Provider enews WELCOME TO VALUEOPTIONS. September 2012

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1 Provider enews September 2012 This is the Twenty-First issue of the Arkansas newsletter. This newsletter alerts providers on a bimonthly basis about upcoming changes and other informational or procedural updates. WELCOME TO VALUEOPTIONS EMPLOYEE SPOTLIGHT Justin Hunt, MD, MS ValueOptions, Inc West Capitol Avenue Suite 330 Little Rock, AR (Phone) Toll Free Phone: (General Fax) Website: Got Questions Please feel free to your Provider Relations questions to VOArkansasproviderrelations@valueOptions.com. Justin Hunt started as the new Vice President of Medical Services and the Medical Director of the Arkansas Service Center on July 16 th, Prior to joining ValueOptions, he was on faculty at the UAMS Psychiatric Research Institute for 3 years as an Assistant Professor of Psychiatry. In this faculty position, he was principal investigator on two grants funded through the Department of Defense and NIMH to develop screening and clinical interventions for returning Iraq and Afghanistan veterans attending college on the New (Post-9-11) GI Bill. His clinical work included inpatient psychiatry and treating students at UAMS. He continues to serve as a core faculty member of the VA South Central Mental Illness Research Education and Clinical Center (MIRECC) where he is working on the rural, community-based VA Mental Health Clergy Partnership. Justin grew up in three separate SEC college towns including Athens, GA, Lexington, KY, and Fayetteville, Arkansas. Both of his parents are teachers, with his mother being a professor at the University of Arkansas and his father being a teacher in the Fayetteville Public Schools. He completed high school at Fayetteville High and then stayed in town to graduate Summa Cum Laude from the University of Arkansas with a BS degree in chemistry. He completed both medical school and general psychiatry training at UAMS and a medicine internship at the University of Michigan. During residency, he served as Chief Resident of the psychiatry residency program and was accepted into the Robert Wood Johnson (RWJ) Clinical Scholars Program at the University of Michigan where he pursued his research interests in mental health policy, young adult mental health, and the association between mental health and overall human capital accumulation. Through the RWJ program at Michigan, he received a Master of Science in Health and Health Care Research which included course work in research methodology and health policy and financing. While he was able to apply his interests in health policy within academia, he is excited to have more direct exposure in his new position at ValueOptions. Justin lives in Little Rock with his wife of seven years, Katy, and his nearly three year old son, Ben. Katy is a speech and language pathologist by training, but is currently staying at home to care for Ben and the next little one to arrive in January, 2013.

2 THANK YOU! THANK YOU! THANK YOU! The Family Involvement Focus Group would like to thank everyone for taking the time in their busy day to complete the Family Involvement Survey. It was a very successful survey with over 300 responses. We would like to share some of the results, as well as recognize the positive efforts that are going on in the state to engage families and improve outcomes for at risk youth. Positive family engagement activities in no specific order of occurrence. Home based services, including home visits, by both MHP and MHPP Communication/building rapport with family members Flexible schedules, most useful was after hours clinics and after school appointments Using liaisons such as MHPP, peer support, school personnel, other Family fun nights, family engagement activities Partnering, attending EAP, other meetings with the parents Providing transportation, assisting with access to transportation Wrap, resources, System of Care

3 FAMILY INVOLVEMENT SURVEY

4 FAMILY INVOLVEMENT SURVEY

5 FAMILY INVOLVEMENT SURVEY

6 New additions to our website arkansas.valueoptions.com We ve added a link on the Provider s section of our website specifically for our Focus Groups. Check out these topics to see minutes from the meetings and updates!

7 Provider Information Notifications and Alerts. Outpatient RSPMI Providers Change to Retroactive Review Adverse Determination Letter For the purpose of quality feedback the letter will include specific services being denied in conjunction with Arkansas Medicaid RSPMI regulations. Questions? Please contact: Melissa Ortega, LCSW at or Jennifer Daniel-Brezee at RSPMI IOC Deficiency Review Requests Ever thought that some of the deficiencies on your IOC report were cited in error? You now have an opportunity to request a formal review. The request must include sufficient supporting evidence to establish that the findings were erroneous at the time of the IOC. Providers were first notified about this new process in an August 14, 2012 Provider Alert**. Critical Timeframes: Providers have 14 calendar days from date of receipt of the IOC report and the letter of Request for Corrective Action Plan (CAP) to submit request. 30 calendar day timeframe for submission of CAP will be suspended upon receipt of written request. The Process: 1. Submit request to the Quality Manager for review of deficiencies provider finds to have been cited in error. The request: Must be in writing Must include any documentation supporting disputed deficiency Must be sufficient to establish an erroneous finding at the time of the IOC Must be submitted utilizing one of three options: Upload to ProviderConnect Fax to (877) (must use IOC Deficiency Review Fax Coversheet) Mail to ValueOptions, 1401 W. Capitol, Suite 330, Little Rock, AR ValueOptions reviews the submitted documentation, along with original documentation from the IOC. 3. A decision is made as to whether the deficiency is: Reversed or Modified IOC report will be revised New letter of Request for CAP will be submitted to provider Provider will have 30 calendar days to submit CAP Sustained Provider notified by Provider will have 30 calendar days to submit CAP For Assistance Contact: Charity Moore at ( ) or Charity.Moore@valueoptions.com, or Patricia Gann at ( ) or Patricia.Gann2@valueoptions.com ** Provider Notifications may be found at

8 Provider Information Notifications and Alerts. Arkansas Medicaid Rolls Out Episodes of Care: ADHD Goes Live October 1 In 2011, Arkansas Medicaid, the Arkansas Department of Human Services, Arkansas Blue Cross and Blue Shield, and Arkansas QualChoice partnered to transform our state s health care and payment system. The collaboration is called the Arkansas Health Care Payment Improvement Initiative. A key part of the initiative is the Episode of Care. Over the summer, Arkansas Medicaid introduced several new episodes at town hall meetings throughout state. ADHD is the focus for the first behavioral health care episode. Providers need to prepare to participate in the ADHD episode by doing the following: Read More about the ADHD Episode Go to Questions? Contact Arkansas Medicaid Payment Initiative Customer Service (In state only) (Local and out of state) By at ARKPII@hp.com. Apply for Access to the AHIN Provider Portal AHIN will serve as the initiative s common portal: For the entry of quality metrics required for PAPs eligibility for gain sharing. To view and download reports on quality, cost and utilization Required beginning October 1, 2012 Go to to sign up. Research and Stay Current on ADHD Clinical Guidelines Here are some resource materials to help you get started: American Academy of Pediatrics, ed4-981c-ea616b1cfce4 American Academy of Child and Adolescent Psychiatry, Scottish Intercollegiate Guidelines Network, Canadian ADHD Resource Alliance Guidelines,

9 Outpatient RSPMI Retrospective Review Record requests for the second pull of 100 records will be sent the first week of October. The following are the components of the medical record that need to be submitted. We request you to submit your information in this order: PCP referrals * All required assessments, including SED/SMI Certifications where applicable * Mental Health Evaluation/Diagnosis (Intake assessment) * Psychiatric Diagnostic Assessment, or most recent PDA completed * Psychological Evaluation and subsequent reports generated from this testing Current Master Treatment Plan * Periodic Reviews (for the specified time frame) Initial YOQ Clinician s Report and any YOQ Clinician s Report completed in relation to the Periodic Review of the Master Treatment Plan for the specified time frame as well as any documentation that addresses barriers, clinical exceptions to frequency, and/or attempts to complete the YOQ.* All progress notes, including but not limited to MHP, MHPP and physician notes (for the specified time frame) Physician orders (for the specified time frame) including any Medication Administration records * Items with asterisks above must be submitted for the review, even if they are outside of the date range requested. All medical records must be submitted to the contractor via fax, mail, or ProviderConnect. Provider Connect: Attach to the most recent ValueOptions authorization Most cost effective means of transmitting records Instant confirmation that records are received Secure Mail: When mailing records, send them to the attention of Retrospective Review Process Fax: Please use the Retrospective Fax Coversheet A Retrospective Fax Coversheet is available on the ValueOptions website. This coversheet must be used when submitting records via fax.

10 ATTENTION!!! Please note changes to ORF form at: How to Upload Charts/Documents and Additional Requested Information to ProviderConnect : Instructions may be found at: Providers are now able to enter their own discharge reviews using ProviderConnect. Please use the complete discharge review button available in each authorization. If you have any questions or need additional information about any of this, please contact: Patricia Gann, LPC at Patricia.Gann2@valueoptions.com Jennifer Daniel-Brezee, LCSW at Jennifer.Daniel-Brezee@valueoptions.com How to Enter a Discharge in ProviderConnect: Instructions may be found at:

11 Intervention and Collateral Services SATS - Documenting Prior Authorization and the Clinical Record Arkansas Medicaid RSPMI Rehabilitative Day Services for Children and Adolescents Arkansas Medicaid RSPMI Crisis Services Corrective Action Plans Development and Submission Acute Inpatient Psychiatric Services U21 Documenting to Acuity RTC/RTU Inpatient Psychiatric Services U21 Documenting to Acuity Retrospective Review Process and Content Arkansas Payment Improvement Initiative ADHD Episode Goals and Measurable Objectives For more information or to schedule a training for your organization please contact Patricia Gann: Patricia.Gann2@valueoptions.com Office Phone: Cell Phone: FOCUS GROUP MEETING MINUTES AND INFORMATION RETROSPECTIVE REVIEW INSPECTION OF CARE FAMILY INVOLVEMENT

12 FAX COVERSHEETS We would like to remind all providers to please use the appropriate Fax Coversheets found on the ValueOptions website when faxing information. These fax coversheets contain barcodes that direct faxed information into the appropriate fax queue for processing. Using the wrong fax coversheet or faxing information using your company s fax coversheet may result in a delay in the processing of information. Fax Coversheets may be found at (Clinical Forms Section) Retrospective Review Fax Coversheet (PDF) Reconsideration Fax Coversheet (PDF) Inpatient Fax Coversheet (PDF) Outpatient Fax Coversheet (PDF) Other Fax Coversheet (PDF) (Inspection of Care Section) IOC Deficiency Review Fax Coversheet (PDF) Inspection of Care In the month of July, ValueOptions began utilizing a new address for the submission of IOC Notification Letters, submission of CAPs, IOC Reports and Requests for CAPs. ARInspectionofCare@valueoptions.com You may begin using this address immediately.

13 Provider Reminders The HIPAA Privacy Rule does allow covered providers to fax and mail protected health information (PHI). However, reasonable safeguards need to be in place to avoid a potential breach of beneficiary confidentiality. Remember to double check addresses and fax numbers before sending PHI. For more information about reasonable safeguards, please go to hipaa/faq/disclosures/482.html Please be sure to check out our forms on our website at: Included in these forms are the following: Retrospective Review Fax Coversheet (PDF) Reconsideration Fax Coversheet (PDF) Inpatient Fax Coversheet (PDF) Outpatient Fax Coversheet (PDF) Other Fax Coversheet (PDF) Substance Abuse Codes (PDF) Adult RSPMI Authorization Request for ORF2 (PDF) Child RSPMI Authorization Request for ORF2 (PDF) Impairment Scale and Risk Rating Guide (PDF) Non-RSPMI Outpatient Authorization Request for ORF2 (PDF) Change in RSPMI Primary Provider Form Copy of Certification of Need (CON) (PDF) Inpatient Treatment Report (ITR) (PDF) Outpatient Review Form (ORF 2) (PDF) Outpatient Information for Residential Requests

14 Important Contact Information Clinical Queue Toll Free Number Clinical Fax coversheet) (Please use appropriate EDI Helpdesk Beneficiary Eligibility Beneficiary Coverage Did you know our website is Network specific? Medical Director Justin Hunt, MS, MD Project/Clinical Director Nicole May Project Director Patricia Gann Compliance Director Sheree Marzka Quality Management Manager Janice Malone Clinical Services Manager Melissa Ortega Clinical Services Manager Jennifer Daniel-Brezee Provider Relations Manager Care Coordinator Team Leader Jamie Ables Clinical Services Team Lead David Paul Lewis Office: Cell: Office: Cell: Office: Office: Cell: Office: Office: Office: Office: Office: To visit our website you must go to: On our Network Specific website you will find forms tailored to fit the Arkansas providers. On our website you will find: Provider Alerts Provider Forms Provider Newsletters Provider Handbook Provider Training & Education Fraud & Abuse Information Reference Documents Retrospective Review Information There is a wealth of information available to you on our website.