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An Overview of Beacon
Health Options and
ProviderConnect for HARP
Providers
September 2015
ValueOptions, Inc. is a Beacon Health Options company.
Objectives
2An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Overview
Operational Areas
Programs Available
Communication Channels & Spotlight Topics
Electronic Resources
• ValueOptions.com
• ProviderConnectSM
ProviderConnect Overview
Contact Information
Questions and Answers
Company
Overview
3
ValueOptions, Inc. is a Beacon Health Options company.
An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Beacon Health Options
4
Headquartered in Boston;
more than 70 US locations
and an office in London
4,300 employees nationally
and in the UK serving more
than 45 million people
225 employer clients,
including 45+ Fortune 500
companies
Partnerships with more than
100 health plans
Programs serving Medicaid
recipients in 25 states and the
District of Columbia
Serving 8.5 million military
personal, federal civilians and
their families
Leader serving dual-eligible
beneficiaries in six states
Accreditation by both URAC &
NCQA
An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Beacon Health Options’ Footprint
5An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Merging Markets – Sharing Networks
6
Health and Recovery Plan (HARP)
• Five Plans to be shared on two Platforms:
EmblemHealth – ProviderConnect
VNSNY – ProviderConnect
MetroPlus - eServices
Affinity – eServices
Amida Care - eServices
NYC Outside of NYC
October 1st - Mainstream plans and HARPs will
implement non-HCBS behavioral health services for
enrolled members in NYC
April 1, 2016 - First Phase of HARP Enrollment
Letters Distributed
October 2015-January 2016 - HARP NYC enrollment
phases in
July 1, 2016 - Mainstream Plan Behavioral Health
Management and Phased HARP Enrollment Begins
January 1, 2016 -
HCBS begins for HARP NYC population
An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Overview of
Operational
Areas
7
ValueOptions, Inc. is a Beacon Health Options company.
An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Operational Areas: National Network Services
8
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
An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Operational Areas: National Network Services
9
Provider Credentialing & Recredentialing
Credentialing Application required for network consideration
Eligible providers are encouraged to provide their CAQH ID when requesting an application or
during recredentialing
Recredentialing is required every three years through CAQH,
ProviderConnect or a supplemental paper application if required by contract
Notification occurs four months prior to due date (telephonic), one week later (email/fax), 15
and 30 days prior to due date
Failure to respond to requests will result in disenrollment from the network
Provider Contracting
Regionally based contracting directors
Questions about Contracting and Credentialing?
Call 800.397.1630
8:00 a.m. – 8:00 p.m. ET
An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Operational Areas: Quality Management
10
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
Accreditation (at select locations) by URAC & NCQA
An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Operational Areas: Quality Management
11
Ongoing Quality Improvement Activities (QIAs)
• Clinical QIAs
– Improving Ambulatory Follow-Up Following Inpatient
Admission For Mental Health Treatment
– Improving Initiation And Engagement And Treatment For
Alcohol And Substance Abuse
– Assuring Accurate Risk Tracking – Referral For Urgent
And Emergent Treatment
• Service QIAs
– Member Satisfaction By Improving Customer Service
Response
– Provider Satisfaction With Utilization Management
An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Operational Areas: Customer Service
12
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
An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Operational Areas: Care Management
13An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Operational Areas: Care Management and Referral Assistance
14
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 us for referral assistance if needed
Providers should us 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
Self-referral: members can submit a request for care management
An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Clinical Resources for Providers
15
Customer Service*
EmblemHealth: 888.447.2526 (8:00 a.m. – 8:00 p.m. ET Monday – Friday)
VNSNY: 855.735.6098 (8:00 a.m. – 6:00 p.m. ET Monday – Friday)
*In addition, our 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 for one of your EmblemHealth or VNS patients through
HARP, you contact us as soon as possible, but no later than 24 hours
after the emergent contact/session/admission.
Clinical information on www.valueoptions.com:
ValueOptions Medical Necessity criteria
Changes to Substance Use Medical Necessity Criteria
Treatment Practice guidelines
PCP Consult line: 877.241.5575 9:00 a.m. – 5:00 p.m. ET
Intensive Case Management Services
An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Clinical Resources for Providers, cont’d.
16
MCTAC.ORG
For managed care readiness tools, resources and announcements
Clinical information: www.valueoptions.com:
Pharmacy program analyzes pharmacy data and uses automated
rules engine to screen for:
• Sub-optimal therapy
• Under-use
• Early discontinuation
• Automatic notification to providers
Federal Mental Health Parity Final Rule
Achieve Solutions®
Outpatient Detoxification/Buprenorphine (Suboxone® or Subutex® )
Maintenance ProgramAn Overview of Beacon Health Options and ProviderConnect for HARP Providers
17
Communications
& Spotlight Topics
ValueOptions, Inc. is a Beacon Health Options company.
An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Communication Channels
18
Email Alerts
Webinars
Video Tutorials
Monthly Valued Provider eNewsletter
Provider PulseSM Messages
Fax Communications
Provider Mailings
An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Spotlight Topics: ICD-10
19
The 10th modification to International Classification of
Diseases (ICD) codes has been scheduled for October 1,
2015
On April 1, 2014, the President signed into law legislation passed by the
House and Senate delaying ICD-10. The Centers for Medicare and
Medicaid Services (CMS) has announced the new compliance date for
health care providers, health plans, and health care clearinghouses to
transition to ICD-10 is October 1, 2015.
For more information, please see the ICD-10 Transition Spotlight on
www.valueoptions.com/providers
ICD-9 codes can not be accepted after September 30, 2015, following
the time parameters of the regulation.
ValueOptions continues to make changes to comply with the regulation
and can only accept ICD-10 codes on or after October 1, 2015.
An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Spotlight Topics:Stamp Out Stigma (S.O.S.) Campaign
20
S.O.S. encourages individuals to talk to friends and loved ones
about mental illness to show commitment to stamping out
stigma of mental illness.
The campaign was introduced to further
support our valued providers when
communicating with patients about
mental illness.
A provider toolkit is available online for our providers to access
S.O.S. materials.
Visit our provider page to learn more about S.O.S.
An Overview of Beacon Health Options and ProviderConnect for HARP Providers
21
Electronic
Resources
ValueOptions, Inc. is a Beacon Health Options company.
An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Electronic Resources: ValueOptions.com
22
Provider Homepage is the
most visited page on website
– an excellent resource to
find training opportunities,
forms, handbooks and more
Locate the New York City
Health Plan Network-Specific
Page
Bookmark ValueOptions and
ProviderConnect website
An Overview of Beacon Health Options and ProviderConnect for HARP Providers
23
Overview of
ProviderConnect
ValueOptions, Inc. is a Beacon Health Options company.
An Overview of Beacon Health Options and ProviderConnect for HARP Providers
ProviderConnect - Services
24
Services of ProviderConnect:
• Verify member benefits and eligibility • View and print forms
• Request and view authorizations • Download and print authorization letters
• Submit claims and view status • Access Provider Summary Vouchers
(PSV)
• Submit updates to provider
demographic information
• Submit recredentialing applications
• Submit customer service inquiries • Access ProviderConnect message
center
Access to support:
ProviderConnect Technical Questions (EDI Help Desk):
888.247.9311 (8:00 a.m. – 6:00 p.m. ET Monday – Friday)
An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Benefits
25
Free and secure online
application, available 24 / 7Reduces paper files
Mobile Device friendlyReduces the need to call
for routine information
Quicker PaymentMac and Windows
compatible
INCREASED CONVENIENCE, DECREASED ADMINISTRATIVE PROCESSES
Disclaimer: Please note that ProviderConnect may look different and have
different functionalities based on individual contract needs, therefore some
functions may not be available or may look different for your
specific contract.
An Overview of Beacon Health Options and ProviderConnect for HARP Providers
How to Access
ProviderConnect
26
ValueOptions, Inc. is a Beacon Health Options company.
An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Registering Option 1: Online
27
Go to www.ValueOptions.com, choose
“Providers”
On the right side select “Getting Started,”
then “Register”
Complete Registration page
**Note: The online registration process now includes e-signature
for claims access
An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Registering Option 1: Online
28An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Registering Option 2: Account Request Form
29
Go to www.ValueOptions.com, choose
“Providers”
Choose “Forms” under Overview on the right
side of the screen, then click “Administrative
Forms”
Under ProviderConnect Forms choose
“Online Services Account Request Form”
Complete the form and fax to the fax number
indicated on the form
An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Registering Option 2: Account Request Form
30An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Role-Based Security: Features
31
Allows administrator (Super User) accounts who can:
• Create new users
• Manage existing users
• Deactivate accounts
Password Verification
• Required for first time login users
• Increased security for new accounts created by Super User
• Managed user can change password
An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Logging into ProviderConnect
32
Go to www.ValueOptions.com, choose
“Providers”
Click on Login under “ProviderConnect” on the
right side of the screen
An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Logging into ProviderConnect
33An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Member Eligibility
and Benefits
34
ValueOptions, Inc. is a Beacon Health Options company.
An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Verifying Member Eligibility
35An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Member Eligibility
36An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Member Demographics
37An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Member Enrollment History
38An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Member Benefits
39An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Authorizations
40
ValueOptions, Inc. is a Beacon Health Options company.
An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Enter an Authorization Request
41An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Disclaimer
42An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Search a Member
43An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Member Information
44An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Service Address
45An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Requested Services Header
46An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Review an Authorization
47An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Search Authorizations
48An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Authorization Search Results
49An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Claims
50
ValueOptions, Inc. is a Beacon Health Options company.
An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Electronic Claim Submission: Advantages
51
Better, faster, and cheaper
Reduces paper files
Reduces labor and postage expenses
Reduces potential of error or mishandling
Faster claims processing improves cash flow
Accepts claims files from any Practice Management System
outputting HIPAA formatted 837P or 837I batch files, and from EDI
claims submission vendors
An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Direct Claim Submission
52
Ability to enter a claim directly into ProviderConnect portal without
using special software
Expedites processing of the claim and payment
Available for professional services only, not higher levels of care
Recommended for providers submitting a lower volume of outpatient
claims
An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Direct Claim Submission
53An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Batch Claim Submission
54
Allows you to upload HIPAA 5010 compliant files directly to
ValueOptions
Expedites processing of the claim and payment
Available for all levels of care
Recommended for facilities and providers submitting a higher
volume of claims
An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Batch Claim Submission
55An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Batch Claim Submission
56An Overview of Beacon Health Options and ProviderConnect for HARP Providers
ProviderConnect Resources
57
Free demonstration: http://www.valueoptions.com/PMC_prototype/ProviderConnect/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
Personalized Training Webinars
• Scheduled at your convenience
• Available to just one employee or your entire office
• Training topics are customized based on your needs, timeframes, etc.
An Overview of Beacon Health Options and ProviderConnect for HARP Providers
ProviderConnect Resources
58
Training webinars
Scheduled monthly
Topics include: High Level Overview, Authorizations,
Claims, Enhancements, etc.
Webinar calendar available on ValueOptions.com
Upcoming Webinars:
• ProviderConnect Enhancements
• Thursday, 10/1/15 from 11:00 a.m. – 12:00 p.m. ET
• ProviderConnect Overview
• Wednesday, 10/14/15 from 2:00 – 3:00 p.m. ET
• Registration available by clicking “Education Center”
from the Provider Homepage
An Overview of Beacon Health Options and ProviderConnect for HARP Providers
59
How to Contact
ValueOptions
ValueOptions, Inc. is a Beacon Health Options company.
An Overview of Beacon Health Options and ProviderConnect for HARP Providers
Provider Contacts
60
New York Provider Relations Team
Provider Customer Service
EmblemHealth: 888.447.2526 (8:00 a.m. – 8:00 p.m. ET Monday – Friday)
VNSNY: 855.735.6098 (8:00 a.m. – 6:00 p.m. ET Monday – Friday)
General Provider Relations, Credentialing and Contracting
800.397.1630 (8:00 a.m. – 8:00 p.m. ET Monday – Friday)
EDI Help Desk: Electronic Claims & ProviderConnect:
888.247.9311 (8:00 a.m. – 6:00 p.m. ET Monday – Friday)
An Overview of Beacon Health Options and ProviderConnect for HARP Providers
61
Thank you
ValueOptions, Inc. is a Beacon Health Options company.
An Overview of Beacon Health Options and ProviderConnect for HARP Providers