The Provider Handbook outlines the ValueOptions® standard policies and procedures for individual providers, affiliates, group practices, programs and facilities. Providers are encouraged to carefully review the Handbook as well as visit the Network-Specific page to verify which policies and procedures are applicable to them.
This handbook is an extension of the provider agreement and includes guidelines on doing business with ValueOptions, including policies and procedures for individual providers, affiliates, group practices, programs and facilities. Together, the provider agreement, addenda, and this handbook outline the requirements and procedures applicable to participating providers in the ValueOptions network(s). This handbook replaces in its entirety the previous version.
Questions, comments and suggestions regarding this handbook should be directed to ValueOptions at (800) 397-1630.
Please click below to launch the Provider Handbook and the Provider Handbook Appendices. You will need Adobe® Reader to view the Handbook. If you do not have access to this software, you may download and install these applications on your computer.
- Section 1.0 Overview
- Section 2.0 About ValueOptions
- Section 3.0 Contact Information
- Section 4.0 E-Commerce Requirement
- Section 5.0 Electronic Resources
- Section 6.0 Participating Providers
- Section 7.0 Credentialing & Re-Credentialing
- Section 8.0 Sanctions
- Section 9.0 Appeals of National Credentialing Committee (NCC)/Provider Appeals Committee (PAC) Decisions
- Section 10.0 Office Procedures
- Section 11.0 Services to Members
- Section 12.0 Participating Provider Complaints, Grievances & Appeals
- Section 13.0 Claims Procedures & E-Commerce Requirements
- Section 14.0 Utilization Management
- Section 15.0 Appeal of Adverse Determinations
- Section 16.0 Quality Management/Quality Improvement
- Appendix 1 Handbook Glossary (PDF)
- Appendix 2 List of Forms & Reference Documents
- Clinical Criteria
- Treatment Guidelines
- Resource Documents
- Member Rights (English) (PDF)
- Member Rights (Spanish) (PDF)
- EDI Resource Document – E-Support Services for ProviderConnect and Electronic Claims (PDF)
- Provider Summary Voucher Form Sample (PDF)
- CMS 1500 Claim Form (Version 02/12) (PDF)
- Tips for Completing the CMS 1500 (PDF)
- UB04 Claim (PDF)
- Tips for Completing the UB04 (PDF)
- Clinical Department Hours of Operation (PDF)
- Appendix 3: State/Government Program/Network Specific Provision and/or Supplements
- Appendix 4: Medicare Advantage Specific Provisions (PDF)
- Appendix 4A: New York State Specific – Medicare Advantage/Medicare-Medicaid Dual Eligible Required Provisions (Fully Integrated Duals Advantage (FIDA)) (PDF)
- Appendix 5: EAP Handbook (PDF)
- Appendix 5A: MOS Handbook (PDF)
Provider Handbook Updates
ValueOptions reserves the right to interpret and construe any terms or provisions in this Handbook and to amend it, at its sole discretion, at any time. To the extent that there is an inconsistency between the Handbook and the provider contract, ValueOptions reserves the right to interpret such inconsistency. ValueOptions' interpretation shall be final and binding.