Provider Handbook

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.

ValueOptions Provider Handbook (PDF)

  • 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

Appendices

Provider Handbook Updates

Important Notice

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.