization Process • Member “pass through” visits: • Empire Plan – 10 visits per member/per provider/per lifetime • GHI-BMP – 10 visits per member/per provider/per year • Start Date: Prior authorization is required for all visits beyond the initial “pass through” visits. Please indicate your requested start date on the ORF – we will consider up to 30 days before or after the date the form was received in our office • End Date: All outpatient mental health authorizations end on December 31st of the current calendar year • Number of Visits: It will be important for you to monitor the number of visits authorized and utilized to ensure that additional visits are requested within the allowed timeframes.

11. Clinical Operations(continued) • Options for Requesting Outpatient Mental Health Treatment • Online: You can submit requests for outpatient mental health therapy and medication management at www.valueoptions.com OR

12. Clinical Quality Initiatives • Increasing Family Involvement in Adolescent Outpatient Treatment • Goal: To involve family members in outpatient treatment within first 90 days after discharge • 21.6% of high risk adolescents had documented family involvement • Outreach to parents and providers of adolescents who have recently been hospitalized • Ambulatory Follow-Up • Goal: To increase the percentage of members that receive timely follow-up care after inpatient psychiatric hospitalization • Ambulatory Follow-Up Team (AFT) places appointment reminder calls to members and confirms attendance

13. Antidepressant Medication Management • Proactive identification of members newly prescribed antidepressants through GHI- BMP Express Scripts • 4541 new prescriptions were filled • 3614 reminder letters were mailed to members • 1845 letters were mailed to GHI MDs • Ongoing analysis to assess improvement in antidepressant compliance • Prescribing patterns of PCP’s versus BH MDs • Generic versus brand-name

14. Disease Management Programs • Depression Identification & Management (222889) • ADHD Identification & Management (223009) • Eating Disorders (223010) Call 800-446-3995 and enter 6 digit extension above to reach the program line. Complementing the treatment and care that you provide.

15. Depression Identification & Management / ADHD Programs • Member and Family education • Screening available with option to send results to physician • Recognizing signs and symptoms, treatment options • Referrals to behavioral health care

16. Eating Disorder Disease Management Program • Intensive Care Management for high –risk, complex members with a diagnoses of Anorexia Nervosa and Bulimia Nervosa • Emphasis on coordination of care • Referrals to behavioral health care • Member education/preventive care

17. Claims and Customer Service Committed to your service needs …

18. Claims • Our Focus • Tips on avoiding administrative claim denials – no one likes them! • Health Insurance Portability and Accountability Act (HIPAA) • Scanning by means of Optical Character Recognition (OCR) technology allows for a more automated process of capturing information • Electronic claims – the key to quicker payment

19. Claims – Administrative Claim Denials

20. Health Insurance Claim Form

21. Need new background When Do You Call Customer Service When Do You Call Customer Service? • Overview of Service Operations • Key Facts • Technology and Resources

22. Provider Relations Creating new choices for our providers today and tomorrow.

23. Provider Service Options

24. ProviderConnect (www.valueoptions.com) • Benefits of using ProviderConnect: • Eligibility and benefit verification • Authorization status and view authorization letters • Claim status • Single and batch claims submission (excluding GHI and Empire) • Send Inquiries • Request Authorizations • Provider Data Sheet – Coming Soon

25. Demonstration of ProviderConnect Demonstration of ProviderConnect

26. Most Common Provider Topics: • Adherence to access and availability standards. • Holding the member harmless for all fees related to covered services, with the exception of any applicable co-payments or coinsurance. • Compliance with requests from ValueOptions® for treatment records. • Verification of member eligibility and benefits prior to rendering care, as well as preauthorize care when required prior to rendering care. • Submitting claims within timely filing requirements. • Reporting any “adverse incidents” to ValueOptions® within 24 hours. • Compliance with re-credentialing requests every three years

27. Network Operations

28. National Network Operations • All changes regarding your provider demographic information orTax Identification Number must be submitted in writing. Please go to www.valueoptions.com and click on the ‘forms’ section • Forms: Current downloadable forms on the website • Change of Address • W-9 forms • Please contact us at (800) 397-1630 for other inquiries regarding: • Credentialing/re-credentialing issues • Application status updates • Comments or concerns regarding ValueOptions’® policies and procedures

29. Substitute for Form W-9 Substitute for Form W-9

30. Address Change Form

31. Provider Data Verification • Annually, ValueOptions® sends provider data verification form to all providers verifying all demographic information • All forms must be completed and signed • Completed information ensures accurate referrals and claims payment. • Quick Address Solutions • Validates addresses against official postal authority records • Improved overall address data quality • Increased productivity • Reduced waste caused by undeliverable mail.

32. Sample your unique registration code: xxxxxxxx pay to vendor number for eft registration only: A123456 DEMO HEALTHCARE PARTNERS 4439 EASY ST ANYTOWN, MA 12345 To Our Providers: ValueOptions now offers Providers PaySpan Health - a solution that delivers Electronic Payments (EFTs), Remittance Advices (ERAs), and much more. FREE to (insert Payer Name here) Providers, the solution enables online presentment of remittances, and straightforward reconciliation of payments to empower our Providers to reduce costs, speed secondary billings, and improve cash flow. Convenient Payments PaySpan Health gives you the option to receive payments according to preference: electronically direct to a bank account, or by traditional paper check. You are also able to choose the method in which you receive remittance information: • Electronic remittance advices presented online and printed on location. • HIPAA 835 electronic remittance files for download directly to a HIPAA-compliant Practice Management or Patient Accounting System. • Provider Benefits • As a Provider, you can gain immediate benefits by signing up for PaySpan Health:

33. New York State Welcome Package E-Pub Visits to Key Facilities Annual Revision to Provider Handbook Representation at Trade Shows Provider Forums valueoptions.com Continuous Program of Provider Education ValueOptions® Newsletters

34. Provider Relations: Email Address and Helpline

35. Questions and Answers

36. Thank You! Please remember to complete your evaluation forms and return to our office via fax – 518-266-3299.