State of Maryland Department of Health and Mental

State of Maryland Department of Health and Mental Hygiene & VALUEOPTIONS® Clinical Training for RTC Providers September 2009

2 Welcome to Value. Options®

Presenters • Nancy Calvert, Director, Value. Options® Maryland Provider Relations • Jennifer Lowther, Clinical Director, Value. Options® Maryland

Agenda • Update • Overview of Provider. Connect • Requesting Authorizations • Questions

Updates • Value. Options® Maryland Website • http: //maryland. valueoptions. com – Provider Alerts • MHA Policy Clarification Memos and Announcements • Value. Options® Maryland Updates and Announcements – Training Schedule – Provider. Connect “tips” – Maryland Specific Provider. Connect “demo” – Provider Forms – including a hard copy concurrent review form – Coming Soon: • Provider Manual • Diagnostic Crosswalk • Fee Schedule • Service Grid – Consumer Information

Contact Information • Main Value. Options® 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 • Value. Options® Maryland Mailing Address PO Box 618 Hanover, MD 21076

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

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 Provider. Connect

9 Provider. Connect

Value. Options® Provider. Connect 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

Value. Options® Provider. Connect Features With Provider. Connect 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

Accessing Provider. Connect • Each provider has a secure login and online registration, including a provider ID number via the Provider. Connect Web site. • Additional logins for other providers in the same practice are available through Provider. Connect. Contact: Value. Options® 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.

September 25 th 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.

Requesting an RTC Authorization • Live demonstration

15 Questions valueoptionstransition@dhmh. state. md. us

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