State of Maryland Department of Health and Mental Hygiene & V ALUE O PTIONS ® June 2009 G ETTING C ONNECTED

2 Welcome to ValueOptions ®

Presenters Lissa Abrams – Deputy Director Mental Hygiene Administration Mary Mastrandrea – ValueOptions ® Maryland CEO Clarence Jordan – ValueOptions ® Director, Recovery & Resiliency Ray Coleman – ValueOptions ® National Director, Provider Relations Mara Rapant – ValueOptions ® National Director, Clinical Services Kathy Melia – ValueOptions ® Vice President, Operations

4 An Introduction to ValueOptions ®

ValueOptions ® − The Best Resource for the Behavioral Healthcare People Need Singularly qualified – 30 years experience providing behavioral health and wellness services. Nation’s largest independent behavioral health and wellness company – more than 23 million covered lives nationally. More than 50,000 providers nationwide More than 300 corporate clients, including 50% of the Fortune 10 companies. Technology used to drive down costs.

ValueOptions ® − Recognized Public Sector Leader Currently manages more public sector behavioral health contracts than any other company More than 4.5 million covered lives across 14 states. Many of these contracts have Member populations exceeding 400,000, and several exceed 1 million covered lives.

ValueOptions ® Public Sector Contracts

8 ValueOptions ® Recovery & Resiliency

Recovery and Resiliency Philosophy consistent with 2006 SAMHSA National Consensus Statement Respect and support of culturally sensitive individual affirmations of self-efficacy Prevention Education and Outreach – support staff and provide community outreach Community Stakeholder Collaboration – consumers, family members, providers and other stakeholders

10 ValueOptions ® Clinical Services

ValueOptions ® Utilization Management Clinical transition will be seamless to providers and consumers will automatically connect to ValueOptions ® staff – September 1, Current authorizations transfer from current ASO to the ValueOptions ® system. Maryland medical necessity criteria will be used. Telephonic reviews and Web based applications will be used for authorization requests.

ValueOptions ® Utilization Management Services that are currently authorized by Core Service Agencies will continue to be reviewed by CSA staff and will be incorporated into ValueOptions authorization system

ValueOptions ® Care Management A dedicated team of local Maryland care management staff Acceptance of referrals from medical, behavioral, substance abuse, CSA, consumers and family members Proactive identification of high risk consumers Referrals and reviews as needed Outreach to all involved in consumer’s care Treatment plan coordination Discharge planning

14 ValueOptions ® Provider Relations

A guide to ValueOptions ® policies and procedures for all providers Available on the ValueOptions ® Maryland website Provider Handbook

ValueOptions ® Provider Website Regulatory News: Changes in state and federal laws affecting providers. The Valued Provider: Newsletter highlighting service authorization and claims payment improvements. Achieve Solutions ® : A comprehensive library of consumer behavioral health educational articles.

17 ValueOptions ® ProviderConnect Overview

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.

ValueOptions ® ProviderConnect Features Verify Consumer eligibility Request Authorizations View Authorizations Submit Claims (Batch and Single claim) View Claim Status View and Print Provider Summary Voucher Submit inquiries to Customer Service Access and print forms With ProviderConnect providers can:

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.

ProviderConnect Demonstration Step 1: Step 2: Click on “Providers” Step 3: Click on “Try the Demo”

ProviderConnect Login Screen

User Agreement

Search/View Member Eligibility

Member Eligibility Results

Review an Authorization

Search Authorizations

Authorization Search Results

Authorization Summary

Authorization Detail

My Online Registration Profile

Updating My Online Profile

ProviderConnect Message Center (Personalized!)

Inquiry Details

View Provider Summary Voucher

Provider Summary Voucher Search

Provider Summary Voucher Results

38 EDI Claims Submission

EDI Claims Set-up ValueOptions ® will accept any HIPAA compliant 837p or 837i file Claims are submitted through Filing guidelines are the same, regardless of the software used to submit a claim. A completed Account Request Form must accompany all claims. Billing agents must also submit an Intermediary Form. ValueOptions ® has Experience working with multiple clearing houses

EDI Claims Set-up (continued) Account request and intermediary forms can be faxed to Allow 2 days for account set-up in test mode. An ID and Password will be sent via .

EDI Claims Set-up (continued) Once a file is successfully submitted in test mode: – Call ValueOptions ® EDI Helpdesk at to be taken out of test mode. – Normal claims submission can begin During normal claims submission, eSupport will send two s: – The1 st confirms receipt of file – The 2 nd confirms pass/failure of file. If file fails, the will explain the reason for failure

42 PaySpan Health and Electronic Funds Transfer (EFT)

The ValueOptions ® Electronic Funds Transfer ValueOptions ® partners with PaySpan to give providers the ability to: – Receive Electronic Funds Transfer (EFT) – View and Print Provider Summary Voucher PaySpan Features – Ability to control each user’s access to specific customer applications – Logs all user activity on the PaySpan provider site – Online Help on every screen – Supports Internet Explorer 5.0 and above

Next Steps Provider/Stakeholder Advisory Committee Provider/Stakeholder meetings coming soon (July and August) Upcoming Provider trainings, multiple modalities Maryland Website development continues This presentation/updates will be posted on the DHMH Website ValueOptions ® contract will be effective September 1, 2009

46 Questions

47 Thank You!