Provider enews WELCOME TO VALUEOPTIONS. May 2012

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1 Provider enews May 2012 This is the Nineteenth 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 Corinne Sappington ValueOptions, Inc West Capitol Avenue Suite 330 Little Rock, AR (Ph.) Toll Free Phone: Fax: Website: Got Questions Please feel free to your Provider Relations questions to VOArkansasproviderrelations@valueOptions.com. Corinne Sappington is a Care Coordinator at our Arkansas Service Center. The Care Coordination team collaborates with guardians and providers offering assistance with treatment engagement, education, advocacy, referrals and linkages to natural supports in the community to promote positive outcomes for children and families. Corinne and her team serve as a single point of contact for individuals whose needs are complex and severe. Corinne graduated Magna Cum Laude from the University of Tulsa with her Bachelor s Degree in Psychology in After graduation, Corinne moved back home and started her career in mental health providing case management services to both adults and children in inpatient treatment as well as working in conducting assessments and referrals. In the fall of 2007, Corinne enrolled in the Master s Program of Social Work at UALR. Corinne chose the advanced direct practice track and completed internships in a school based program as well as an inpatient psychiatric unit for PTSD. Corinne worked as a school based therapist after completing graduate school before joining her Care Coordination team at ValueOptions in January Corinne grew up in Little Rock and is proud to call it home. She currently lives with her husband, Mike, an attorney at the Saline County Prosecutor s Office and their two rescue dogs, Wally and Hank. Corinne loves cooking, baking, and trying new recipes with her friends. Corinne also enjoys traveling with her four best friends from high school. The group has visited Portland, Miami, Hilton Head, Savannah, and will go to Chicago this August.

2 ***Reminder*** When submitting requests for CSRs for RTC/RTU: Concurrent Review of Prior Authorization If inpatient services are to continue beyond the current prior authorized period and the facility wishes to prevent a lapse in coverage, the facility must transmit copies of the recipient s record to the MART no later than five (5) working days before the current prior authorized period ends. An acute care facility must transmit this information within forty-eight (48) hours before the previously prior authorized time period ends The Medicaid Agency Review Team will not perform retroactive concurrent reviews. The facility will transmit all updates or changes to patient records that were previously submitted to the MART along with the following: A. Transmittal sheet; B. Individual plan of care, thirty (30) calendar day reviews; C. Subsequent continued stay ninety (90) calendar day reviews and D. Summary of treatments and response to treatment from date of admission until the current date. This information will be reviewed by the MART to determine whether inpatient psychiatric services are medically necessary and whether to approve or deny coverage of an additional period.

3 How to attach documents, charts, and requested additional information in Provider Connect

4 How to attach documents, charts, and requested additional information in Provider Connect (Continued)

5 How to attach documents, charts, and requested additional information in Provider Connect (Continued) For any questions about attaching documents and charts in Provider Connect, please contact: Patricia Gann, LPC, at: Phone:

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7 Provider Notification May 10, 2012 RE: Telemedicine Regulation Changes Effective May 15, 2012, Arkansas Medicaid RSPMI policy will include Psychiatric Diagnostic Assessment Initial and Continuing Care and Pharmacological Management by Physician via telemedicine services for the U21 population. Providing services via telemedicine for all ages will require provider telemedicine certification. Certification will be provided through UAMS, The Center for Distance Health Network Management. See attached flyer from UAMS for certification information and contacts. Because all telehealth providers cannot be certified by the May 15th deadline, the providers of adult services need to contact Tina Butler and schedule a certification appointment, at the RSPMI contact number, Once the appointment has been made, providers can continue to provide services to adults only. Providers who intend to serve children must wait until the certification is complete to begin providing the two services outlined in policy for children. Section of the Arkansas Medicaid RSPMI Manual has been revised to include the following telemedicine procedure codes and modifiers for the U21 population: T1023, U7 for Psychiatric Diagnostic Assessment Initial (telemedicine); and T1023, U7, U1 for Psychiatric Diagnostic Assessment Continuing Care (telemedicine), and Section includes 90862, U7 for Pharmacological Management by a Physician. Sections and of the Arkansas Medicaid RSPMI Manual are updated to include services provided via telemedicine for all beneficiaries. Section is also updated to include the minimum acceptable standards providers must meet for reimbursement by Arkansas Medicaid for providing services via telemedicine in the RSPMI program. RA messages detailing the changes may be found at:

8 To request a Telemedicine Assessment Form or schedule a certification appointment, please call our RSPMI contact number, Our program managers and video support personnel will send you the assessment form and work with you to schedule a convenient time for an onsite visit. What is Telemedicine? Patient consultations via video conferencing, transmission of still images, e-health including patient portals, remote monitoring of vital signs, continuing medical education, consumer-focused wireless applications and nursing call centers, among other applications, are all considered part of telemedicine and telehealth. What is ATOM (Arkansas Telehealth Oversight & Management)? ATOM is a collaboration of hospitals and clinics positioned to implement and operate advanced telehealth systems more effectively and for a lower cost than providers operating individually. ATOM is focused on bringing a single, statewide broadband health network to Arkansas. What is the Arkansas Telehealth Network? The Arkansas Telehealth Network (ATN) provides HIPAA compliant encryption to those who link in through the network to provide telehealth. The network is operated at UAMS and consists of approximately 500 healthcare and healthcare education sites. (Please see the back of this document for additional information) Definitions: Kilobyte: A Kilobyte is approximately 1,000 Bytes, actually 1,024 Bytes depending on which definition is used. 1 Kilobyte would be equal to this paragraph you are reading, whereas 100 Kilobytes would equal an entire page. Megabyte (Mbps): A Megabyte is approximately 1,000 Kilobytes. Multiprotocol Label Switching (MPLS) is a mechanism in high-performance telecommunications networks which directs and carries data from one network node to the next with the help of labels. MPLS makes it easy to create virtual links between distant nodes. It can encapsulate packets of various network protocols. Cloud: The cloud is a physical place, perhaps owned and controlled by some other entity, containing computing resources that are available on demand for a price. End point: Entity on one end of a connection. Qualifications for RSPMI Requirements for clinics/physicians: Equipment: Must have a screen size no less than 20 inches diagonal. Video equipment must have the ability to dial H.323 via IP or E.164 and connect to UAMS infrastructure equipment for firewall registration. Desktop clients such as Skype, oovoo, and ichat are proprietary and do not have the ability to connect to the UAMS Video network. UAMS CDH can assist in placing your organization in touch with companies to determine what equipment will work best. All equipment must by UL and FCC Class A approved. Connectivity: You must have an Internet connection with a static IP address. Contact your local Internet service provider (ISP), whether it is DSL or Cable. Business class connectivity is strongly preferred as it gives a better level of customer service and other features.

9 Line Speed: For best video outcome, should be a minimum of 6Mbps download and 1Mbps upload. Must Join the Arkansas Telehealth Network to ensure ability to participate in Medicaid quality assurance measures, scheduling, educational encounters and HIPAA compliance. There will be a fee dependent on number of sites you wish to connect. Optional additional services are also available. Completion of Assessment Form: A telemedicine form will be sent to you upon request from UAMS CDH that will allow us to perform initial assessment of your equipment and connectivity. Upon completion of this form, fax or it back to UAMS CDH. The UAMS CDH team will then call to set up an onsite certification appointment. Certification Appointment: The UAMS CDH team will come to your site(s) to view and test the equipment and connectivity that your organization intends to use to provide telemedicine consultations. If requirements are met, Arkansas Medicaid will be notified of your certification status. Certification is good for one year. Follow up certifications will take less time to conduct. Your organization will be issued a telemedicine certification that will be displayed and/or kept on file for auditing purposes. If requirements are not met, the UAMS CDH team will provide follow-up recommendations/suggestions and reschedule a site visit for further evaluations as requested. UAMS CDH and the ATN will view connectivity statistics from your site to ensure appropriate bandwidth is being used during sessions. Random site visits by UAMS CDH may occur at the discretion of Medicaid if connectivity statistics are not sufficient consistently. Fee: $3,000 per certification Arkansas Telehealth Network Management The Arkansas Telehealth Network is a healthcare network that consists of a 24/7/365 IT command center that facilitates broadband connectivity that empowers distant healthcare providers to connect to other member healthcare providers and educators. The sole purpose of this network is to provide clinical, research and education activities related to healthcare. The UAMS Center for Distance Health provides expertise, training and management for the network. Services fees, as related to applicants activities, include: Connectivity to the Arkansas Telehealth Network This includes: Connection on the ATN (individual site responsible for bandwidth and Internet connection to public Internet) Security and encryption Firewall traversal of LAN to the ATN network Utilization of the ATN network for clinical, point to point interactive video connections during normal business hours (8:00 am 4:30 pm, Monday Friday) Technical and troubleshooting support for the connectivity to the ATN through the UAMS CDH technical support center during normal business hours Certified RSPMI sites will receive scheduling and technical support that allows them to utilize the ATN in clinical, educational and administrative business practices Additional services are available. The services provided through The Center for Distance Health Network Management request will ensure that the applicant s telehealth activities operate fluidly and technical issues are resolved by a skilled staff of telehealth experts. The applicant will have access to Center for Distance Health telehealth technologists, a 24/7 telehealth technical support hotline and technology training. Center for Distance Health services ensure proposed telehealth activities are met with efficiency through expert-level support

10 Provider Information (RSPMI) Outpatient Providers: Please provide ValueOptions with the addresses at which you would like to be notified when you have beneficiaries that have been randomly selected for Retrospective Review. It is strongly recommended that you provide more than one contact in order to ensure receipt of notification in the event of employee changes, vacations, illness, or other absences. Send these addresses to on or before May 30 th, Providers are now able to enter their own discharge reviews using Provider Connect. 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 or or Jennifer Brezee, LCSW at or

11 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 Reconsideration requests can be ed to ArkansasAppeals@valueoptions.com as well as faxed using the Reconsideration Fax Request Form (PDF). Please be sure to check out our forms on our website at: Included in these forms are the following: Substance Abuse Codes (PDF) Reconsideration Fax Request Form (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) Inpatient Fax Request Form Outpatient Fax Request Form Other Fax Request Form (PDF) Outpatient Information for Residential Requests Psychological Testing Form (PDF)

12 IMPORTANT CONTACTS HOW TO CONTACT VALUEOPTIONS VIA AND TELEPHONE PROVIDERCONNECT SM & WEBSITE INFORMATION Clinical Queue Toll Free Number Clinical Fax Reconsideration Request Fax EDI Helpdesk Beneficiary Eligibility Beneficiary Coverage Project/Clinical Director Nicole May Nicole May Cell Phone Project Director Nelda Michael Nelda Michael Cell Phone Compliance Director Sheree Marzka Quality Management Manager Janice Malone Janice Malone Cell Phone Clinical Services Manager Melissa Ortega Provider Relations Manager Patricia Gann Clinical Services Team Lead Jennifer Daniel-Brezee Care Coordinator Team Leader Jamie Ables Did you know our website is Network specific? 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 There is a wealth of information available to you on our website. A Member of the ValueOptions Staff use the Formula firstname.lastname@valueoptions.com