chrysler group llc provider training · consolidating behavioral healthcare vendors for its union...

Copyright 2014 ValueOptions.® All rights reserved.

CHRYSLER GROUP LLC

PROVIDER TRAINING


Objectives

2

1. Overview of

ValueOptions®

2. Operational Areas

3. Chrysler LLC Changes

4. Electronic Resources

ValueOptions.com

ProviderConnect®

5. New Claim Submission

Process

6. Contact Information

7. Questions and Answers


Overview of

ValueOptions

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ValueOptions

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Founded in 1983

30 years of market

leadership

Largest independent

behavioral health

company

Serving 31 million members

54 Fortune 500 clients

130,000 provider locations

More than 30 contracts

with 18 health plans

More than 50 Medicaid

contracts in 14 states

Administers the largest EAP

contract in the world

(six million members)


ValueOptions National Presence

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32 Million Members 130,000 Provider locations

Under 100,000 Members

100,000 – 500,000 Members

500,000 – 1,000,000 Members

1,000,000 –2,500,000 Members

Over 2,500,000 Members

Engagement Centers

Corporate Headquarters

National Technology Center

National Operations Center


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

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Provider Credentialing

Completion of Credentialing Application required for

network participation

CAQH®

• New providers eligible to join the ValueOptions provider

network are able to use CAQH for the initial provider

credentialing process.

• For more information about CAQH:

Visit the ValueOptions Credentialing Spotlight page to access

the CAQH FAQ.

Visit the CAQH website at http://www.caqh.org.

http://www.valueoptions.com/providers/Spotlight.htm

http://www.caqh.org/


Operational Areas:

National Network Services (cont’d.)

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Provider Recredentialing (every three years)

CAQH

ValueOptions ProviderConnect Application

Documentation

Send all updated license, certification and malpractice

information

Required Disclosure Forms must be received for

recredentialing to be considered completed

• Notifications

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


Operational Areas:

National Network Services (cont’d.)

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Provider Contracting

ValueOptions Provider Agreements

Questions about Contracting and Credentialing?

Call (800) 397-1630

8 a.m. – 8 p.m. ET


Operational Areas:

Quality Management

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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

Accredited with URAC and NCQA

Standards


Operational Areas:

Quality Management

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Ongoing Quality Improvement Activities (QIAs)

Clinical QIAs

Ambulatory Follow-up

• Time in the Community – Depression Management

• Risk Tracking – Referral for Urgent and Emergent Treatment

Service QIAs

• Average Speed of Answer

• Provider Satisfaction with Utilization Management


Operational Areas:

Customer Service

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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:

Customer Service (cont’d.)

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Operational Areas:

Care Management and Referral Assistance

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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 ValueOptions for referral assistance

if needed

Providers should contact ValueOptions 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


Operational Areas:

Utilization Management

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Inpatient

Requests are completed via the web or telephonically by calling the

number on the back of the members Identification card

Some clients still require pre-authorization for HLOC – notification

requirements may also vary

ValueOptions staff are available 24 hours a day/ seven (7) days a

week

Outpatient

Since pass through or registration no longer applies to outpatient

services impacted by federal parity, authorization cannot be required

Not all clients are subject to federal parity

It is important to check benefits and authorization requirements on

each member via the web or by calling the number on the member’s

identification card


Operational Areas:

Utilization Management (cont’d)

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Outpatient

Outpatient care management will be conducted primarily

through front-end claims or claims extracts, and will

emphasize four areas:

1. Complex Diagnoses

2. Outlier cases

3. Outlier Providers

4. Intensive Care Management


Clinical Resources for Providers

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Clinical information on www.valueoptions.com:

ValueOptions Medical Necessity criteria

Changes to Substance Use Medical Necessity Criteria

Treatment Practice guidelines

PCP consult line 9:00 a.m. to 5:00 p.m. (ET)

Intensive Case Management Services

Health Alert

Federal Mental Health Parity Final Rule

On Track

Achieve Solutions®

http://www.valueoptions.com/


Chrysler LLC Changes

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Effective July 1, 2014, Chrysler Group LLC will be

consolidating behavioral healthcare vendors for its union

represented active and retiree population from the existing

vendors, Blue Cross Blue Shield and ValueOptions, Inc., to

exclusively ValueOptions.

If you are currently a ValueOptions and a Blue Cross Blue

Shield Participating Provider, the only change is that you will

begin to submit claims to ValueOptions.



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If you are not a ValueOptions provider, when you call to

register outpatient treatment under the Transition Benefit,

the ValueOptions representative will enter transition benefit

session(s) through September 30, 2014.

The transition benefit will end on September 30, 2014, unless

ValueOptions determines that it is medically necessary for

further care under a continuity of care waiver.


Electronic Resources

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Electronic Resources:

ValueOptions.com

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Provider webpages are the most visited pages on the

website

Excellent resource to quickly find latest news in industry,

training opportunities, forms, handbooks and more

Recommend providers bookmark ValueOptions and

ProviderConnect website



ValueOptions.com

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ValueOptions.com – Network Specific

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New E-Commerce Requirements for 2014-2015

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By January 1, 2015, existing providers in the ValueOptions

network will be required to complete routine transactions

electronically

New providers with a contract date on or after July 1, 2014 will

need to meet this requirement at the time they join

ValueOptions

For claim submission, ValueOptions recommends

ProviderConnect®, but will also accept claim submissions from

clearinghouses (our payer ID is FHC &Affiliates)

E-Commerce Toolkit -

http://www.valueoptions.com/providers/E-Commerce.htm






E-Commerce Advantages

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Better, faster and cheaper

Reduced paper files

Reduced labor and postage expenses

Reduced potential of error or mishandling

Faster claims processing improves cash flow


Overview of

ProviderConnect

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Electronic Resources: ProviderConnect

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A HIPAA-secure online tool where providers can:

Verify member eligibility Access ProviderConnect Message

Center

Access and Print Forms Request and View Authorizations

Download and Print Authorization

Letters

Submit Claims and View Status

Access PSVs Submit Customer Service Inquiries

Submit Updates to Provider

Demographic Information

Submit Recredentialing Applications


How to Access ProviderConnect

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Go to www.ValueOptions.com, choose “Providers”

In-network providers can self register by using their assigned

provider ID number

Multiple logons from same provider ID number available

• Fax completed Provider Services Account Request Form to

(866) 698-6032

Contact Information:

ValueOptions EDI Helpdesk

(888) 247-9311

[email protected]

Monday to Friday, 8:00 a.m. - 6:00 p.m. ET

http://www.valueoptions.com/

mailto:[email protected]




Role-Based Security: Features

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New level of ProviderConnect access to enhance security as

required by HIPAA guidelines

Level of ProviderConnect access defined by role

Roles defined by user type and/or VO business rules

Users assigned roles with access to certain functions

i.e. claims

User Types: Super User, Managed User (managed by Super User),

Standard User


ProviderConnect Resources

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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

• Recredentialing

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





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Training webinars

Scheduled monthly

Topics include: Authorizations, Claim Submission, Role-

based security, Recredentialing, Viewing Patient Info,

etc.

Webinar calendar available on ValueOptions.com

• Next webinar scheduled for 07/16/14, which will provide a

detailed tutorial on ProviderConnect



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Personalized Training

Scheduled at your convenience

Available to just one employee or your entire office

Training topics are customized based on your needs,

timeframes, etc.



PaySpan® Health

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A tool enabling you to:

Receive payments automatically

Receive email notifications immediately upon payment

View your remittance advice online

Download an 835 file to use for auto-posting purposes

Visit the PaySpan Health website at www.payspanhealth.com

http://www.payspanhealth.com/


Claim

Submission Process

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Claim Submission

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As of July 1, 2014, your ValueOptions Provider

Agreement will apply to services provided to

Chrysler Group LLC union represented members.

For dates of service beginning on and after July 1,

2014, claims for Chrysler Group LLC for only union

represented members should be submitted

electronically through ProviderConnect.

Providers unable to submit claims electronically

can submit paper claims by mail to:

ValueOptions

PO Box 930829

Wixom, MI 48393-0829


Electronic Claim Submission

38

Effective January 1, 2015, providers in the

ValueOptions network will be expected to

electronically conduct all routine transactions,

including submission of claims.

Electronic Claim Submission Solutions:

• ProviderConnect

• Clearinghouses

• ValueOptions Electronic Data Interchange (EDI)


ProviderConnect: Claim Submission

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No charge for electronic claims submission

Accept claims files from any Practice Management System

outputting HIPAA 5010 formatted 837P or 837I files, and from EDI

claims submission vendors

Offer Direct Claims Submission on website to providers who do not

have own software or who wish to submit certain claims outside

their batch files

• These claims are processed immediately, and you are provided

the claim number

• You may submit batch claims files or Direct Claims

interchangeably

Access to support:

• http://www.valueoptions.com/providers/Provider_Connect.htm

• [email protected]

• Helpdesk: (888) 247-9311 between 8 a.m. – 6 p.m. ET

http://www.valueoptions.com/providers/Provider_Connect.htm

http://www.valueoptions.com/providers/Provider_Connect.htm





How to Contact

ValueOptions

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Provider Contacts

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Chrysler LLC Toll-Free Number:

(800)346-7651

Provider Relations, Credentialing and Contracting Questions:

(800) 397-1630 (8:00 a.m. – 8:00 p.m. ET Monday – Friday)

Electronic Claims & ProviderConnect Technical Questions (EDI

Help Desk):

(888) 247-9311 (8 a.m. – 6 p.m. ET Monday - Friday)

[email protected]

For PaySpan Registration Provider Support contact:

(877) 331-7154 (8 a.m. to 8 p.m. ET Monday – Friday)

[email protected]






Questions

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Questions?


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Thank You

chrysler group llc provider training · consolidating behavioral healthcare vendors for its union...

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