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State of Maryland Department of Health and Mental Hygiene & V ALUE O PTIONS ® September 2009 Clinical Training for RTC Providers.

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Presentation on theme: "State of Maryland Department of Health and Mental Hygiene & V ALUE O PTIONS ® September 2009 Clinical Training for RTC Providers."— Presentation transcript:

1 State of Maryland Department of Health and Mental Hygiene & V ALUE O PTIONS ® September 2009 Clinical Training for RTC Providers

2 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 – 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 Contact Information Main ValueOptions® Maryland Telephone Number: – Secure Clinical Fax Number: – Dedicated RTC Care Managers: – Janice Jenkins Moylan – – Jenny Rowe – (PRTF Waiver) DES 1000: – Dee Hrvat – ValueOptions® Maryland Mailing Address PO Box 618 Hanover, MD 21076

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 9

10 ValueOptions ® ProviderConnect Free, secure, online application Easy access 24 hours a day, 7 days a week Complete multiple transactions in a single sitting ProviderConnect is an online tool that increases convenience & decreases administrative burden.

11 ValueOptions ® ProviderConnect Features 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 With ProviderConnect providers can:

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) , Option 3 Monday through Friday 8 a.m. – 6 p.m. EST Turn around time for additional logins is 48 hours.

13 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.

14 Requesting an RTC Authorization Live demonstration

15 15 Questions

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


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