GENERAL IMPLEMENTATION TRANSITION QUESTIONS

Transcription

1 GENERAL IMPLEMENTATION TRANSITION QUESTIONS Q. When will ValueOptions begin to manage the MHSA plan for Michelin? A. ValueOptions will begin to manage the MHSA plan for Michelin on January 1, ValueOptions will continue to manage the benefit for Michelin. Q. What telephone number do I call to contact ValueOptions? A. For your clinical and claims questions, contact and you will be connected with ValueOptions. For provider contracting and credentialing questions, please contact the ValueOptions Provider Services Line at between 8 a.m. and 5 p.m. ET, Monday through Friday. Beginning January 1, 2014, the Provider Services Line will be available between 8 a.m. and 8 p.m. ET. Q. How do I obtain continued authorization under ValueOptions since I am authorized by the current carrier to see a Michelin member for MHSA? A. Inpatient The current carrier will be responsible for authorization of treatment begun prior to 12/31/13, and through transition to a less restrictive level of care or for 30 days, whichever comes first. ValueOptions will assume management of these Inpatient cases when the patient discharges or steps down to a loser level of care, or in 30 days, whichever comes first. Residential, Partial, and Intensive Outpatient levels of care ValueOptions will assume management of all Residential, Partial Hospitalizations and Intensive Outpatient cases. This would include any cases that the previous carrier is managing prior to 12/31/13. Actual date ValueOptions assumes case is 1/1/14. Page 1 of 11

2 Q. What is different or unique about serving Michelin? A. To become a preferred provider, you must participate in the On Track Program. Preferred providers will get the most referrals. If you do not use On Track, you will be removed from the Preferred Provider list used by our staff to make referrals. Q. What is the On Track Program? A. Again, the On Track Program is a required program for Michelin preferred providers. It is required for both EAP and MHSA/Behavioral Health providers. Please be sure to check the box on the client feedback form if the case is EAP. The ValueOptions On Track program is a client-centered outcomes informed care program. The goal of On Track is to provide clinicians with state of the art, easy-to-use tools that promote improved client outcomes. On Track is designed to support clinicians as they help their clients achieve their goals. ValueOptions clinicians may use On Track for all of their EAP, commercially insured or private pay clients, including, if they choose, those clients who are not ValueOptions members. For more information on OnTrack, go to Providers are required to attend an On Track Program webinar and to register for the On Track program in order to become a preferred Michelin provider. Please visit the following website to register for the upcoming On Track webinar training - Q. Have there been any changes to the Michelin EAP benefit and Health and Wellness program? A. Yes. Michelin has made the On Track program mandatory for all preferred providers. The Employee Life Services remain the same. Here is a summary of the plan: 8 session EAP model Unlimited telephonic support 24/7 Access to Services Achieve Solutions Web Site: Page 2 of 11

3 Workplace Consult: Work/Life Services o Adoption o Childcare o Eldercare o Special Needs o Educational Support Legal and Financial Services o Mediation o 30 minute free consult with attorney or financial advisor o Debt management o Identity Theft support o MySecureAdvantage 100% Follow up on EAP referrals PROVIDER NETWORK PARTICIPATION, CREDENTIALING AND CONTRACTING Q. Do I have to be credentialed by ValueOptions? A. Yes. All non-participating providers must be credentialed by ValueOptions in order to participate in the ValueOptions network. Q. I recently completed my credentialing/recredentialing with another carrier; can you accept their credentialing/recredentialing materials instead of me completing the ValueOptions application? A. No. You must complete the ValueOptions credentialing application. Q. Who do I call if I have questions regarding provider credentialing, rates and contracting? A. Please contact the ValueOptions Provider Services Line at between 8 a.m. and 5 p.m. ET, Monday through Friday. A Provider Network Representative will be able to assist you with any questions. Page 3 of 11

4 CLINICAL SERVICES Q. What are the ValueOptions Clinical Department s hours of operation? A. Licensed clinicians are available 24-hours a day, 7 days a week and 365 days a year. ONLINE SERVICES Q. What online services does ValueOptions offer? A. ValueOptions offers an online provider portal, called ProviderConnect, to our participating providers. ProviderConnect is a secure, HIPAA-compliant website that enables participating ValueOptions network providers to conduct online claims and authorization transactions accurately and efficiently, while also providing them the opportunity to spend more time with who matters most their patients. Capabilities and Benefits Verify member eligibility Submit claims, re-credentialing applications and provider updates View and submit authorization requests Print forms and authorization letters Communicate to ValueOptions via an online message center Access Provider Summary Vouchers Reduce paper files, phone calls, labor and postage expenses and potential errors Improve cash flow due to faster claims processing Submit claims files from any system outputting 5010 HIPAA formatted 837P or 837I files (and from EDI claims submission vendors) Page 4 of 11

5 Complete multiple transactions in a single sitting Getting Started with Provider Connect Register Try the Demo Getting Started with ProviderConnect Guide Q: Will my current log in to ValueOptions ProviderConnect allow me to access electronic submissions for Michelin? A. Yes. You can use your ValueOptions ProviderConnect login to access electronic submissions for Michelin. Q. What other online services does ValueOptions offer? A. The On Track program is also available online for providers. Here is a Quick Guide to ValueOptions On Track Outcomes for Providers 1. Access On Track Using ProviderConnect a. Individual clinicians with access to the ValueOptions ProviderConnect web portal can use the On Track tools by clicking on the program links after they have logged into ProviderConnect at b. If you are not yet a ProviderConnect user, just click on the Register button on the login page to become a new user. c. Group practices and group practice administrators will not be able to access On Track through ProviderConnect. Please [email protected] for information about how to begin using On Track. 2. Print the Client Feedback Form (CFF) a. Once connected to ProviderConnect, click on the link View my Outcomes with On Track under Clinical Support Tools, then click on the icon labeled Print an On Track Outcomes Client Feedback Form for access to your personalized CFFs. b. The first time you use On Track you will be asked to confirm key information used by On Track before being connected to the On Track Page 5 of 11

6 forms and tools. c. Print copies of the CFF and Information for Clients to have ready for your new clients. 3. Review the Confirmation a. You will receive an from ValueOptions business partner for On Track, the Center for Clinical Informatics, confirming that you are set up to use the On Track tools. 4. Administer the CFF to New Clients a. Administer the CFF to new commercially-insured clients prior to the first, third, and every third session thereafter (or at the closing session for EAP cases). b. The CFF may be used with non-valueoptions clients. Make sure to use the most recent version of the CFF which has a field to identify whether it is for a ValueOptions case. c. Give clients a copy of the Information for Clients summary with the initial CFF. d. Enter a Case Number on the CFF. This can be any number you choose, but should only be used for one client and be entered on every CFF submitted for that client. Do not use an SSN, phone number, or other number that would directly identify the client. e. Clients should return the completed CFF to you at the start of the session. f. Make sure to indicate on the CFF whether or not the case is an EAP case. 5. Fax the CFF to a. This is a toll free, confidential fax line. You do not need to send a cover page. b. Retain a copy of the CFF in the client s file. 6. View CFF results by Connecting to On Track Through ProviderConnect a. CFF results are typically available within one (1) business day after faxing the form. b. Click on the View On Track Results link to access the On Track webbased Toolkit. c. You may receive an reminder to check your results online when a CFF with potentially severe clinical risks is received. A ValueOptions representative may contact you in a small percentage of potentially high-risk ValueOptions cases. Note: The ValueOptions On Track program does not make recommendations or decisions about appropriate clinical care or Page 6 of 11

7 service. Any questionnaires, reports, guidelines and other material related to this program are intended as an informational aid to providers. They do not substitute for or limit in any way the use of other resources and the provider's own professional judgment in the delivery of counseling services. Q. Does ValueOptions deliver Electronic Funds transfer (EFT) online solutions? A. Yes, ValueOptions partners with PaySpan, Inc. Q. What are PaySpan, Inc. and PaySpan Health? A. PaySpan, Inc. is a vendor that partners with ValueOptions to deliver an EFT solution to our providers. PaySpan Health is the software that PaySpan, Inc. uses for online registration for EFT. PaySpan Health is a multi-payer adjudicated invoices settlement service that delivers electronic payments and electronic remittance advices based on your provider preferences. With PaySpan Health, you stay in control of bank accounts, file formats, and accounting processes. Q. Is EFT required / available for all accounts? A. No, EFT is not required and yes, it is available for all active accounts. Q. How do I access PaySpan Health? A. Q. Do I have to provide my bank account information to use PaySpan? A. A bank account will not be required for obtaining Provider Summary Vouchers (PSV) only electronically. If a provider wants to receive Electronic Payments or ACH information they will need to provide bank account information. Q. Can I opt out of participation with PaySpan, Inc. and still receive paper PSVs? Page 7 of 11

8 A. No. PSVs for network providers will not be mailed. While participation with PaySpan is not required, PSVs can only be retrieved through PaySpan or ValueOptions ProviderConnect website. Q. Can I obtain the same PSV information on ProviderConnect? A. Yes. Printable versions of PSVs are available on ProviderConnect. Q. What is the difference between the legacy code and the registration code? A. The registration code is different than the legacy code. The registration code is the code ValueOptions obtains from PaySpan. ValueOptions supplies the registration code to providers after enrolling with PaySpan. The legacy code is the provider s ValueOptions pay to vendor number. Q. According to PaySpan, the NPI number and TIN can be used without the "legacy code" when in the system. However this code needs to be entered to register. Please clarify. A. The NPI/legacy code is the provider s ValueOptions pay to vendor number. The provider needs three things to register: i. Their VO pay-to-vendor number (legacy/npi number field on the PaySpan site) ii. Their TIN iii. Their registration code Once they have registered with these three (3) elements, they will use their address as their log-on and the eight (8) character/digit password that they set up during the registration process. Q. How do I obtain my unique registration code number? Page 8 of 11

9 A. Your unique registration code is the registration number that ValueOptions supplies to providers for enrolling in PaySpan Health. If you do not have the letter with your unique registration code, please send an to and include the following information: 1. Your ValueOptions pay-to-vendor number (PIN) 2. Your Tax Identification Number (TIN) or your Social Security Number (SSN) You will receive an with your registration code letter within three business days of your request. Note: If you recently received a payment from ValueOptions, your unique registration code will be located on the check stub after the marketing caption. Additional questions about PaySpan can be addressed by calling PaySpan, Inc. Customer Service at , Monday-Friday 8 a.m. 8 p.m. ET. Q. I signed up for PaySpan, but not all my payments are arriving electronically. How can I correct this? A. Please contact Corporate Finance at: [email protected] Please supply the following information: Pay-to-Vendor Number and TIN or SSN. Q. I don t have a computer. May I still receive paper PSVs and checks? A. You can receive paper checks but not paper PSVs. In order to obtain a faxed copy of your PSV, you must utilize our automated faxback service by dialing Q. I don t want to have to use multiple websites to obtain information. Is the information available on one site for both payments and PSVs? A. Yes. Both are available on Q. Can I still receive a paper check? Page 9 of 11

10 A. Yes. Q. Will ValueOptions/PaySpan be able to deduct money from my bank account? A. No. We only have permission to deposit. CLAIM SUBMISSION MHSA claims for all dates of service prior to January 1, 2014 should be submitted to the previous carrier. EAP claims with dates of service prior to January 1, 2014 would continue to be submitted to ValueOptions. Q. Can I submit my claims electronically to ValueOptions? A. Yes. Participating providers can submit MHSA and EAP claims electronically through ProviderConnect either through direct claims submission or batch claim submission. CMS 1500 and UB04 (837P and 837I) electronic submissions are accepted according to guidelines contained in the ValueOptions EDI materials found on For EAP Claims, Case Activity Forms (CAF) forms can also be submitted via ProviderConnect. If you are interested in electronic claim submission, please contact our EDI Help Desk at between 8 AM and 6 PM Eastern Time, Monday through Friday. We strongly encourage providers to submit claims electronically to achieve the greatest efficiency in claims processing. Q. How do I submit a MHSA paper claim on or after January 1, 2014? A. MHSA claims for services rendered by participating providers with dates of service on or after January 1, 2014 should be submitted to ValueOptions at: ValueOptions P.O Box 1347 Page 10 of 11

11 Latham, New York Any questions regarding claims with dates of service on or after January 1, 2014 should be directed to ValueOptions at Q. How do I submit an EAP paper claim (CAF) on or after January 1, 2014? A. EAP claims for services rendered by participating providers with dates of service on or after January 1, 2014 should be submitted to ValueOptions at: ValueOptions EAP Claims P.O Box 1347 Latham, New York Q. On or after January 1, 2014, where do I go to have a claim question/issue resolved? A. Please visit us online via ProviderConnect to check and review claim status or call Page 11 of 11