Franciscan Missionaries of Our Lady Health System (FMOLHS) Provider Frequently Asked Questions

Transcription

1 Franciscan Missionaries of Our Lady Health System (FMOLHS) Provider Frequently Asked Questions The series of questions and answers below are intended to assist providers and stakeholders with the transition to ValueOptions, effective January 1, This FAQ document will continue to be reviewed and updated frequently in order to provide the most current and pertinent information. General Questions Q. What is the effective date that this transition will occur? A. ValueOptions will begin to provide mental health and substance abuse (MHSA) benefits and employee assistance program (EAP) for FMOLHS members on January 1, Q. As a provider, is there anything I need to do in order to participate in this network? A. Yes. Providers for this network will receive a contract amendment. It must be signed and returned for you to be eligible for participation. We strongly urge providers to execute the document and return within 10 days to ensure Innetwork status by 1/1/13. Q. Describe the MHSA and EAP benefits associated with FMOLHS? A. ValueOptions will offer MHSA benefits for FMOLHS s PPO plan (copays and coinsurance after deductible) and a High Deductible Health Plan (coinsurance after the member has met their deductible). ValueOptions EAP plan will include 5 EAP visits per plan year/per member/per incident, visits under the EAP must be preauthorized. Transition of Care Q. What is the transition benefit plan for MHSA and EAP providers who are currently seeing members but are not in the ValueOptions network? A. ValueOptions is committed to ensuring minimal disruption through a welldefined transition plan for FMOLHS members who are receiving mental health and substance abuse (MHSA) treatment. 1

2 MHSA Providers who are not in the ValueOptions network will receive: Outpatient treatment: Providers who are currently In-Network with MHNet may continue to treat the member until March 31, The provider or member MUST contact ValueOptions for authorization. Inpatient treatment: For members who are inpatient on 12/31/2012 and continue inpatient treatment on 1/1/2013 with an In-Network MHNet provider will be paid at the In-Network level of benefits. The provider or member MUST contact ValueOptions for authorization. Once a member has been discharged this benefit will end. ValueOptions in-network providers will receive: ValueOptions providers seeing FMOLHS members on 1/1/2013 will be reimbursed at their contracted rate with the exception of FMOLHS providers. Members entering treatment on/after January 1, 2013 ValueOptions will authorize treatment based on medical necessity and provider status. For authorizations or questions, contact ValueOptions at Q. How do you verify copays and deductibles? A. Providers can contact ValueOptions at if they would like to verify member copays and deductibles. Authorization for Care Inpatient Level of Care and Alternative Levels of Care (Residential, Partial, Intensive Outpatient, etc.) If a member or dependent is receiving inpatient treatment in a hospital or residential treatment center on or before January 1, 2013, we recommend that the current carrier continue to handle the case through closure. This assures continuity of benefits for the member. We would commence care management of the case at the point inpatient treatment has ended. (VO will take over all incurred claims as of 1/1 MHNet s contract does not require them to continue with a case. After January 1, 2013, if the provider wants to switch the member to an alternative level of treatment. The provider must contact our care 2

3 management department to open a new course of treatment, based on medical necessity. At that point, ValueOptions will begin managing the care of the member. For inpatient care needed on or after January 1, 2013, providers will need to contact ValueOptions at to authorize care. Outpatient Levels of Care Authorization to see an outpatient provider is not required. EAP Authorization for EAP visits is required Psychological Testing & ECT Pre-authorization is still required for Psychological Testing and ECT services. Provider Network Contracting and Credentialing Q. I am not a provider in the ValueOptions network. What should I do to join the network? A. Please contact the ValueOptions National Provider Services line at , between 7 AM and 4 PM Central Time, Monday through Friday. A Provider Network Representative will be available to assist you regarding participation in the ValueOptions network. Q. I am participating in the ValueOptions network and I have questions regarding credentialing, rates or my contract agreement? A. Please contact the ValueOptions National Provider Services line at , between 7 AM and 4 PM Central Time, Monday through Friday. Online Services ProviderConnect Q. What online services does ValueOptions offer? A. ValueOptions has enhanced our on-line services to provide added convenience for our members and providers. The following services available 3

4 are: ProviderConnect is an enhanced version of our online transaction services. It is a self-service tool available 24/7 that gives you access to the following features: single and multiple electronic claims submission, claims status review (for both paper and online submitted claims), Provider Summary Vouchers (PSVs), eligibility status, your provider practice profile, Health Alerts, and correspondence (which includes authorization letters). Find more information about ProviderConnect on Claims Claims for all dates of service prior to January 1, 2013 should be submitted to MHNet Behavioral Health. Any questions regarding claims for these dates of service should be directed to the customer service number listed below. MHNet Behavioral Health P.O. Box 7802 London, KY Customer Service phone number: Claims for services rendered by participating ValueOptions providers with dates of service on or after January 1st, should be submitted to: ValueOptions PO Box 1920 Latham, New York Any questions regarding claims on or after January 1, 2013 should be directed to ValueOptions at: Q. What paper forms can be used for claims submission? A. Providers are required to bill on standard CMS 1500 and UB92 forms. Red ink forms should be used as these can be scanned, which expedites the claim entry into the claims system. The UB92 Form can only be used for inpatient and alternative levels of care for mental health and substance abuse, not outpatient professional mental health services. The CMS 1500 form should be used for outpatient professional services. 4

5 Q. Can I submit my claims electronically to ValueOptions? A. Yes. CMS 1500 and UB92 electronic submissions are accepted according to guidelines contained in the ValueOptions EDI materials found on If you are interested in electronic claim submission, please contact our ValueOptions EDI Helpdesk at We strongly encourage providers to submit claims electronically for the efficiencies gained by both providers and in claims processing. Q. Does the ValueOptions electronic claims format work with other claims clearing houses? A. Please contact our ValueOptions Electronic Claims Specialist at Please note: ValueOptions does not reimburse for provider expenses associated with electronic claims submission. Q. When ValueOptions authorizes care, is the authorization an automatic guarantee of payment for services rendered? A. No, authorization of services is not a guarantee of payment. Payment depends on a number of factors including member eligibility, provider contract status, and benefit limits at the time care is rendered. Q. As an individual practitioner billing outpatient services, do I need to include the provider number on my claims? A. Outpatient professional services must be billed on a CMS-1500 form. In addition, please visit for more information on proper billing procedures. Q. For claims previously rejected that need to be resubmitted, what do I need to do? A. Provider should clearly write Corrected Claim on these types of claims and send to: ValueOptions PO Box 1920 Latham, New York Providers need to be aware of the timely filing requirements as stated in their contract with ValueOptions. This pertains to first time submissions, as well as resubmissions and a previously processed claim. 5

6 Q. As a facility billing for outpatient services, what information is required to be included on my claims? A. Outpatient professional services must be billed on a CMS-1500 form. In addition, please visit for more information on proper billing procedures. Q. As a Facility billing for services other than outpatient, how do I bill? A. Inpatient services and Alternate Levels of Care (PHP, IOP, etc.) must be billed on a UB-92 form. In addition, please visit for more information on proper billing procedures. Q. On or after 1/1/13, where do I go to have a claim question/issue resolved? A. Please visit us on-line at to check and review a claim status or call Q: Can I submit my EAP invoices/case Activity Form (CAF) electronically to ValueOptions? A. The electronic Case Activity Form (CAF) can be submitted via ProviderConnect or via fax to OR via ValueOptions, PO Box 1920, Latham NY Q: What paper forms can be used for EAP invoice submission? A. Providers are required to bill on the customized CAF that will be provided with the authorization letter. Q: Does the ValueOptions electronic invoices format work with other invoices clearing houses? A. For the EAP Case Activity Form (CAF), ValueOptions cannot accept invoices from clearing houses. These must be directly submitted to ValueOptions through ProviderConnect, Fax or USPS. Q: What is the timely filing requirement for Case Activity Forms? A. Case Activity Form (CAF) must be submitted to ValueOptions within 90 business days of the date of service and may contain multiple sessions. Additionally, within 90 business days of finishing services the final CAF should be submitted for processing payment. 6

7 Q: As an individual practitioner, billing EAP outpatient services, do I need to include the provider number on my Case Activity Form (CAF)? A. You must include your NPI number on the Case Activity Form (CAF). Q: As an EAP provider, how soon will I receive an invoices payment? A. If provider submits a clean Case Activity Form (CAF) electronically within timely filing limits, compensation to the provider shall be at the rates specified in the reimbursement schedule and paid to the provider within 30 days. Q: Where do I call if I have questions about EAP invoices or payments? A. Please call the ValueOptions Customer Service Department at , Monday Friday 8 a.m. 5 p.m. CST. Claims Payment Q: What are PaySpan, Inc and PaySpan Health? A. PaySpan, Inc. is a vendor that partners with ValueOptions to deliver an electronic funds transfer (EFT) solution to our providers. PaySpan Health is the software that PaySpan, Inc. uses for online registration for EFT. PaySpan Health is a multi-payer adjudicated invoices settlement service that delivers electronic payments and electronic remittance advices based on your provider preferences. With PaySpan Health, you stay in control of bank accounts, file formats, and accounting processes. Q: Is EFT required / available for all accounts? A. No, EFT is not required and yes, it is available for all active accounts. Q: How do I access PaySpan Health? A. 7

8 Q: Do I have to provide my bank account information to use PaySpan? A. A bank account will not be required for obtaining Provider Summary Vouchers (PSV) only electronically. If a provider wants to receive Electronic Payments or ACH information they will need to provide bank account information. Q: Can I opt out of participation with PaySpan, Inc. and still receive paper PSVs? A. No. PSVs for network providers will not be mailed. While participation with PaySpan is not required, PSVs can only be retrieved through PaySpan or ValueOptions ProviderConnect website. Q: Can I obtain the same (i.e. PSVs) information on ProviderConnect? A. Yes. Printable versions of PSVs are available on ProviderConnect. Q: What is the difference between the legacy code and the registration code? A. The registration code is different than the legacy code. The registration code is the code obtained from PaySpan. The legacy code is the provider s pay to vendor number from ValueOptions. Q: According to PaySpan, the NPI number and TIN can be used without the "legacy code" when in the system. However this code needs to be entered to register. Please clarify. A. The Legacy number is the provider s ValueOptions pay-to-vendor number. The provider needs three things to register: i. Their VO pay-to-vendor number (legacy/npi number field on the PaySpan site) ii. Their TIN iii. Their registration code Once they have registered with these three elements, they will use their address as their log-on and the eight (8) character/digit password that they set up during the registration process. 8

9 Q: What is the unique registration code number that PaySpan Health requests and how do I obtain it? A. Your unique registration code is the registration number that ValueOptions supplies to providers for enrolling in PaySpan Health. If you do not have the letter with your unique registration code, please send an to CorporateFinance@valueoptions.com and include the following information: 1. Your ValueOptions pay-to-vendor number (PIN) 2. Your Tax Identification Number (TIN) or your Social Security Number (SSN) You will receive an with your registration code letter within three business days of your request. Note: If you recently received a payment from ValueOptions, your unique registration code will be located on the check stub after the marketing caption. Additional questions about PaySpan can be addressed by calling PaySpan, Inc. Customer Service at , Monday-Friday 8 a.m. 8 p.m. ET. For additional information on PaySpan Health, please visit: ation.pdf Q: I signed up for PaySpan, but not all my payments are arriving electronically. How can I correct this? A. Please contact Corporate Finance at: CorporateFinance@valueoptions.com Please supply the following information: Pay-to-Vendor Number and TIN or SSN. Q: I don t have a computer. May I still receive paper PSVs and checks? A. You can receive paper checks but not paper PSVs. In order to obtain a faxed copy of your PSV, you must utilize our automated faxback service by dialing Q: I don t want to have to use multiple websites to obtain information. Can the 9

10 information be available on one 1 site for both payments and PSVs? A. Yes. Both are available on Q: Can I still receive a paper check? A. Yes. Q: How do I contact ValueOptions for assistance? A. For questions relative to PSVs, you can reach ValueOptions by calling the tollfree number at (877) between 8 AM and 6 PM Eastern Time, Monday through Friday. Or submit an inquiry via ProviderConnect. In order to obtain a faxed paper copy of your PSV, you must utilize our automated faxback service by dialing Q: Will ValueOptions/PaySpan be able to deduct money from my bank account? A. No. We only have permission to deposit. Q. I am having trouble downloading my PSVs from ProviderConnect. I receive an error message or the PSV does not appear when I click view. What do I need to do? A. You may be experiencing technical difficulty when attempting to download your PSVS on ProviderConnect because your pop-up blocker has not been disabled. Please disable your pop-up blocker if this problem persists please contact the EDI help desk at Q. How do providers obtain their Provider Summary Voucher (PSV) if they do not have access to the internet or ProviderConnect? A. Providers can obtain copies of their PSVs by using the fax back option by calling Q. As a provider, how soon will I receive a claims payment? A. If provider submits a clean claim electronically within timely filing limits, compensation to the provider shall be at the rates specified in the 10

11 reimbursement schedule and paid to the provider within 30 days. Clinical, Authorization and Quality Services Q. What are the hours of the ValueOptions Clinical Department? A. Licensed clinicians are available 24-hours a day, 7 days a week, and 365 days a year. It is imperative that, in the event of emergent care, the provider contact ValueOptions as soon as possible, but no later than 24-hours after the emergent contact/session/admission. Q. Where can I locate the ValueOptions Treatment Guidelines and Clinical Criteria? A. The ValueOptions Clinical Treatment Guidelines and Clinical Criteria are on the website under Provider Handbook. The links to each section are provided below: Provider Handbook: Provider Treatment Guidelines: s.htm Provider Clinical Criteria: 11