1. CMHRS Provider Overview Medallion 4.0
4/22/2019
PROV_0718-CPOM

2. Agenda Plan Summary Authorizations
Portal Training Slide (training documents attached separately)
CMHRS Services
CMHRS Registration and Authorization Forms
Provider Overview for Medallion 4.0
4/22/2019

3. Agenda (continued) CMHRS Registration vs. Authorization
CMHRS Continuity of Care and the Medical Transition Report
CMHRS Claims Submission
A Word of Thanks
Contact Information
Provider Overview for Medallion 4.0
4/22/2019

4. Plan Summary Product Line Virginia Premier Advantage Elite (HMO MAPD)
Virginia Premier Elite Individual & Elite Family
(Medallion 4.0 beginning 7/1/2018)
Virginia Premier Advantage Elite
(HMO MAPD)
Applicable Dates
Current
1/1/2017
Eligible Members
Medicaid Medallion 3.0
FAMIS
FAMIS PLUS
FAMIS MOMS
D-SNP (Dual Special Needs Plan)
18 and older
Full Medicare and Medicaid benefits (QMB+, SLMB+, FBDE)
Benefits Offered
Medicaid benefits
Carved-out benefits administered through DMAS
Medicare parts A, B, and D benefits
Supplemental benefits (vision, dental, hearing)
Provider Overview for Medallion 4.0
4/22/2019

5. Plan Summary (continued)
Product Line
Virginia Premier
Advantage Gold and
Platinum (HMO MAPD)
Virginia Premier Elite Plus
(CCC Plus)
Applicable Dates
1/1/2018
8/1/2017
Eligible Members
MAPD plan
Members 65 and older
People under 65 with certain disabilities
Full Medicaid and any Medicare A and/or B coverage.
Individuals living in a Nursing Facility
Individuals in the CCC Plus Waiver
Individuals in the 3 waivers serving the Developmental Disabilities CCC and Aged, Blind and Disabled
Benefits Offered
Medicare parts A, B, and D
Supplemental benefits (vision, dental, hearing, etc.)
Medicaid benefits
HCBS Waiver benefits
Supplemental benefits (vision, dental)
Provider Overview for Medallion 4.0
4/22/2019

6. Authorizations
Virginia Premier Elite Individual, Elite Family (Medallion 4.0)
Virginia Premier Elite Plus (CCC Plus)
Virginia Premier Advantage Elite, Platinum and Gold
(Medicare Advantage)
LTSS Requests
Fax:
Or contact our Care Coordination Team:
Outpatient Service Requests (excluding LTSS)
Authorizations Dedicated Phone Line:
Fax:
Authorizations Dedicated Phone Line:
Fax:
Medical Admission Requests
Fax:
Behavioral Health (including CMHRS and ARTS)
Phone Line:
Inpatient Fax:
Outpatient Fax:
Portal: ders/medicaid/provider-portals/
Services authorized by Beacon Health Options.
Outpatient Fax:
Provider Overview for Medallion 4.0
4/22/2019

7. Portal Information – Training
A separate training session for the Portal will be coming soon.
Provider Overview for Medallion 4.0
4/22/2019

8. CMHRS Services January 1, 2018 Provider Overview for Medallion 4.0
4/22/2019

9. CMHRS Registration and Authorization Forms
Use of the Portal is highly encouraged for CMHRS services.
Forms will need to be attached to the portal authorization submissions.
Registration Form
Initial Authorization Form
ABA Behavior Therapy
Day Treatment/PHP
Intensive In Home
Intensive Community Treatment
Mental Health Skill Building
Psychosocial Rehabilitation
Therapeutic Day Treatment for Adolescents/Children
Continued Stay Form
Provider Overview for Medallion 4.0
4/22/2019

10. CMHRS Registration vs. Authorization
Community Mental Health Rehabilitation Services
Procedure Code
Registration vs. Authorization
Initial Request
Continued Stay Request
Mental Health Case Management
H0023 R
Mental Health Peer Support Services – Individual
H0025 A
Mental Health Peer Support Services – Group
H0024
Crisis Intervention
H0036
Crisis Stabilization
H2019
Intensive Community Treatment
H0039
Intensive In-Home
H2012
Provider Overview for Medallion 4.0
4/22/2019

11. CMHRS Registration vs. Authorization (continued)
Community Mental Health Rehabilitation Services
Procedure Code
Registration vs. Authorization
Initial Request
Continued Stay Request
Therapeutic Day Treatment (TDT) for Children *TDT School Day
H0035
*HA A
Therapeutic Day Treatment (TDT) for Children *TDT Afterschool
*HA *UG
Therapeutic Day Treatment (TDT) for Children *TDT Summer
*HA *U7
Day Treatment/Partial Hospitalization *Adults
*HB
Mental Health Skill-building Services (MHSS)
H0046
Psychosocial Rehab
H2017
EPSDT Behavioral Therapy (ABA)
H2033
Provider Overview for Medallion 4.0
4/22/2019

12. CMHRS Continuity of Care and the Medical Transition Report (MTR)
Health plans must honor a continuity of care period for up to 30 days, which includes honoring all existing service authorizations.
Health plans receive existing service authorizations through the Medical Transition Report (MTR).
For Virginia Premier, new MTR authorization numbers are generated and letters are sent to providers and members.
Provider Overview for Medallion 4.0
4/22/2019

13. CMHRS Claims Submission
You can submit claims to Virginia Premier via:
Paper Claims Electronic Claims Provider Portal
Virginia Premier Health Plan Availity: Submit CMS 1500
P. O. Box Payer ID: VAPRM
Richmond, VA Relay Health:
Change Healthcare:
Payer ID: VAPRM
Provider Overview for Medallion 4.0
4/22/2019

14. A Word of Thanks
We recognize you’re providing a needed service to your community, and we sincerely appreciate what you do.
Provider Overview for Medallion 4.0
4/22/2019

15. CMHRS Contact Information
Provider Overview for Medallion 4.0
4/22/2019