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Value Behavioral Health of Pennsylvania, Inc. Auto Approvals for Outpatient and Clozapine Supports Services via ProviderConnect The webinar will begin.

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Presentation on theme: "Value Behavioral Health of Pennsylvania, Inc. Auto Approvals for Outpatient and Clozapine Supports Services via ProviderConnect The webinar will begin."— Presentation transcript:

1 Value Behavioral Health of Pennsylvania, Inc. Auto Approvals for Outpatient and Clozapine Supports Services via ProviderConnect The webinar will begin at 10:00 AM We are waiting for the other participants to join

2 Presenters Shar Whitmire, Director of Provider and Member Services Jim Friend, Special Projects Manager Gary Kordes, VBH-PA Clinical Manager Kim Keller, OTR Authorization Specialist Lori Raling, OTR Authorization Specialist Tracy Phelps, OTR Authorization Specialist Pennsylvania Service Center Value Behavioral Health of Pennsylvania

3 3 Webinar Rules All lines are open so we ask that all attendees place there phones on mute at this time by pressing *6 or the mute button on your phone. Again, please mute your phone by pressing *6 or we will be able to hear any background noise. We appreciate you keeping your line muted. If you have to take a call please disconnect from this call. DO NOT use HOLD. We will have to talk over the music. If you happen to get disconnected from the audio portion please call back into the same number you just dialed. The visual portion of this presentation is web based. Of course you can choose the audio portion only but if you would like to join/login to see the webinar presentation/PowerPoint,the login information is located on the invite you received after you registered. If you are experiencing any problems with that particular link to join you can also go to and enter the web ID: There will be a designated question and answer portion at the end of today’s presentation. We ask attendees to hold their questions for this designated question/answer period.

4 Value Behavioral Health of Pennsylvania 4 Audio Component of the Webinar For the audio component the call in number is and the participant code is

5 Value Behavioral Health of Pennsylvania 5 Agenda Outpatient Authorizations Evaluations Authorizations Medication Management Authorizations Clozapine Support Services Authorizations ProviderConnect Demonstration Questions and Answers Contact Information

6 Value Behavioral Health of Pennsylvania 6 Auto Approvals for Outpatient and Clozapine Supports Services via ProviderConnect

7 Value Behavioral Health of Pennsylvania 7 Outpatient Registration ORF1 Form

8 Value Behavioral Health of Pennsylvania 8 Auto Authorized Services Outpatient individual psychotherapy Outpatient group therapy Outpatient family psychotherapy Psychiatric Evaluation / Examination Medication Management Clozapine Support

9 Value Behavioral Health of Pennsylvania 9 Value Behavioral Health of PA Homepage For Providers Only Go to: Click on: For Providers Click on: ProviderConnect Enter: User ID Enter Password

10 Value Behavioral Health of Pennsylvania 10 Value Behavioral Health of PA Web-Site

11 Value Behavioral Health of Pennsylvania 11 ProviderConnect Logon Homepage

12 Value Behavioral Health of Pennsylvania 12 After logging in, providers will initially view their home page. Authorization Requests are started by utilizing the Enter an Authorization Request

13 Value Behavioral Health of Pennsylvania 13 After selecting Enter an Authorization Request providers will be directed to a disclaimer page and then to a Search a Member page where Member ID and Date of Birth are required elements. The system defaults to the current date for “As of Date” but can be changed as needed. The Member ID is the nine digit Medicaid ID number. Providers will be offered a page to confirm the consumer information.

14 Value Behavioral Health of Pennsylvania 14 Next, the provider must select the correct service address on the Select a Service Address page. This address needs to be a match to the primary location where the consumer will receive services, and is the key to successful navigation through the request process. Funding streams, program codes and provider types are linked to this selection.

15 Value Behavioral Health of Pennsylvania 15 Submitting Outpatient (OUT) Authorization Requests There are two options for providers requesting authorizations for OUT services. The provider must select either Mental Health or Substance Abuse (Type of Service field) On the Requested Services Header screen the provider must provide the following information to successfully enter the Outpatient (OUT) authorization. Requested Start Date– the date the provider wishes to begin this authorization request. Level of Service – select Outpatient Type of Service –select Mental Health or Substance Abuse Type of Care – for Mental Health select “Psychiatric” and for Substance Abuse leave blank “Select ”

16 Value Behavioral Health of Pennsylvania 16 Level of Service Select Outpatient or Medication Management

17 Value Behavioral Health of Pennsylvania 17 Type of Service: Select Mental Health or Substance Abuse Select Mental Health or Substance Abuse

18 Value Behavioral Health of Pennsylvania 18 Below is an example of a Mental Health request For Mental Health select the Type of Care field Psychiatric

19 Value Behavioral Health of Pennsylvania 19 Below is an example of a Substance Abuse Outpatient Service request For Substance Abuse the Type of Care field is left blank (Select)

20 Value Behavioral Health of Pennsylvania 20 Click OK to proceed with Auth Approval

21 Value Behavioral Health of Pennsylvania 21 Enter Contact Name and Telephone Number

22 Value Behavioral Health of Pennsylvania 22 Use of hyperlinks to search with pop ups – entering partial information in a field may assist in narrowing search for desired information. However, if the information is known and the field allows free text, the information can data entered. If Mental Health is selected (TOS), a Mental Health diagnosis code must be entered. If Substance Abuse is selected (TOS), a Substance Abuse diagnosis code must be entered.

23 Value Behavioral Health of Pennsylvania 23 The provider requesting Outpatient services will be offered the Accept/Reject option for 72 units. These requests may approve or pend depending on the type of services being requested and if the member has exceeded the 72 units within a 12 month period, or there has been previous outpatient requests during the course of the year. Accepting these units will allow the process to move forward. Accept 72 units of Outpatient Services

24 Value Behavioral Health of Pennsylvania 24 Requested Service Screen The provider will be asked to enter the specific Place of Service, Service Class and Units. Place of service must always be “Office”. Leave CPT and Modifier blank Options for Outpatient Services are as follows: Service Class-options are as follows: (1) Outpatient Services, (2) Examinations, (3) Medication Management. Total units can not exceed 72 units for all three Outpatient services combined. Please Note: The Place of Service (POS), Service Class and Units selections will result in an authorization request for the service class. This service class allows providers to bill any of the service codes and modifiers for that class on the VBH-PA service class grid. However, in order to be paid for that service you must first be contracted for that service. This allows for flexibility in providing services to the consumer.

25 Value Behavioral Health of Pennsylvania 25 Requested Service Screen Note: OUT, EXM, and RXM can be combined Can not exceed 72 units Outpatient=OUT Examinations / Evaluations= EXM Medication Management= RXM

26 Value Behavioral Health of Pennsylvania 26 Approved authorizations will span 12 months. Authorization will span 12 months

27 Value Behavioral Health of Pennsylvania 27 Pended Confirmation for Further Review

28 Value Behavioral Health of Pennsylvania 28 Printing and Saving Options on Confirmation Page

29 Value Behavioral Health of Pennsylvania 29 Submitting Clozapine (CME, CS1,CS2, PRC) Authorization Requests On the Requested Services Header screen the provider must provide the following information to successfully submit a Clozapine authorization. Requested Start Date– the date the provider wishes to begin this authorization request. Level of Service – select Outpatient Type of Service –select Mental Health Type of Care –select Clozapine Support An example of a Clozapine request is displayed below: Must select Clozapine in the Type of Care drop down to get the 104 maximum number of units

30 Value Behavioral Health of Pennsylvania 30 Clozapine (CME, CS1,CS2, PRC) Requests Must select Clozapine Support

31 Value Behavioral Health of Pennsylvania 31 Enter Contact Name, Telephone Number and Diagnosis Code 1 Axis 1 Diagnosis Code 1 needs completed

32 Value Behavioral Health of Pennsylvania 32 Clozapine (CME, CS1,CS2, PRC) Requests The provider will be asked to enter the specific Place of Service, Service Class and Units. Place of service must always be “Office”. Please Note: The Place of Service (POS), Service Class (Clozapine Services) and Units selection will result in an authorization request for the service class. This service class allows providers to bill any of the service codes and modifiers for that class on the service class grid. However, in order to be paid for that service you must first be contracted for that service. This allows for flexibility in providing services to the consumer.

33 Value Behavioral Health of Pennsylvania 33 Clozapine (CME, CS1,CS2, PRC) Requests 104 units will be offered for Clozapine Support services Can choose CME, CS1, CS2 or PRC in any combination CME = Clozaril Monitoring and Support CS1 = Clozaril Support Services-CS1 CS2 = Clozaril Support Services –CS2 PRC = Clozaril Support -PHP

34 Value Behavioral Health of Pennsylvania 34 Clozapine Support level of care is programmed to offer a maximum of 104 units, in any combination of CME, CS1, CS2, or PRC service classes. Select “Accept” to continue with the rest of the authorization process. 104 units will be offered for Clozapine Support services

35 Value Behavioral Health of Pennsylvania 35 Clozapine Support approval

36 Value Behavioral Health of Pennsylvania 36 Submitting Medication Management (RXM) Authorization Requests There are two options for providers requesting authorizations for Medication Management services (RXM). The provider can combine RXM with the 72 units as described in the Outpatient (OUT) example. However, if the member only needs medication management and no other services, RXM can be authorized separately. The provider must follow the work-flows below for either Mental Health or Substance Abuse (Type of Care field) On the Requested Services Header screen the provider must provide the following information to successfully enter the Medication Management (RXM) authorization. Requested Start Date– the date the provider wishes to begin this authorization request. Level of Service – select Medication Management Type of Care –select “Psychiatric” for Mental Health and for Substance Abuse select “SWPA Substance Abuse Drug and Alcohol”

37 Value Behavioral Health of Pennsylvania 37 Submitting Medication Management (RXM) Authorization Requests (MH) Select Psychiatric for Mental Health Select Medication Management

38 Value Behavioral Health of Pennsylvania 38 Medication Management (RXM) Request-(SA) Select Medication Management Select SWPA Substance Abuse Drug and Alcohol for SA services

39 Value Behavioral Health of Pennsylvania 39 Enter Contact Name and Telephone Number and Diagnosis Code 1 Axis 1 Diagnosis Code 1 needs completed

40 Value Behavioral Health of Pennsylvania 40 Medication Management (RXM) Request- continued 24 units will be auto authorized for Medication Management for a 12 month period

41 Value Behavioral Health of Pennsylvania 41 Medication Management (RXM) Request- continued Select Place of Service (Office), Service Class (Medication Management), and Units (24), and click Submit. The provider will be asked to enter the specific Place of Service, Service Class and Units. Place of service must always be “Office”. Please Note: The Place of Service (POS), Service Class and Units selection results in an authorization request for the service class. This service class allows providers to bill any of the service codes and modifiers for that class on the service class grid. However, in order to be paid for that service you must be contracted for that service. This allows for flexibility in providing services to the consumer.

42 Value Behavioral Health of Pennsylvania 42 Medication Management (RXM) Request- continued Select Place of Service (Office), Service Class (Medication Management), and Units (24), and click Submit.

43 Value Behavioral Health of Pennsylvania 43 The confirmation page has the Level of Service (Medication Management), authorization effective and expiration dates, authorization reason code A71, and the number of units (24). Approved

44 Value Behavioral Health of Pennsylvania 44 Continuing authorizations If the member needs additional Outpatient services (more than the 72 that were auto approved) you will have to complete the ORF1 form and / or answer the risk assessment questions on-line via ProviderConnect.

45 Value Behavioral Health of Pennsylvania 45 RFS Form required Services that need reviewed Non-Acute Partial Hospitalization Intensive Case Management / Resource Coordination (ICM/RC)Intensive Intensive Outpatient (IOP ) Methadone Maintenance-use form**

46 Value Behavioral Health of Pennsylvania 46 Enter an Authorization using the Request for Service (RFS) form The Authorization Request function shown below in the screen shot enables users to electronically submit requests for services (RFS) for all the services listed above. Please use the ProviderConnect RFS form found on the VBH-PA website, on the Provider Forms page. Select “Outpatient Request Form” from the drop down list. Click “Yes” if it contains clinical information on the member. Click “Upload file” to attach your request for authorization.

47 Value Behavioral Health of Pennsylvania 47 To request additional services a RFS form must be attached. Browse and find, then upload the RFS form

48 Value Behavioral Health of Pennsylvania 48 Request for Service (RFS)

49 Value Behavioral Health of Pennsylvania 49 Tips for successful submission/navigating screens include ProviderConnect works best with Internet Explorer 6 or IE7 for your browser – if you are having issues with the screens not displaying or pop ups, etc. not working correctly you may be using a newer version of IE or using Fire Fox. If you are using IE8, you can follow the below steps to help with the issue: –Click on the Tools menu at the top of your browser –Click on Compatibility View Settings –Type in: valueoptions.com, and click the Add button –Click the Close button Do not use the browser Back button – use the Back button on the screen itself – using the Back on your browser can result in errors and loss of data. Required fields are indicated by “*”. These fields must be completed each time an authorization is requested. Some fields are dependent on other fields – a positive or negative response to a question may result in other fields being required

50 Value Behavioral Health of Pennsylvania 50 Pass Through Units

51 Value Behavioral Health of Pennsylvania 51 Starting on March 1, 2010 Providers will be able to view their recent authorization letters with a simple click. All authorization letters within the last 30 days will be accessible on the Provider homepage. See the hyperlink below entitled “View My Recent Authorization Letters

52 Value Behavioral Health of Pennsylvania 52 The second enhancement enables providers to run their own weekly authorization reports via ProviderConnect.

53 Value Behavioral Health of Pennsylvania 53 ProviderConnect Demonstration

54 Value Behavioral Health of Pennsylvania 54 Frequently Asked Questions Q: Can I request Outpatient (OUT), Medication Management (RXM) and Examinations/Evaluations (EXM) in the same request? A: Yes. VBH-PA has programmed it so that a combined 72 units will be auto authorized. You can use all 72 units for Outpatient, or break it out into 48 OUT, 22 RXM, and 2 EXM, or any combination of the above. However, the units can not exceed 72. Q: Can I auto auth Clozaril, and Outpatient at the same time on the same request. A: No. Since they are in two different Service Classes, two different requests need to be submitted, but the member can receive services at the same time. Q: If I have an auth for Medication Management that overlaps to the next year can I Auto Auth just OUT? A: Yes, OUT will Auto Auth 72 units

55 Value Behavioral Health of Pennsylvania 55 Frequently Asked Questions Q: What will happen if I choose one of the other selections in the “Type of Care” drop down list. A: You have only two choices for Outpatient Service for Mental Health, Clozapine Support and Psychiatric. The other selections will pend. Q: I noticed there is no Psychiatric “Type of Care” selection for Substance Abuse. What “Type of Care” do I choose? A: Leave the “Type of Care” field at the default which is Select. Q: The member already was authorized 72 units for Mental Health Outpatient. Can the member now get Substance Abuse Outpatient? A: Yes, 72 units will be offered, the same as Mental Health. Q: If I have an auth for Methadone Maintenance that overlaps to the next year, can I Auto Auth OUT? A: Yes, OUT will Auto Auth 72 units.

56 Value Behavioral Health of Pennsylvania 56 Question and Answer Period for Providers

57 Contact Information Jim Friend - Special Projects Manager

58 Value Behavioral Health of Pennsylvania 58 Contacts VBH-PA Provider Line Toll Free Hours: 8:00 a.m. – 5:00 p.m. EST Monday – Friday

59 Thank you!


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