ValueAdded

This is the 196th issue of our VBH-PA information update. These updates will be

emailed to network providers monthly. Please feel free to share our newsletter

with others, and be sure your appropriate clinical and financial staffs receive

copies.

Inside this issue

Certified Recovery Specialists and Drug and Alcohol Case Management ........................... 2

Corrections to Prior Claims Submissions ............................. 3

VBH-PA Billing Resources ........ 4

Save the Date—Provider Appreciation Breakfast ........... 4

CAMP “T.A.A.G.” Picnic A Success! ............................... 5 Register Now! 8th Annual NW3 Forum ..................................... 6

Seeking Nominations for the 8th

Annual NW3 Forum ................. 7

WPIC 2015 Fall Videoconference Series ...................................... 8

Vol. 17 Issue 10 October 2015

VBH-PA Member Lines There are designated toll-free numbers for all of our members to contact Value

Behavioral Health of Pennsylvania (VBH-PA) based on their county of residence.

Providers may refer members to a VBH-PA Member Services Representative if the

member has any questions or would like to find out more about behavioral health

services. Phones are answered 24 hours a day, seven days a week, every day of the

year.

VBH-PA Toll-Free Member Lines by County

County Toll-Free Number

Armstrong 877-688-5969

Beaver 877-688-5970

Butler 877-688-5971

Cambria 866-404-4562

Crawford 866-404-4561

Fayette 877-688-5972

Greene 877-688-5973

Indiana 877-688-5969

Lawrence 877-688-5975

Mercer 866-404-4561

Venango 866-404-4561

Washington 877-688-5976

Westmoreland 877-688-5977

TTY—All Counties 877–615-8502

2

ValueAdded—October 2015

Certified Recovery Specialists and Drug and Alcohol

Case Management—How Do These Services Fit Into

Treatment? Case management services and peer

support services are, for many members,

an integral part of the treatment team.

SAMHSA TIP 27 discusses at length the

necessity for case management within the

drug and alcohol field and how

indispensable case management is for an

individual with substance use concerns.

SAMHSA’s best practice standards

suggest that case management for

individuals with substance abuse concerns

should have some unique skill sets. For

example, according to SAMHSA, “case

management is grounded in an

understanding of clients' experiences and

the world they inhabit—the nature of

addiction and the problems it causes, and

other problems with which clients

struggle (such as HIV infection, mental

illness, or incarceration). In addition,

according to SAMHSA, case management

services for substance abuse should

include “Understanding a variety of

models and theories of addiction and

other problems related to substance use.

Ability to describe the philosophies,

practices, policies, and outcomes of the

most generally accepted and scientifically

supported models of treatment, recovery,

relapse prevention, and continuing care

for addiction and other substance-related

problems. Recognizing the importance of

family, social networks, and community

systems in the treatment and recovery

process.”

Peer Support Services (PSS) are

specialized therapeutic interactions

conducted by self-identified current or

former consumers of behavioral health

services who are trained and certified to

offer support and assistance in helping

others in their recovery and community-

integration process. Peer support is

intended to inspire hope in individuals

that recovery is not only possible, but

probable. The service is designed to

promote empowerment, self-

determination, understanding, coping

skills, and resiliency through mentoring

and service coordination. Peer support

is designed on the principles of

consumer choice and the active

involvement of persons in their own

recovery process. For substance abuse

services, the individual that provides

the peer support services is called a

Certified Recovery Specialist. Certified

Recovery Specialists are an important

part of the member’s treatment team as

the Certified Recovery Specialist can

assist with difficult transition periods

and meet the member in the

community to assist in mentoring.

Certified Recovery Specialists are

responsible for ensuring outreach,

mentoring, peer support and guidance,

as well as a resource for information

and referrals. Certified Recovery

Specialists work closely with program

participants before, during and after

their treatment experiences to support

and assist them in their recovery, in

understanding and navigating the

system of care, as well as to encourage

and guide any necessary connections

with other service systems. Certified

Recovery Specialists can start working

with the member while they are still in

a residential treatment program so that

they may be better able to navigate

back to community living.

Research supports that peer support

assists members in their recovery

process. Research shows that using

trained peers leads to improvement in

psychiatric symptoms and decreased

hospitalization (Galanter, 1998;

Kennedy, 1990; Kurtz 1988). From

the research, peer-delivered peer

service participants showed greater

levels of independence, empowerment

and self-esteem. Over 60% of the

participants in the study indicated

increased development of social

supports with the utilization of peer

support services versus those who did

not have peer support services (Van

Tosh & del Vecchio, 2000). In studies

of persons dually diagnosed with

serious mental illness and substance

abuse, peer-led interventions were

found to significantly reduce

substance abuse, mental illness

symptoms and utilization of crisis

services (Magura, Laudet, Rosenblum

& Knight, 2002).

If there are questions about making

referrals to or the utilization of either

drug and alcohol case management or

certified peer specialists, please feel

free to call VBH-PA and we can assist

with the process. Drug and alcohol

case management and recovery

support services may also be found in

the VBH-PA County Provider

Directories and Resource Guides.

Visit http://www.vbh-pa.com/

member/mbr_prvDirect.htm to view

these county-specific guides.

3

ValueAdded—October 2015

Corrections to Prior Claims Submissions

Any time that a change is being made to a claim, please be sure to submit your request for

correction on an industry standard claim form. The only acceptable claim formats are the

CMS-1500 or a UB-04. All other types of formats submitted as a corrected claim will be

returned to the provider. A corrected claim consists of a change to any line of a prior claims

submission. All corrected claims must have a notation as to what is changed from the

original, as well as listing the claim number of the claim that needs to corrected.

Correction Do’s

If the claim line paid zero dollars and is within the timely filing limitations, it can be

submitted as new using EDI or mailing a paper claim to the appropriate initial claims

address.

Utilize ProviderConnect Change/Reprocess of Professional Claims for all corrections

to CMS-1500 or 837 Professional Claims for exceptional turnaround time! The link

to the step-by-step guide is below:

http://valueoptions.com/providers/Compliance/

Guide_to_Changing_or_Reprocessing_Professional_Claims_Online.pdf

All corrections to a claim should be made at one time to avoid further billing errors.

All claim lines must reflect the actual service that took place for the date billed.

Web inquiries are still an acceptable means for submitting reprocessing requests. If

you are not currently using this method and would like to understand this better,

please contact the VBH-PA Customer Service Department.

Quality check adjustment requests before faxing or mailing to VBH-PA. A large

volume of adjustment requests are returned because they are not compliant with

VBH-PA reimbursement policies.

Correction Don’ts

Do not include dates of service that have never been processed on a corrected claim.

Do not bill date spans for any service that is more than 1 unit per day. If a claim

denies for needing an itemized statement, this indicates that each date within the

specified date range will need billed to reflect the services and units provided for

those dates.

Do not submit a claim form if corrections are not necessary. Copies of authorization

letters, PROMISe™ eligibility printouts, or any other internal documents are not

necessary unless they are specifically requested by the Customer Service Department

for resolution of a specific issue.

VBH-PA encourages all of our providers to be proactive when resolving problems. The

VBH-PA Customer Service Department is available Monday through Friday from

8:00 a.m. to 5:00 p.m. to answer questions or direct providers to the appropriate department.

The toll-free number is 1-877-615-8503.

4

ValueAdded—October 2015

Helpful VBH-PA Billing Resources

Provider billing staffs should review the resources on our website at http://www.vbh-

pa.com/provider/prv_information.htm. Here, you will find a Billing Guide that is specific

to the VBH-PA line of business. This guide should be used in conjunction with existing

ValueOptions’ provider guides when training new hires or re-educating veteran staff. We’ve

paired the Billing Guide with customer service audio recordings which allows you to

hear mock conversations related to adjustment requests, authorizations, and secondary

claims adjustments.

We believe, by offering different types of learning tools to your staff, it will enhance their

capabilities of billing appropriately the first time. In doing so, your business does not

experience delays in payment. Please also remember that electronic claim submissions of

accurate or “clean” claims are the best way to keep your business in good financial health.

Upcoming BHRS & RTF Summits

BHRS SUMMITS

(Your choice of two

locations per month.)

December 4—

Courtyard by Marriott

Greensburg, PA

CANCELLED

December 11 —

Hampton Inn & Suites

Mercer, PA

RTF SUMMITS

October 9 —

Doubletree by Hilton,

Mars, PA

.

Join VBH-PA for a

Date: Friday, December 11, 2015

Where: Doubletree by Hilton Monroeville

101 Mall Boulevard

Monroeville, PA 15146

More details coming soon.

BHRS Summit Cancellation Notice

Due to the Provider Appreciation Breakfast, please

note that the December 11th BHRS Summit in

Mercer, PA is cancelled.

5

ValueAdded—October 2015

CAMP “T.A.A.G.” Picnic A Success!

On Wednesday, August 12, 2015, the annual “T.A.A.G.” Picnic was held at a new venue—the Family Resources Family

Retreat Center in Mars, PA. The weather was perfect for a day of outside activities! CAMP “T.A.A.G.” attendees starting

arriving at 10:30 a.m. The schedule was jammed packed with camping activities that included fishing, canoeing, hiking,

swimming, a sports court, a team-building rope course, and zip line! Eighty-two youth/young adults attended the picnic

this year, bringing the total to 148 attendees, which included Value Behavioral Health staff and other adults who supported

the youth/young adults during their time at CAMP “T.A.A.G.” Other special events that took place during the day were

the pass, punt and kick contest, scavenger hunt, 99.7 Street Treat Patrol, and arts and crafts. One of the highlights of the

day was DJ Gia. She had members moving and learning lots of dance moves. Everyone would like her to return next year!

Exhibitors brought their information and swag for the youth/young adults to collect. Attendees were given a punch card,

and when they visited each exhibit table would get their card punched for a chance to win a gift card. The exhibitors

included “T.A.A.G.”, VBH-PA, Primary Health Network, Beaver County Rehabilitation Center, PA System of Care

Partnership, Greater Pittsburgh Community Food Bank, Youth M.O.V.E. Fayette County, Westmoreland Casemanagement

and Supports, Inc., MHY Family Services, Family Behavioral Health and AERI, and Pressley Ridge. The youth/young

adults stated on their evaluation forms that they really enjoyed the exhibitors and wanted to ask them back for next year.

After all the donated gift baskets from the exhibitors were raffled off, thank-yous were made, and final goodbyes said, I was

reminded once again of how youth/young adults, given the chance to interact from a variety of very diverse cultures, can

come together and enjoy each other’s company. Until next year’s “T.A.A.G.” Picnic—we bid a fond adieu.

Watch for the “Save the Date” for CAMP “T.A.A.G.” coming out in January 2016.

Create Your Own Personal Camping Adventure Article by Karan Steele, Prevention, Education and Outreach Coordinator

6

ValueAdded—October 2015

Join us at Crawford, Mercer & Venango counties’ behavioral health

forum featuring the “Exceptional Individual and Parent Awards” and

featured speaker Clarence Jordan, Beacon Health Options’ VP of

Wellness and Recovery. Education and information will be presented to

enhance and empower participants’ recovery journeys.

Free for all attendees.

“Acknowledging the Journey”

Thursday, November 12, 2015

9:00 a.m. to 4:30 p.m. (Registration begins at 8:00 a.m.)

Park Inn by Radisson, 3377 New Castle Road (Rt 18)

West Middlesex, PA 16159

General Registration Now Open! Join us at the 8th Annual “Acknowledging the Journey,” a forum for families and adult

HealthChoices members. The NW3 Forum General Registration form is currently available on

the VBH-PA homepage, under the Provider and Member News and Events sections at

www.vbh-pa.com.

Attention Prospective Exhibitors! Reservations are open to exhibit at the 8th Annual “Acknowledging the Journey,” a

behavioral health member forum for HealthChoices members residing in Crawford, Mercer

and Venango counties. The NW3 Forum Exhibitor Registration Form is currently available on

the VBH-PA homepage, under the Provider and Member News and Events sections at

www.vbh-pa.com.

If you have any questions, please contact Shelley Thomas, PE&O Coordinator, at (724) 962-8032 or 1

(866) 404-4561, or by email at shelley.thomas@valueoptions.com.

“Acknowledging the Journey” 8th Annual Family & Adult Behavioral Health Forum

A Value Behavioral Health of Pennsylvania Family And Adult Members Forum

Crawford, Mercer and Venango Counties

Exhibitors at work engaging with consumers and educating them with resources. Pictures from 2014 Forum.

7

ValueAdded—October 2015

Would you like your efforts and supports acknowledged through the

progress and empowerment of a VBH-PA member whom you have

served?

Are you inspired by hearing people’s stories of recovery and

resiliency?

Nominate someone you consider as an Exceptional Individual, Parent or Caregiver!

** Nominations are now open and need to be submitted by Friday, October 16, 2015. **

Once again, this year’s event program will acknowledge all nominations and award winners’ names

along with each agency who takes the time and effort to nominate a deserving individual. Many of you

have already experienced the inspiration of seeing people being “Acknowledged for their Journey” and

being recognized as an Exceptional Individual or Family Member. VBH-PA thanks you for the part you

play in this effort.

Please consider nominating a VBH-PA HealthChoices member whom you consider exceptional reflected

by their active journey and their engagement of and encouragement to other members in theirs. Please

nominate at least one HealthChoices VBH-PA member residing in one for the northwest three (NW3)

counties of Crawford, Mercer or Venango. Two awards will be given for each county. One award will be

given to an adult VBH-PA member for the Exceptional Individual Award. The other award will be given

to a parent or caregiver of a child or adolescent VBH-PA member. A total of six awards will be presented

for all three counties. The individuals nominated will also be acknowledged at this event.

The NW3 Members Forum will publically acknowledge HealthChoices members who have demonstrated

courage, creativity and leadership in their journeys at the:

“Acknowledging the Journey”

8th Annual Behavioral Health Forum

Thursday, November 12, 2015

Park Inn by Radisson, West Middlesex, PA

9:00 a.m. – 4:30 p.m.

(Registration begins at 8:00 a.m.)

The NW3 Forum Nomination Form is currently available on the VBH-PA homepage, under the Provider

and Member News and Events sections at www.vbh-pa.com. Please feel free to re-nominate someone

whom you may have nominated in previous years but did not receive the Exceptional Award.

Please take the time to pass this request onto your many staff members who also do exceptional work

with VBH-PA HealthChoices members. Your agency may nominate as many adult and family members

as they like. The NW3 Members Forum Workgroup will review all nominations and vote. The greater the

detail you include the more likely your nominee will receive the award. Nominations are due by Friday,

October 16, 2015. Thank you for all your hard work in seeing people succeed!

Attention Providers and County Staff!

NW3 2015 Exceptional Individual/Parent Crawford Mercer &

Venango Counties Nominations Needed!

8

ValueAdded—October 2015

2015 WPIC Videoconferences Fall Series!

VBH-PA is pleased to announce that our Engagement Center will be a videoconferencing

site for the WPIC Office of Education and Regional Programming 2015 fall

videoconference series. These programs are free of charge and there are NO fees for

continuing education credits. The videoconferences are held from 9:00 a.m. to 11:00 a.m.

in the Walnut Room at VBH-PA’s Trafford Engagement Center. For CEU information,

registration information and complete descriptions of these trainings, please view

“Upcoming Trainings” on our Provider Training webpage.

Upcoming Videoconferences*

October 14—ECT in Late Life Depression

November 18—Strategies for Working with Reactive Attachment Disorder (RAD) Children in

Adoptive, Residential and Family of Origin Homes

December 9—Mental Health and Homelessness

Registration:

To register for these trainings, please visit the ValueOptions® Provider Trainings Web

page. Select Pennsylvania from the state dropdown list (DO NOT change any of the

other fields) and then click on Select. Scroll down the screen and put a check mark in

the box next to the event(s) and then hit Register. Phone-in registrations will not be

accepted.

*Please Note: These videoconferences are NOT webinars. You must be in attendance at

the Trafford Engagement Center to view these videoconferences. VBH-PA is one of

many sites offering this opportunity. Please click here to view all locations offering this

videoconference series. To register with another location, please contact the coordinator for

that site.

Suggestions or ideas for

articles that you would

like to see published in

ValueAdded can be

faxed to Kim Tzoulis, Val-

ueAdded Editor, at (724)

744-6363 or emailed to

kimberly.tzoulis@

valueoptions.com

Articles of general im-

portance to the provid-

er network will be con-

sidered for publication.

Value Behavioral Health

of PA, Inc.

520 Pleasant Valley Rd

Trafford, PA 15085

Phone: (877) 615-8503

Fax: (724) 744-6363

www.vbh-pa.com

Contacting VBH-PA

Provider Relations has

never been easier! Click

on the Webmaster email

address below to send an

email:

vbhpawebmaster@value

options.com