an overview of beacon health options and providerconnect ... · an overview of beacon health...

An Overview of Beacon

Health Options and

ProviderConnect for HARP

Providers

September 2015

ValueOptions, Inc. is a Beacon Health Options company.

Objectives

2An Overview of Beacon Health Options and ProviderConnect for HARP Providers

Overview

Operational Areas

Programs Available

Communication Channels & Spotlight Topics

Electronic Resources

• ValueOptions.com

• ProviderConnectSM

ProviderConnect Overview

Contact Information

Questions and Answers

Company

Overview

3


An Overview of Beacon Health Options and ProviderConnect for HARP Providers

Beacon Health Options

4

Headquartered in Boston;

more than 70 US locations

and an office in London

4,300 employees nationally

and in the UK serving more

than 45 million people

225 employer clients,

including 45+ Fortune 500

companies

Partnerships with more than

100 health plans

Programs serving Medicaid

recipients in 25 states and the

District of Columbia

Serving 8.5 million military

personal, federal civilians and

their families

Leader serving dual-eligible

beneficiaries in six states

Accreditation by both URAC &

NCQA


Beacon Health Options’ Footprint


Merging Markets – Sharing Networks

6

Health and Recovery Plan (HARP)

• Five Plans to be shared on two Platforms:

EmblemHealth – ProviderConnect

VNSNY – ProviderConnect

MetroPlus - eServices

Affinity – eServices

Amida Care - eServices

NYC Outside of NYC

October 1st - Mainstream plans and HARPs will

implement non-HCBS behavioral health services for

enrolled members in NYC

April 1, 2016 - First Phase of HARP Enrollment

Letters Distributed

October 2015-January 2016 - HARP NYC enrollment

phases in

July 1, 2016 - Mainstream Plan Behavioral Health

Management and Phased HARP Enrollment Begins

January 1, 2016 -

HCBS begins for HARP NYC population


Overview of

Operational

Areas

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Operational Areas: National Network Services

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Provider Relations

Ensures members’ behavioral health care needs are met through a

geographically and clinically robust network of providers

Ensures maintenance of network composition by engaging in assertive

retention strategies

Engages in timely and appropriate recruitment

Engages in professional, consistent, and educative communications with

provider community and staff


Operational Areas: National Network Services

9

Provider Credentialing & Recredentialing

Credentialing Application required for network consideration

Eligible providers are encouraged to provide their CAQH ID when requesting an application or

during recredentialing

Recredentialing is required every three years through CAQH,

ProviderConnect or a supplemental paper application if required by contract

Notification occurs four months prior to due date (telephonic), one week later (email/fax), 15

and 30 days prior to due date

Failure to respond to requests will result in disenrollment from the network

Provider Contracting

Regionally based contracting directors

Questions about Contracting and Credentialing?

Call 800.397.1630

8:00 a.m. – 8:00 p.m. ET


Operational Areas: Quality Management

10

Quality Management Program Oversight provided by Medical

Director

Key Quality Indicators include but are not limited to:

Satisfaction Survey measures

Access/Availability of Services – geographic access, phone statistics,

appointment availability, etc.

Complaints/Grievances - tracking and reporting

Patient Safety – adverse incidents and quality of care

Coordination of Care

Quality Improvement Activities/Projects

Accreditation (at select locations) by URAC & NCQA


Operational Areas: Quality Management

11

Ongoing Quality Improvement Activities (QIAs)

• Clinical QIAs

– Improving Ambulatory Follow-Up Following Inpatient

Admission For Mental Health Treatment

– Improving Initiation And Engagement And Treatment For

Alcohol And Substance Abuse

– Assuring Accurate Risk Tracking – Referral For Urgent

And Emergent Treatment

• Service QIAs

– Member Satisfaction By Improving Customer Service

Response

– Provider Satisfaction With Utilization Management


Operational Areas: Customer Service

12

Committed to providing our members and providers with the

most accurate and informed benefit, eligibility, claims, and

certification information in the most effective, efficient, and

compassionate manner

Puts our members’ needs and concerns first and is committed

to resolving inquiries promptly without the need to make a re-

contact

We value our members’ questions and concerns and place

member satisfaction at the heart of our Customer Service

philosophy


Operational Areas: Care Management


Operational Areas: Care Management and Referral Assistance

14

Licensed care management staff is available 24 hours a

day/seven days a week for referral and utilization management.

Member referral process:

Emergencies are followed until disposition

Urgent referrals are offered appointments within 48 hours and are called

to ensure appointment is kept

Providers can contact us for referral assistance if needed

Providers should us 24 hours a day/seven (7) days a week if members

require higher level of care or increased visit frequency

Care Management staff will assist with referral to inpatient or specialty

programs

Self-referral: members can submit a request for care management


Clinical Resources for Providers

15

Customer Service*

EmblemHealth: 888.447.2526 (8:00 a.m. – 8:00 p.m. ET Monday – Friday)

VNSNY: 855.735.6098 (8:00 a.m. – 6:00 p.m. ET Monday – Friday)

*In addition, our licensed clinicians are available 24 hours a day, 7 days

a week and 365 days a year. It is imperative that, in the event of

emergent care for one of your EmblemHealth or VNS patients through

HARP, you contact us as soon as possible, but no later than 24 hours

after the emergent contact/session/admission.

Clinical information on www.valueoptions.com:

ValueOptions Medical Necessity criteria

Changes to Substance Use Medical Necessity Criteria

Treatment Practice guidelines

PCP Consult line: 877.241.5575 9:00 a.m. – 5:00 p.m. ET

Intensive Case Management Services


http://www.valueoptions.com/

Clinical Resources for Providers, cont’d.

16

MCTAC.ORG

For managed care readiness tools, resources and announcements

Clinical information: www.valueoptions.com:

Pharmacy program analyzes pharmacy data and uses automated

rules engine to screen for:

• Sub-optimal therapy

• Under-use

• Early discontinuation

• Automatic notification to providers

Federal Mental Health Parity Final Rule

Achieve Solutions®

Outpatient Detoxification/Buprenorphine (Suboxone® or Subutex® )

Maintenance ProgramAn Overview of Beacon Health Options and ProviderConnect for HARP Providers

http://mctac.org/

http://www.valueoptions.com/

17

Communications

& Spotlight Topics



Communication Channels

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Email Alerts

Webinars

Video Tutorials

Monthly Valued Provider eNewsletter

Provider PulseSM Messages

Fax Communications

Provider Mailings


Spotlight Topics: ICD-10

19

The 10th modification to International Classification of

Diseases (ICD) codes has been scheduled for October 1,

2015

On April 1, 2014, the President signed into law legislation passed by the

House and Senate delaying ICD-10. The Centers for Medicare and

Medicaid Services (CMS) has announced the new compliance date for

health care providers, health plans, and health care clearinghouses to

transition to ICD-10 is October 1, 2015.

For more information, please see the ICD-10 Transition Spotlight on

www.valueoptions.com/providers

ICD-9 codes can not be accepted after September 30, 2015, following

the time parameters of the regulation.

ValueOptions continues to make changes to comply with the regulation

and can only accept ICD-10 codes on or after October 1, 2015.


http://www.valueoptions.com/providers

Spotlight Topics:Stamp Out Stigma (S.O.S.) Campaign

20

S.O.S. encourages individuals to talk to friends and loved ones

about mental illness to show commitment to stamping out

stigma of mental illness.

The campaign was introduced to further

support our valued providers when

communicating with patients about

mental illness.

A provider toolkit is available online for our providers to access

S.O.S. materials.

Visit our provider page to learn more about S.O.S.


21

Electronic

Resources



Electronic Resources: ValueOptions.com

22

Provider Homepage is the

most visited page on website

– an excellent resource to

find training opportunities,

forms, handbooks and more

Locate the New York City

Health Plan Network-Specific

Page

Bookmark ValueOptions and

ProviderConnect website


23

Overview of

ProviderConnect



ProviderConnect - Services

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Services of ProviderConnect:

• Verify member benefits and eligibility • View and print forms

• Request and view authorizations • Download and print authorization letters

• Submit claims and view status • Access Provider Summary Vouchers

(PSV)

• Submit updates to provider

demographic information

• Submit recredentialing applications

• Submit customer service inquiries • Access ProviderConnect message

center

Access to support:

ProviderConnect Technical Questions (EDI Help Desk):

888.247.9311 (8:00 a.m. – 6:00 p.m. ET Monday – Friday)

[email protected]


mailto:[email protected]

Benefits

25

Free and secure online

application, available 24 / 7Reduces paper files

Mobile Device friendlyReduces the need to call

for routine information

Quicker PaymentMac and Windows

compatible

INCREASED CONVENIENCE, DECREASED ADMINISTRATIVE PROCESSES

Disclaimer: Please note that ProviderConnect may look different and have

different functionalities based on individual contract needs, therefore some

functions may not be available or may look different for your

specific contract.


How to Access

ProviderConnect

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Registering Option 1: Online

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Go to www.ValueOptions.com, choose

“Providers”

On the right side select “Getting Started,”

then “Register”

Complete Registration page

**Note: The online registration process now includes e-signature

for claims access


Registering Option 1: Online


Registering Option 2: Account Request Form

29


“Providers”

Choose “Forms” under Overview on the right

side of the screen, then click “Administrative

Forms”

Under ProviderConnect Forms choose

“Online Services Account Request Form”

Complete the form and fax to the fax number

indicated on the form


Registering Option 2: Account Request Form


Role-Based Security: Features

31

Allows administrator (Super User) accounts who can:

• Create new users

• Manage existing users

• Deactivate accounts

Password Verification

• Required for first time login users

• Increased security for new accounts created by Super User

• Managed user can change password


Logging into ProviderConnect

32


“Providers”

Click on Login under “ProviderConnect” on the

right side of the screen


Logging into ProviderConnect


Member Eligibility

and Benefits

34



Verifying Member Eligibility


Member Eligibility


Member Demographics


Member Enrollment History


Member Benefits


Authorizations

40



Enter an Authorization Request


Disclaimer


Search a Member


Member Information


Service Address


Requested Services Header


Review an Authorization


Search Authorizations


Authorization Search Results


Claims

50



Electronic Claim Submission: Advantages

51

Better, faster, and cheaper

Reduces paper files

Reduces labor and postage expenses

Reduces potential of error or mishandling

Faster claims processing improves cash flow

Accepts claims files from any Practice Management System

outputting HIPAA formatted 837P or 837I batch files, and from EDI

claims submission vendors


Direct Claim Submission

52

Ability to enter a claim directly into ProviderConnect portal without

using special software

Expedites processing of the claim and payment

Available for professional services only, not higher levels of care

Recommended for providers submitting a lower volume of outpatient

claims


Direct Claim Submission


Batch Claim Submission

54

Allows you to upload HIPAA 5010 compliant files directly to

ValueOptions

Expedites processing of the claim and payment

Available for all levels of care

Recommended for facilities and providers submitting a higher

volume of claims


ProviderConnect Resources

57

Free demonstration: http://www.valueoptions.com/PMC_prototype/ProviderConnect/pvd.html

Quick Start Guide and Comprehensive User Guide

Short Video Tutorials:

• Viewing Member’s Eligibility

• Viewing and Submitting Authorizations

• Direct Claim Submission Process

• Batch Claim Submission Process

Personalized Training Webinars

• Scheduled at your convenience

• Available to just one employee or your entire office

• Training topics are customized based on your needs, timeframes, etc.


http://www.valueoptions.com/PMC_prototype/ProviderConnect/pvd.html

ProviderConnect Resources

58

Training webinars

Scheduled monthly

Topics include: High Level Overview, Authorizations,

Claims, Enhancements, etc.

Webinar calendar available on ValueOptions.com

Upcoming Webinars:

• ProviderConnect Enhancements

• Thursday, 10/1/15 from 11:00 a.m. – 12:00 p.m. ET

• ProviderConnect Overview

• Wednesday, 10/14/15 from 2:00 – 3:00 p.m. ET

• Registration available by clicking “Education Center”

from the Provider Homepage


59

How to Contact

ValueOptions



Provider Contacts

60

New York Provider Relations Team

[email protected]

Provider Customer Service

EmblemHealth: 888.447.2526 (8:00 a.m. – 8:00 p.m. ET Monday – Friday)

VNSNY: 855.735.6098 (8:00 a.m. – 6:00 p.m. ET Monday – Friday)

General Provider Relations, Credentialing and Contracting


EDI Help Desk: Electronic Claims & ProviderConnect:


[email protected]




61

Thank you



an overview of beacon health options and providerconnect ... · an overview of beacon health...

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