CHRYSLER GROUP LLC PROVIDER TRAINING. Copyright 2014 ValueOptions. All rights reserved.

Transcription

1 CHRYSLER GROUP LLC PROVIDER TRAINING

2 Objectives 1. Overview of ValueOptions 2. Operational Areas 3. Chrysler LLC Changes 4. Electronic Resources ValueOptions.com 5. New Claim Submission Process 6. Contact Information 7. Questions and Answers ProviderConnect 2

3 Overview of ValueOptions 3

4 ValueOptions Founded in 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) 4

5 ValueOptions National Presence 32 Million Members 130,000 Provider locations Corporate Headquarters Engagement Centers National Technology Center National Operations Center Under 100,000 Members 100, ,000 Members 500,000 1,000,000 Members 1,000,000 2,500,000 Members Over 2,500,000 Members 5

6 Overview of Operational Areas 6

7 Operational Areas: National Network Services 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 7

8 Operational Areas: National Network Services 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 8

9 Operational Areas: National Network Services (cont d.) 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 ( /fax), 15 and 30 days prior to due date Failure to respond to requests will result in disenrollment from the network 9

10 Operational Areas: National Network Services (cont d.) Provider Contracting ValueOptions Provider Agreements Questions about Contracting and Credentialing? Call (800) a.m. 8 p.m. ET 10

11 Operational Areas: Quality Management 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 11

12 Operational Areas: Quality Management 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 12

13 Operational Areas: Customer Service 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 13

14 Operational Areas: Customer Service (cont d.) 14

15 Operational Areas: Care Management and Referral Assistance 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 15

16 Operational Areas: Utilization Management 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 16

17 Operational Areas: Utilization Management (cont d) 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 17

18 Clinical Resources for Providers Clinical information on 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 18

19 Chrysler LLC Changes 19

20 Chrysler LLC Changes 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. 20

21 Chrysler LLC Changes 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, 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. 21

22 Electronic Resources 22

23 Electronic Resources: ValueOptions.com 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 23

24 Electronic Resources: ValueOptions.com 24

25 Electronic Resources: ValueOptions.com Network Specific 25

26 Electronic Resources: New E-Commerce Requirements for 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

27 E-Commerce Advantages Better, faster and cheaper Reduced paper files Reduced labor and postage expenses Reduced potential of error or mishandling Faster claims processing improves cash flow 27

28 Overview of ProviderConnect 28

29 Electronic Resources: ProviderConnect A HIPAA-secure online tool where providers can: Verify member eligibility Access and Print Forms Download and Print Authorization Letters Access PSVs Submit Updates to Provider Demographic Information Access ProviderConnect Message Center Request and View Authorizations Submit Claims and View Status Submit Customer Service Inquiries Submit Recredentialing Applications 29

30 How to Access ProviderConnect Go to 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) Contact Information: ValueOptions EDI Helpdesk (888) Monday to Friday, 8:00 a.m. - 6:00 p.m. ET 30

31 Role-Based Security: Features 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 31

32 ProviderConnect Resources Free demonstration: 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 32

33 ProviderConnect Resources Training webinars Scheduled monthly Topics include: Authorizations, Claim Submission, Rolebased 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 33

34 ProviderConnect Resources 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. 34

35 Electronic Resources: PaySpan Health A tool enabling you to: Receive payments automatically Receive 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 35

36 Claim Submission Process 36

37 Claim Submission 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 Wixom, MI

38 Electronic Claim Submission 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) 38

39 ProviderConnect: Claim Submission 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: Helpdesk: (888) between 8 a.m. 6 p.m. ET 39

40 How to Contact ValueOptions 40

41 Provider Contacts Chrysler LLC Toll-Free Number: (800) Provider Relations, Credentialing and Contracting Questions: (800) (8:00 a.m. 8:00 p.m. ET Monday Friday) Electronic Claims & ProviderConnect Technical Questions (EDI Help Desk): (888) (8 a.m. 6 p.m. ET Monday - Friday) e-supportservices@valueoptions.com For PaySpan Registration Provider Support contact: (877) (8 a.m. to 8 p.m. ET Monday Friday) providersupport@payspanhealth.com 41

42 Questions 42

43 Questions? 43

44 Thank You 44