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ValueAdded
This is the 196th issue of our VBH-PA information update. These updates will be
emailed to network providers monthly. Please feel free to share our newsletter
with others, and be sure your appropriate clinical and financial staffs receive
copies.
Inside this issue
Certified Recovery Specialists and Drug and Alcohol Case Management ........................... 2
Corrections to Prior Claims Submissions ............................. 3
VBH-PA Billing Resources ........ 4
Save the Date—Provider Appreciation Breakfast ........... 4
CAMP “T.A.A.G.” Picnic A Success! ............................... 5 Register Now! 8th Annual NW3 Forum ..................................... 6
Seeking Nominations for the 8th
Annual NW3 Forum ................. 7
WPIC 2015 Fall Videoconference Series ...................................... 8
Vol. 17 Issue 10 October 2015
VBH-PA Member Lines There are designated toll-free numbers for all of our members to contact Value
Behavioral Health of Pennsylvania (VBH-PA) based on their county of residence.
Providers may refer members to a VBH-PA Member Services Representative if the
member has any questions or would like to find out more about behavioral health
services. Phones are answered 24 hours a day, seven days a week, every day of the
year.
VBH-PA Toll-Free Member Lines by County
County Toll-Free Number
Armstrong 877-688-5969
Beaver 877-688-5970
Butler 877-688-5971
Cambria 866-404-4562
Crawford 866-404-4561
Fayette 877-688-5972
Greene 877-688-5973
Indiana 877-688-5969
Lawrence 877-688-5975
Mercer 866-404-4561
Venango 866-404-4561
Washington 877-688-5976
Westmoreland 877-688-5977
TTY—All Counties 877–615-8502
2
ValueAdded—October 2015
Certified Recovery Specialists and Drug and Alcohol
Case Management—How Do These Services Fit Into
Treatment? Case management services and peer
support services are, for many members,
an integral part of the treatment team.
SAMHSA TIP 27 discusses at length the
necessity for case management within the
drug and alcohol field and how
indispensable case management is for an
individual with substance use concerns.
SAMHSA’s best practice standards
suggest that case management for
individuals with substance abuse concerns
should have some unique skill sets. For
example, according to SAMHSA, “case
management is grounded in an
understanding of clients' experiences and
the world they inhabit—the nature of
addiction and the problems it causes, and
other problems with which clients
struggle (such as HIV infection, mental
illness, or incarceration). In addition,
according to SAMHSA, case management
services for substance abuse should
include “Understanding a variety of
models and theories of addiction and
other problems related to substance use.
Ability to describe the philosophies,
practices, policies, and outcomes of the
most generally accepted and scientifically
supported models of treatment, recovery,
relapse prevention, and continuing care
for addiction and other substance-related
problems. Recognizing the importance of
family, social networks, and community
systems in the treatment and recovery
process.”
Peer Support Services (PSS) are
specialized therapeutic interactions
conducted by self-identified current or
former consumers of behavioral health
services who are trained and certified to
offer support and assistance in helping
others in their recovery and community-
integration process. Peer support is
intended to inspire hope in individuals
that recovery is not only possible, but
probable. The service is designed to
promote empowerment, self-
determination, understanding, coping
skills, and resiliency through mentoring
and service coordination. Peer support
is designed on the principles of
consumer choice and the active
involvement of persons in their own
recovery process. For substance abuse
services, the individual that provides
the peer support services is called a
Certified Recovery Specialist. Certified
Recovery Specialists are an important
part of the member’s treatment team as
the Certified Recovery Specialist can
assist with difficult transition periods
and meet the member in the
community to assist in mentoring.
Certified Recovery Specialists are
responsible for ensuring outreach,
mentoring, peer support and guidance,
as well as a resource for information
and referrals. Certified Recovery
Specialists work closely with program
participants before, during and after
their treatment experiences to support
and assist them in their recovery, in
understanding and navigating the
system of care, as well as to encourage
and guide any necessary connections
with other service systems. Certified
Recovery Specialists can start working
with the member while they are still in
a residential treatment program so that
they may be better able to navigate
back to community living.
Research supports that peer support
assists members in their recovery
process. Research shows that using
trained peers leads to improvement in
psychiatric symptoms and decreased
hospitalization (Galanter, 1998;
Kennedy, 1990; Kurtz 1988). From
the research, peer-delivered peer
service participants showed greater
levels of independence, empowerment
and self-esteem. Over 60% of the
participants in the study indicated
increased development of social
supports with the utilization of peer
support services versus those who did
not have peer support services (Van
Tosh & del Vecchio, 2000). In studies
of persons dually diagnosed with
serious mental illness and substance
abuse, peer-led interventions were
found to significantly reduce
substance abuse, mental illness
symptoms and utilization of crisis
services (Magura, Laudet, Rosenblum
& Knight, 2002).
If there are questions about making
referrals to or the utilization of either
drug and alcohol case management or
certified peer specialists, please feel
free to call VBH-PA and we can assist
with the process. Drug and alcohol
case management and recovery
support services may also be found in
the VBH-PA County Provider
Directories and Resource Guides.
Visit http://www.vbh-pa.com/
member/mbr_prvDirect.htm to view
these county-specific guides.
3
ValueAdded—October 2015
Corrections to Prior Claims Submissions
Any time that a change is being made to a claim, please be sure to submit your request for
correction on an industry standard claim form. The only acceptable claim formats are the
CMS-1500 or a UB-04. All other types of formats submitted as a corrected claim will be
returned to the provider. A corrected claim consists of a change to any line of a prior claims
submission. All corrected claims must have a notation as to what is changed from the
original, as well as listing the claim number of the claim that needs to corrected.
Correction Do’s
If the claim line paid zero dollars and is within the timely filing limitations, it can be
submitted as new using EDI or mailing a paper claim to the appropriate initial claims
address.
Utilize ProviderConnect Change/Reprocess of Professional Claims for all corrections
to CMS-1500 or 837 Professional Claims for exceptional turnaround time! The link
to the step-by-step guide is below:
http://valueoptions.com/providers/Compliance/
Guide_to_Changing_or_Reprocessing_Professional_Claims_Online.pdf
All corrections to a claim should be made at one time to avoid further billing errors.
All claim lines must reflect the actual service that took place for the date billed.
Web inquiries are still an acceptable means for submitting reprocessing requests. If
you are not currently using this method and would like to understand this better,
please contact the VBH-PA Customer Service Department.
Quality check adjustment requests before faxing or mailing to VBH-PA. A large
volume of adjustment requests are returned because they are not compliant with
VBH-PA reimbursement policies.
Correction Don’ts
Do not include dates of service that have never been processed on a corrected claim.
Do not bill date spans for any service that is more than 1 unit per day. If a claim
denies for needing an itemized statement, this indicates that each date within the
specified date range will need billed to reflect the services and units provided for
those dates.
Do not submit a claim form if corrections are not necessary. Copies of authorization
letters, PROMISe™ eligibility printouts, or any other internal documents are not
necessary unless they are specifically requested by the Customer Service Department
for resolution of a specific issue.
VBH-PA encourages all of our providers to be proactive when resolving problems. The
VBH-PA Customer Service Department is available Monday through Friday from
8:00 a.m. to 5:00 p.m. to answer questions or direct providers to the appropriate department.
The toll-free number is 1-877-615-8503.
4
ValueAdded—October 2015
Helpful VBH-PA Billing Resources
Provider billing staffs should review the resources on our website at http://www.vbh-
pa.com/provider/prv_information.htm. Here, you will find a Billing Guide that is specific
to the VBH-PA line of business. This guide should be used in conjunction with existing
ValueOptions’ provider guides when training new hires or re-educating veteran staff. We’ve
paired the Billing Guide with customer service audio recordings which allows you to
hear mock conversations related to adjustment requests, authorizations, and secondary
claims adjustments.
We believe, by offering different types of learning tools to your staff, it will enhance their
capabilities of billing appropriately the first time. In doing so, your business does not
experience delays in payment. Please also remember that electronic claim submissions of
accurate or “clean” claims are the best way to keep your business in good financial health.
Upcoming BHRS & RTF Summits
BHRS SUMMITS
(Your choice of two
locations per month.)
December 4—
Courtyard by Marriott
Greensburg, PA
CANCELLED
December 11 —
Hampton Inn & Suites
Mercer, PA
RTF SUMMITS
October 9 —
Doubletree by Hilton,
Mars, PA
.
Join VBH-PA for a
Date: Friday, December 11, 2015
Where: Doubletree by Hilton Monroeville
101 Mall Boulevard
Monroeville, PA 15146
More details coming soon.
BHRS Summit Cancellation Notice
Due to the Provider Appreciation Breakfast, please
note that the December 11th BHRS Summit in
Mercer, PA is cancelled.
5
ValueAdded—October 2015
CAMP “T.A.A.G.” Picnic A Success!
On Wednesday, August 12, 2015, the annual “T.A.A.G.” Picnic was held at a new venue—the Family Resources Family
Retreat Center in Mars, PA. The weather was perfect for a day of outside activities! CAMP “T.A.A.G.” attendees starting
arriving at 10:30 a.m. The schedule was jammed packed with camping activities that included fishing, canoeing, hiking,
swimming, a sports court, a team-building rope course, and zip line! Eighty-two youth/young adults attended the picnic
this year, bringing the total to 148 attendees, which included Value Behavioral Health staff and other adults who supported
the youth/young adults during their time at CAMP “T.A.A.G.” Other special events that took place during the day were
the pass, punt and kick contest, scavenger hunt, 99.7 Street Treat Patrol, and arts and crafts. One of the highlights of the
day was DJ Gia. She had members moving and learning lots of dance moves. Everyone would like her to return next year!
Exhibitors brought their information and swag for the youth/young adults to collect. Attendees were given a punch card,
and when they visited each exhibit table would get their card punched for a chance to win a gift card. The exhibitors
included “T.A.A.G.”, VBH-PA, Primary Health Network, Beaver County Rehabilitation Center, PA System of Care
Partnership, Greater Pittsburgh Community Food Bank, Youth M.O.V.E. Fayette County, Westmoreland Casemanagement
and Supports, Inc., MHY Family Services, Family Behavioral Health and AERI, and Pressley Ridge. The youth/young
adults stated on their evaluation forms that they really enjoyed the exhibitors and wanted to ask them back for next year.
After all the donated gift baskets from the exhibitors were raffled off, thank-yous were made, and final goodbyes said, I was
reminded once again of how youth/young adults, given the chance to interact from a variety of very diverse cultures, can
come together and enjoy each other’s company. Until next year’s “T.A.A.G.” Picnic—we bid a fond adieu.
Watch for the “Save the Date” for CAMP “T.A.A.G.” coming out in January 2016.
Create Your Own Personal Camping Adventure Article by Karan Steele, Prevention, Education and Outreach Coordinator
6
ValueAdded—October 2015
Join us at Crawford, Mercer & Venango counties’ behavioral health
forum featuring the “Exceptional Individual and Parent Awards” and
featured speaker Clarence Jordan, Beacon Health Options’ VP of
Wellness and Recovery. Education and information will be presented to
enhance and empower participants’ recovery journeys.
Free for all attendees.
“Acknowledging the Journey”
Thursday, November 12, 2015
9:00 a.m. to 4:30 p.m. (Registration begins at 8:00 a.m.)
Park Inn by Radisson, 3377 New Castle Road (Rt 18)
West Middlesex, PA 16159
General Registration Now Open! Join us at the 8th Annual “Acknowledging the Journey,” a forum for families and adult
HealthChoices members. The NW3 Forum General Registration form is currently available on
the VBH-PA homepage, under the Provider and Member News and Events sections at
www.vbh-pa.com.
Attention Prospective Exhibitors! Reservations are open to exhibit at the 8th Annual “Acknowledging the Journey,” a
behavioral health member forum for HealthChoices members residing in Crawford, Mercer
and Venango counties. The NW3 Forum Exhibitor Registration Form is currently available on
the VBH-PA homepage, under the Provider and Member News and Events sections at
www.vbh-pa.com.
If you have any questions, please contact Shelley Thomas, PE&O Coordinator, at (724) 962-8032 or 1
(866) 404-4561, or by email at [email protected].
“Acknowledging the Journey” 8th Annual Family & Adult Behavioral Health Forum
A Value Behavioral Health of Pennsylvania Family And Adult Members Forum
Crawford, Mercer and Venango Counties
Exhibitors at work engaging with consumers and educating them with resources. Pictures from 2014 Forum.
7
ValueAdded—October 2015
Would you like your efforts and supports acknowledged through the
progress and empowerment of a VBH-PA member whom you have
served?
Are you inspired by hearing people’s stories of recovery and
resiliency?
Nominate someone you consider as an Exceptional Individual, Parent or Caregiver!
** Nominations are now open and need to be submitted by Friday, October 16, 2015. **
Once again, this year’s event program will acknowledge all nominations and award winners’ names
along with each agency who takes the time and effort to nominate a deserving individual. Many of you
have already experienced the inspiration of seeing people being “Acknowledged for their Journey” and
being recognized as an Exceptional Individual or Family Member. VBH-PA thanks you for the part you
play in this effort.
Please consider nominating a VBH-PA HealthChoices member whom you consider exceptional reflected
by their active journey and their engagement of and encouragement to other members in theirs. Please
nominate at least one HealthChoices VBH-PA member residing in one for the northwest three (NW3)
counties of Crawford, Mercer or Venango. Two awards will be given for each county. One award will be
given to an adult VBH-PA member for the Exceptional Individual Award. The other award will be given
to a parent or caregiver of a child or adolescent VBH-PA member. A total of six awards will be presented
for all three counties. The individuals nominated will also be acknowledged at this event.
The NW3 Members Forum will publically acknowledge HealthChoices members who have demonstrated
courage, creativity and leadership in their journeys at the:
“Acknowledging the Journey”
8th Annual Behavioral Health Forum
Thursday, November 12, 2015
Park Inn by Radisson, West Middlesex, PA
9:00 a.m. – 4:30 p.m.
(Registration begins at 8:00 a.m.)
The NW3 Forum Nomination Form is currently available on the VBH-PA homepage, under the Provider
and Member News and Events sections at www.vbh-pa.com. Please feel free to re-nominate someone
whom you may have nominated in previous years but did not receive the Exceptional Award.
Please take the time to pass this request onto your many staff members who also do exceptional work
with VBH-PA HealthChoices members. Your agency may nominate as many adult and family members
as they like. The NW3 Members Forum Workgroup will review all nominations and vote. The greater the
detail you include the more likely your nominee will receive the award. Nominations are due by Friday,
October 16, 2015. Thank you for all your hard work in seeing people succeed!
Attention Providers and County Staff!
NW3 2015 Exceptional Individual/Parent Crawford Mercer &
Venango Counties Nominations Needed!
8
ValueAdded—October 2015
2015 WPIC Videoconferences Fall Series!
VBH-PA is pleased to announce that our Engagement Center will be a videoconferencing
site for the WPIC Office of Education and Regional Programming 2015 fall
videoconference series. These programs are free of charge and there are NO fees for
continuing education credits. The videoconferences are held from 9:00 a.m. to 11:00 a.m.
in the Walnut Room at VBH-PA’s Trafford Engagement Center. For CEU information,
registration information and complete descriptions of these trainings, please view
“Upcoming Trainings” on our Provider Training webpage.
Upcoming Videoconferences*
October 14—ECT in Late Life Depression
November 18—Strategies for Working with Reactive Attachment Disorder (RAD) Children in
Adoptive, Residential and Family of Origin Homes
December 9—Mental Health and Homelessness
Registration:
To register for these trainings, please visit the ValueOptions® Provider Trainings Web
page. Select Pennsylvania from the state dropdown list (DO NOT change any of the
other fields) and then click on Select. Scroll down the screen and put a check mark in
the box next to the event(s) and then hit Register. Phone-in registrations will not be
accepted.
*Please Note: These videoconferences are NOT webinars. You must be in attendance at
the Trafford Engagement Center to view these videoconferences. VBH-PA is one of
many sites offering this opportunity. Please click here to view all locations offering this
videoconference series. To register with another location, please contact the coordinator for
that site.
Suggestions or ideas for
articles that you would
like to see published in
ValueAdded can be
faxed to Kim Tzoulis, Val-
ueAdded Editor, at (724)
744-6363 or emailed to
kimberly.tzoulis@
valueoptions.com
Articles of general im-
portance to the provid-
er network will be con-
sidered for publication.
Value Behavioral Health
of PA, Inc.
520 Pleasant Valley Rd
Trafford, PA 15085
Phone: (877) 615-8503
Fax: (724) 744-6363
www.vbh-pa.com
Contacting VBH-PA
Provider Relations has
never been easier! Click
on the Webmaster email
address below to send an
email:
vbhpawebmaster@value
options.com