State of Maryland Department of Health and Mental Hygiene & V ALUE O PTIONS ® October 2009 Clinical Training For PRP/RRP Providers

2 Welcome to ValueOptions ®

Presenters Nancy Calvert, Director, ValueOptions® Maryland Provider Relations Jennifer Lowther, ValueOptions ® Maryland Clinical Director Jennifer Soethe, ValueOptions® Maryland Care Manager

Agenda Overview of ProviderConnect Update Requesting Authorizations Questions Survey

ProviderConnect 5

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 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:

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.

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 auth request screen. – The Service Code Field has been removed – Providers now have the option to print the Plan separately. Additional Reporting: – “MCO” is no longer a required field. – “Education Level” has been deleted – “Living Situation” and “employment status will pre-populate on concurrent reviews – “N/A” is no longer an option to the “Race” question on concurrent reviews. “diagnosis on file?” not required if the consumer was referred by a licensed clinician.

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

PRP Authorizations *Place of Service – from the drop down box in ProviderConnect, select the place of service where the service will be provided. The first column on the grid “ProviderConnect Narrative Description of Place of Service” lists the Place of Service choices appropriate for PRP. The last column “Service Description” describes the type of PRP services, including the location(s) where the service is provided. Cross reference the first column to the last column to make the correct choice for the service request. *CPT or HCPC Code – Enter the appropriate code using column 2, “CPT/HCPC Code”, as a guide. With the exception of H0002, Behavioral Health Screening, the correct code for PRP services is H2018. *Modifier I - Using the last column, “Service Description” as a guide, choose the correct Modifier from column 3. *Visits - For this field, the number of visits equates to the number of months requested.

PRP Place of Service Codes When submitting a claim to report PRP encounters, only the following Place of Service (POS) codes may be used: POS 15 - off site POS 52 - on site

EXAMPLE: To request a minimum of 6 encounters of combined on and off-site PRP services, for six months, for a consumer living independently in the community, you would select *Place of Service*CPT or HCPC Code Modifier I (If Applicable) *Visits Independent ClinicH2018U36

PRP Codes and POS Descriptions Available on the ValueOptions® Maryland website: – – For Providers – Provider Alerts – ValueOptions Alerts –

Priority Population Diagnoses Required for PRP adult, RRP, or mobile services Additionally, PRP must include 2 of: – Inability to maintain employment – Behaviors resulting in MHS intervention – Inability, due to impairment to obtain financial assistance to support living in community – Severe inability to obtain/maintain social support – Need for assistance w/ ADLs Can be waived if: – committed as not criminally responsible & conditionally released from MHA facility – individual in MHA facility with stay of greater than 6 months who requires RRP, but doesn’t have a targeted diagnosis (excludes DD eligible)

Priority Population Diagnoses Required for PRP adult, RRP, or mobile services Schizophrenia, Disorganized Schizophrenia, Catatonic Schizophrenia, Paranoid Schizophrenoform Disorder Schizophrenia, Residual Schizoaffective Disorder Schizophrenia, Unspecified Schizophrenia, Undifferentiated (to include all dx from – ) MDD, Recurrent, Severe, W/O MDD, Recurrent, Severe, W/ Delusional Disorder Psychotic Disorder, NOS Schizotypal Personality Borderline Personality BP I, MRE Manic, Severe, W/O BP I, MRE Manic, Severe, W/ BP I, MRE Dep, Severe, W/O BP I, MRE Dep, Severe, W/ BP I, MRE Mixed, Severe, W/O BP I, MRE Mixed, Severe, W/ Bipolar NOS Bipolar II Disorder

Excluded Diagnoses The following diagnoses are not in the domain of the Public Mental Health System (PMHS). Individuals with co-occurring covered PMHS diagnosis are eligible for services for the co-occurring diagnosis: Mental Retardation Learning Disorders Motor Skills Disorders Communication Disorders Pervasive Developmental D/Os Tic Disorders Delirium, Dementia, Amnesic, and Cognitive Disorders D/Os due to GMC – Except Personality changes due to GMC Substance related D/Os Substance Induced D/Os Sexual dysfunction – Except paraphilias and gender identity D/O Sleep Disorders – Except parasomnia Antisocial Personality Disorder Psychological factors affecting GMC Relational problems V codes

Authorized by ValueOptions or CSA? U2 and U3 – authorized by ValueOptions – Request H2018 CPT Code and H0002 Medicaid: 7 units (to include the H0002 assessment) on a pre-auth 6 units on a concurrent Uninsured: 4 units (to include the H0002 assessment) on a pre-auth 3 units on a concurrent U5, U6, U7 – authorized by Core Service Agencies – PRPs are authorized for 12 months (13 units to include the H0002 assessment) – T2048 Residential Room and Board does not require an authorization (can bill for 365 days to match 12 month PRP auth)

Authorization Time Spans Medicaid = 6 months Uninsured Eligible = 3 months The end date of any authorization period should be the last day of the 6 th month (for Medicaid) and 3 rd month (for Uninsured) – For example, for a Medicaid authorization requested with a start date of 10/16/09, will be authorized for: 10/16/09- 3/30/09

Uninsured PRP Contact Jennifer Soethe, Clinical Care Manager Phone: Office Hours 8:30am-5:00pm

Billing Tips Authorizations are not required for encounters Encounters (H2016): – Use correct POS – 15, 49, 52, not 11 – Report encounters using $1per encounter Uninsured Eligibility co-payments – Not applicable to RRP bed Charges (T2048) – Based on the minimum service level required for the billed service. E.g. H2018-U6, POS 49, Minimum = 17 encounters co-payment = $34, regardless of the number of encounters beyond 17.

Requesting an Authorization PRP/RRP

23 Questions

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