Document

Report
“Administratively Yours”
2008 Provider Forum
1
Agenda
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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
A National Presence
Indicates multiple offices
Satellite/Regional Office
EAP Model Office
Corporate Headquarters
Corporate Support Centers
Regional Service Centers
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Serving:
1 to 3 Million Lives
500,000 to 1 Million Lives
250,000 to 500,000 Lives
Under 250,000 Lives
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
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New York State Empire Plan Service Center
New York State Empire Plan
Over 1 Million covered commercial members and retirees
Utilization Review Accreditation Commission (URAC)
certified
ValueOptions® (Administrator) and GHI (Insurer)
ValueOptions® manages both the Mental Health and
Substance Abuse benefits
Customer Service number: (800) 446-3995
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New York City Service Center
New York City Service Center
Over 3.5 Million Covered Commercial/Medicare/Medicaid members and retirees
Utilization Review Accredited Commission (URAC) certified
ValueOptions® manages both the Mental Health and Substance Abuse benefits
GHI-BMP
(866) 271-6403
GHI-BMP: GHI
pays the claims
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GHI-Medicare
Choice PPO
(866) 318-7595
GHI-Family Health Plus
(866) 801-5367
Liberty Health Advantage
(866) 635-3468
Senior Whole Health
(866) 300-0217
VNS Choice Select
( 866) 317-7773
ValueOptions® pays
the claims
Great-West
Healthcare
(866)714-2960
Suffolk Health Plan
VidaCare
(800) 922-3626
ValueOptions® pays
the claims
Claims are paid by
Royal
Clinical Operations & Quality
Management
Helping meet members’ care needs…..
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Clinical Operations (continued)
Review/Authorization Request Process
Inpatient Treatment
Report (ITR)
Used as a guide for
completing telephonic
reviews of inpatient
and higher levels of
care
Includes provider
rating scale of current
risk to self/others and
12 functional
impairments – rating
scale 0 (none) – 3
(severe)
ASAM Dimensions
8
Outpatient
Registration Form
(ORF1)
Used for requesting
routine outpatient
mental health
treatment
Includes provider
rating scale of current
risk to self/others and
12 functional
impairments – rating
scale 0 (none) – 3
(severe)
Outpatient
Review Form (ORF2)
Used for more
complex outpatient
mental health cases
Includes provider
rating scale of current
risk to self/others and
12 functional
impairments – rating
scale 0 (none) – 3
(severe)
Complete only if
requested
Medication
Management
Registration Form
Used for requesting
medication
management services
only (90862 or 90805)
Note: Medication
management with
psychotherapy
(90807) is requested
via an ORF1 or ORF2
Clinical Operations (continued)
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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.
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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
Empire Plan ORF Fax Numbers:
(866) 757-5101 or (518) 270-2033
Empire Plan Mailing Address:
ValueOptions® Empire Plan
433 River Street, Suite 200
Troy, NY 12180-2259
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New York City ORF Fax Numbers:
(212) 560-7778 or (518) 270-2025
New York City Mailing Address:
ValueOptions®
P.O. BOX 1884
New York, NY 10116
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
•
•
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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
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
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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.
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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
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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
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Claims and Customer
Service
Committed to your service needs …
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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
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Claims – Administrative Claim Denials
No Authorization
9%
13%
30%
Missing Information
Duplicate
24%
24%
19
Submit to Medical
Carrier
Other Carrier
Information
Health Insurance Claim Form
20
Need
newDo
background
Do You Service?
Call
When
You CallWhen
Customer
Customer Service
 Overview of Service Operations
 Key Facts
 Technology and Resources
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Provider Relations
Creating new choices for our
providers today and tomorrow.
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Provider Service Options
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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
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Demonstration
of of
ProviderConnect
Demonstration
ProviderConnect
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Most Common Provider Topics:
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•
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
Network Operations
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National Network Operations
• All changes regarding your provider demographic information or
Tax 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
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Substitute
Substitute
for Form for
W-9Form W-9
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Address Change Form
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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.
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your unique registration code:
xxxxxxxx
pay to vendor number
for eft registration only:
DEMO HEALTHCARE PARTNERS
4439 EASY ST
ANYTOWN, MA 12345
A123456
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:
Reduce accounting expenses – Electronic remittance
advices can be imported directly into Practice
Management or Patient Accounting Systems,
eliminating the need for manual re-keying.
Improve cash flow – Electronic payments can mean
faster payments, leading to improvements in cash flow.
Maintain control over bank accounts – You keep
TOTAL control over the destination of claim payment
funds. Multiple practices and accounts are supported.
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Match payments to advices quickly – You can associate
electronic payments with electronic remittance advices
quickly and easily.
Maintain control over remittance formats – You can
choose from a large library of formats for remittance
advices you will receive.
Manage multiple Payers – Reuse enrollment information
to connect with multiple Payers. Assign different Payers to
different bank accounts, as desired.
Continuous Program of Provider Education
New York State
Welcome Package
ValueOptions®
Newsletters
E-Pub
Visits to
Key Facilities
Annual Revision to
Provider Handbook
Representation at
Trade Shows
Provider
Forums
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valueoptions.com
Provider Relations: Email Address and Helpline
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NY State Empire Plan
New York City Service
Center
(800) 235-3149
[email protected]
valueoptions.com
(866) 477-9741
[email protected]
valueoptions.com
Questions and Answers
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Thank You!
Please remember to complete your evaluation forms
and return to our office via fax – 518-266-3299.
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