1 “ Administratively Yours ” 2008 Provider Forum

2 Agenda 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

3 A National Presence Serving: 1 to 3 Million Lives 500,000 to 1 Million Lives 250,000 to 500,000 Lives Under 250,000 Lives Serving: 1 to 3 Million Lives 500,000 to 1 Million Lives 250,000 to 500,000 Lives Under 250,000 Lives Corporate Headquarters EAP Model Office Corporate Support Centers Regional Service Centers Satellite/Regional Office Indicates multiple offices

4 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

5 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)

6 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) GHI-Medicare Choice PPO (866) GHI-Family Health Plus (866) Liberty Health Advantage (866) Senior Whole Health (866) VNS Choice Select ( 866) Great-West Healthcare (866) Suffolk Health Plan VidaCare (800)  GHI-BMP: GHI pays the claims  ValueOptions ® pays the claims  Claims are paid by Royal

7 Clinical Operations & Quality Management Helping meet members’ care needs…..

8 Clinical Operations (continued) Review/Authorization Request Process Inpatient Treatment Report (ITR) Outpatient Registration Form (ORF1) Outpatient Review Form (ORF2) Medication Management Registration Form  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  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)  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  Used for requesting medication management services only (90862 or 90805)  Note: Medication management with psychotherapy (90807) is requested via an ORF1 or ORF2

9 Clinical Operations ( continued )

10 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.

11 Clinical Operations (continued) Options for Requesting Outpatient Mental Health Treatment Online: You can submit requests for outpatient mental health therapy and medication management at OR Empire Plan ORF Fax Numbers: (866) or (518) Empire Plan Mailing Address: ValueOptions ® Empire Plan 433 River Street, Suite 200 Troy, NY New York City ORF Fax Numbers: (212) or (518) New York City Mailing Address: ValueOptions ® P.O. BOX 1884 New York, NY 10116

12 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 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

13 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

14 Depression Identification & Management (222889) ADHD Identification & Management (223009) Eating Disorders (223010) Call and enter 6 digit extension above to reach the program line. Complementing the treatment and care that you provide. Disease Management Programs

15 Member and Family education Screening available with option to send results to physician Recognizing signs and symptoms, treatment options Referrals to behavioral health care Depression Identification & Management / ADHD Programs

16 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 Eating Disorder Disease Management Program

17 Claims and Customer Service Committed to your service needs …

18 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

19 Claims – Administrative Claim Denials

20 Health Insurance Claim Form

21 Need new background When Do You Call Customer Service  Overview of Service Operations  Key Facts  Technology and Resources When Do You Call Customer Service?

22 Provider Relations Creating new choices for our providers today and tomorrow.

23 Provider Service Options

24 ProviderConnect ( 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

25 Demonstration of ProviderConnect

26 Most Common Provider Topics: 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

27 Network Operations

28 All changes regarding your provider demographic information or Tax Identification Number must be submitted in writing. Please go to and click on the ‘forms’ section Forms: Current downloadable forms on the website Change of Address W-9 forms Please contact us at (800) for other inquiries regarding: Credentialing/re-credentialing issues Application status updates Comments or concerns regarding ValueOptions’ ® policies and procedures National Network Operations

29 Substitute for Form W-9

30 Address Change Form

31 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.

32 DEMO HEALTHCARE PARTNERS 4439 EASY ST ANYTOWN, MA your unique registration code: xxxxxxxx pay to vendor number for eft registration only: A your unique registration code: xxxxxxxx pay to vendor number for eft registration only: A 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.  Match payments to advices quickly – You can associate electronic payments with electronic remittance advices quickly and easily.  Improve cash flow – Electronic payments can mean faster payments, leading to improvements in cash flow.  Maintain control over remittance formats – You can choose from a large library of formats for remittance advices you will receive.  Maintain control over bank accounts – You keep TOTAL control over the destination of claim payment funds. Multiple practices and accounts are supported.  Manage multiple Payers – Reuse enrollment information to connect with multiple Payers. Assign different Payers to different bank accounts, as desired.

33 Continuous Program of Provider Education ValueOptions® Newsletters E-Pub Annual Revision to Provider Handbook valueoptions.com Visits to Key Facilities Representation at Trade Shows New York State Welcome Package Provider Forums

34 Provider Relations: Address and Helpline NY State Empire PlanNew York City Service Center (800) valueoptions.com (866) valueoptions.com

35 Questions and Answers

36 Please remember to complete your evaluation forms and return to our office via fax – Thank You!